Post-intensive Care Syndrome (PICS) | SCCM

Patients may also feel depressed and anxious and may have symptoms of posttraumatic stress disorder (PTSD). These include having nightmares and unwanted ... SCCMHome MySCCM LearnICU Patients&Family Searchfor: LogIn Forgotusernameorpassword? NewUser?SignUpFree. AboutCriticalCare CriticalCareFAQs MeettheCriticalCareTeam DuringtheICU AftertheICU ConnectWithPatientsandFamilies Post-intensiveCareSyndrome PatientandFamilyResources PatientCommunicatorApp IAmAHealthcareProvider Glossary ResourceLibrary SCCM > PatientsandFamilies > AftertheICU>Post-intensiveCareSyndrome AboutCriticalCare CriticalCareFAQs MeettheCriticalCareTeam DuringtheICU AftertheICU ConnectWithPatientsandFamilies Post-intensiveCareSyndrome PatientandFamilyResources PatientCommunicatorApp IAmAHealthcareProvider Glossary ResourceLibrary Post-intensiveCareSyndrome Millionsofpatientsareadmittedtointensivecareunits(ICUs)eachyear,onethirdofwhomneedamachinetohelpthembreathe(ventilator).Thesecriticallyillpatientsmaydevelophealthproblemsrelatedtotheirillness,injury,ventilatororothertreatments.Suchproblemscannotbetotallypreventedandcancontinueafterthepatientleavesthehospital.Delirium,acuterespiratorydistresssyndrome,andsepsisincreasethechancesoftheseproblemsoccurring.They,too,maynotalwaysbeprevented. IfyouareanICUpatientorfamilymember,thisguidehelpsyouunderstandthehealthproblemsknownas post-intensivecaresyndrome,orPICS,soyouknowwhattolookforwhenyoureturnhome.ItalsoincludestipsonhowtominimizePICS.ManypeopledevelopPICS,andhelpisavailable.Youwillhavethebestchanceofrecoveryifyouexplainyourhealthproblemstoyourprimarycaredoctor,whocanreferyoutothespecialistsyouneed. WhatIsPICS? Post-intensivecaresyndrome,orPICS,ismadeupofhealthproblemsthatremainaftercriticalillness.TheyarepresentwhenthepatientisintheICUandmaypersistafterthepatientreturnshome.Theseproblemscaninvolvethepatient'sbody,thoughts,feelings,ormindandmayaffectthefamily.PICSmayshowupasaneasilynoticeddrawn-outmuscleweakness,knownas ICU-acquiredweakness;asproblemswiththinkingandjudgment,called cognitive(brain)dysfunction;andasothermentalhealthproblems. PICS PICSSpanishVersion   ICU-acquiredweakness ICU-acquiredweakness(ICUAW)ismuscleweaknessthatdevelopsduringanICUstay.Thisisacommonproblemofbeingcriticallyillandoccursin: 33%ofallpatientsonventilators 50%ofallpatientsadmittedwithsevereinfection,whichisknownassepsis Upto50%ofpatientswhostayintheICUforatleastoneweek PatientswhodevelopICUAWmaytakemorethanayeartorecoverfully.ICUAWmakestheactivitiesofdailylivingdifficult,includinggrooming,dressing,feeding,bathingandwalking.ICUAWmaygreatlydelaythepatientfromdoingactivitiesinthewayheorsheusedtodothem. Cognitiveorbraindysfunction Thisreferstoproblemsconnectedwithremembering,payingattention,solvingproblems,andorganizingandworkingoncomplextasks.AfterleavingtheICU,30%to80%ofpatientsmayhavethesekindsofproblems.Somepeopleimproveduringthefirstyearafterdischargefromthehospital;otherpeoplemayneverfullyrecover. Cognitivedysfunctionmayaffectwhetherthepatientcanreturntowork,balanceacheckbook,orperformothertasksthatinvolveorganizationandconcentration. Othermentalhealthproblems Criticallyillpatientsmaydevelopproblemswithfallingorstayingasleep.Theymayhavenightmaresandunwantedmemories.Remindersoftheirillnessmayproduceintensefeelingsorstrong,clearimagesintheirmind.Theirreactionstothesefeelingsmaybephysicaloremotional. Patientsmayalsofeeldepressedandanxiousandmayhavesymptomsofposttraumaticstressdisorder(PTSD).Theseincludehavingnightmaresandunwantedmemories,feeling“keyedup,”andwantingtoavoidthinkingortalkingabouttheirstayintheICU. HowDoesPICSAffectRecovery? Upto50%ofpatientsmayreturntoworkwithinthefirstyear,butsomemaynotbeabletoreturntothejobstheyhadbeforetheirillness.Patientsmayneedhelpwithactivitiesafterleavingthehospital. WhatCanFamilyDotoMinimizePICS? Ifyouareafamilymember,youmaybeabletominimizePICSbyhelpingyourcriticallyillfamilymemberstay“oriented”: Talkaboutfamiliarthings,peopleandevents. Talkabouttheday,dateandtime. Bringinfavoritepicturesanditemsfromhome. Readaloudatthebedside. Youcanalsokeepadiaryorjournalandlaterreviewitwiththecareteamandyourfamilymember.Thismayhelpyourfamilymemberunderstandwhathappened,clearupsomememories,andreducestress. Lastly,youcanaskthecareteamtoteachyouhowtohelpwithyourfamilymember’sbedsideexercises.Exercisespreventweaknessbykeepingthejointsandmusclesactive.Patientsshouldmovetheirbodyassoonastheycanandworkwithphysicaltherapists,evenwhileusingaventilator.Movingisalsogoodforthebrain. HowDoesPICSAffectFamily? Criticalillnessisafamilycrisis.Feelingworriedandconfusedcancausefamilymemberstostoptendingtotheirownhealth.Thecareteammayaskthefamilytomakedecisionsaboutimportant,sometimesoverwhelmingmatters.Becauseofthis,30%offamilymembersmayexperiencetheirownmentalhealthproblems,suchasdepression,anxietyandPTSD. HowCanFamilyLowerTheirChancesofDevelopingPICS? Firstandforemost,ifyouareafamilymember,takecareofyourself.Thiscannotbestressedenough.Meetingyourcriticallyillfamilymember’sneedsisamajorpartofcare,butyourneedsarejustasimportant.Ifyouarewell,youhavethephysicalandemotionalstrengthtosupportyourfamilymemberandfeelgoodaboutit.Eatwell,getasmuchrestaspossible,exercise,andseeksupport.Thehospitalhassocialworkers,casemanagers,andpastoralcaregiverswhocanhelp. Taketimetounderstandyourfamilymember’sillnessandtreatmentoptions.Havingthisinformationwillhelpyoumakedecisions,feelconfidentaboutthedecisionsyoumake,andreducestress.Askquestions,asktomeetwiththecareteam,andkeepajournal.Reviewthejournalwithamemberofthecareteamwhomyoutrusttomakesenseofwhathashappenedandhowyouarerespondingtoit.Theseactionscanhelpyouandthecareteamrecognizeandrespectyourfamilymember’swishes,values,andpreferencesasmuchaspossible. Participatinginpatientcareisanotherwaytosupportyourfamilymemberandreducestress.Thebedsidestaffcansuggestactivitiesforthosewhowanttobeinvolved. AfterLeavingtheICU IfyouareanICUpatient,thecareteammaydiagnoseyouwithPICSordetermineyouareatriskfordevelopingit.TheymayreferyoutoothercaregiversforsupportservicesafteryouleavetheICU.Ifnot,thesearepossiblewarningsigns: Muscleweaknessorproblemswithbalance Problemswiththinkingandmemory Severeanxiety Depression Nightmares Ifyounoticeanyoftheseproblems,pleaseaskyour primarycaredoctororcaregiver toreferyoutooneofthesespecialists: Occupationaltherapist: Acaregiverwhohelpsthepatientrelearnlifeskills,suchastheactivitiesofdailylivingandtheuseofmemory(forexample,grooming,feeding,dressing,balancingacheckbook). Physiatrist: Amedicaldoctorwhoisspeciallytrainedtodiagnoseandtreatinjuriestothemuscles,bones,tissuesandnervoussystem.Thephysiatristcanprescribemedication.Heorsheteachespatientsexercisestoimprovewhattheycandoandgivespatientsdevicestohelpthemadapttowhattheycannotdo. Physicaltherapist: Acaregiverwhohelpsrestorethepatient’sabilitytofunctionandbeindependentafterinjuriestothemuscles,bones,tissuesandnervoussystem. Psychiatrist: Amedicaldoctorwhoisspeciallytrainedtodiagnoseandtreatmentalhealthproblems.Thepsychiatristcanprescribemedication. Psychologist: Anadvanceddegreeprofessionalwhocandiagnoseandtreatproblemswiththoughts,emotionsandcopingskills.Thepsychologisttestsandassessesbehaviorandmentalhealth. Speechtherapist: Acaregiverwhohelpsthepatientwithproblemsrelatedtomemory,attentionandswallowing.Thespeechtherapistalsohelpsthepatientlearntospeakagain,ifnecessary. HelpfulWebsites ICU Thesewebsiteshaveallkindsofinformationaboutthecriticalcaresetting,thecaregiversinvolved,andwhatoptionsyouhave: MyICUCareWebsite,createdbytheSocietyofCriticalCareMedicine ICUStepsWebsite,createdbyacharitableorganization Delirium ICUDeliriumWebsite:Thiswebsite, created by Vanderbilt University Medical Center, helpsyouunderstanddelirium,astateofconfusionthatcomesonveryfastandcanbecausedbyacriticalillnessorthecriticalcaresetting. AcuteRespiratoryDistressSyndrome ARDSNetworkWebsite:Thiswebsite, created by the National Heart, Lung and Blood Institute, helpsyouunderstandacuterespiratorydistresssyndrome,aproblemwiththelungsthatleadstolowoxygenlevelsintheblood.AcuterespiratorydistresssyndromeisacommonreasonwhypatientsareintheICU. Sepsis SepsisAllianceWebsite:Thiswebsite, created by a charitable organization, helpsyouunderstandsepsis,thebody’stoxicresponsetoinfection.SepsisisacommonreasonwhypatientsareintheICU. SurvivingSepsisCampaignWebsite:Thiswebsite, created by the Society of Critical Care Medicine, isforcriticalcaredoctors,nursesandother membersofthemultiprofessionalcareteams.Itrecommendshowbesttodiagnoseandtreatsepsis. HelpfulVideoLinks TheSocietyofCriticalCareMedicinehasdevelopedseveralvideosfeaturinginterviewswithcaregiversandICUsurvivors.Thesevideosalsoareavailableat www.youtube.com/SCCM500: WhatadvicewouldyougiveICUstaff? Whatadvicedoyouhaveforothersurvivors? HowcouldyourcareafterICUdischargehavebeenimproved? WhatwasyourexperienceintheICU?​ APatient’sPerspectiveonPost-intensiveCareSyndromeVideo:ThisYouTubevideo,createdbyJohnsHopkinsUniversity,helpsyouunderstandhowpatientsregainhealthafteranICUstay.Thepatientinthevideoisa39-year-oldman.Herecallshisfirstyearafterintensivecare,includinghisdelayedreturntowork.Healsodescribeshealthchallengesthatsomepatientsfacewiththeirbody,thoughts,feelingsormindduringrecoveryaftertheICUstay.Thesehealthissues,knownas post-intensivecaresyndrome,orPICS,ariseduringthepatients’ICUstay.Beingmoreinformedaboutpost-ICUhealthissuescanhelpyoutalktoyourdoctorandnurseaboutthem. DeliriumintheICUVideo:ThisYouTubevideo, created by Johns Hopkins University, helpsyouunderstandtheconfusedthinking,ordelirium,thataffectsmanypatientsduringtheirstayinanICU.Thepatientinthevideoisa60-year-oldwomanwhowasadmittedtothehospitalwithkidneyproblems.Afterheradmission,shedevelopedsevereinfectionandbreathingproblems.TheseproblemsrequiredhertobeintheICUfor11daysonamachinethathelpedherbreathe(mechanicalventilator).Afteronemonthinthehospital,shereturnedhome.ThepatientrecallsherdeliriumintheICUanditseffectonher.Shedescribestheconfusing,sometimesscarymisperceptionsandhallucinationsthatcommonlyoccur.Shealsostressestheneedtoacknowledgetheseexperiences,eventhoughtheywerenotreal-lifeevents.Finally,shesuggestswaysinwhichthefamilycanhelpapatientduringandafterhisorherdelirium. Afterwatchingthesevideos,youmayhavequestionsorconcernsaboutPICSanddelirium.Ifso,talktoyourdoctor,nurseorcareteam.Theyknowyoubestandcanhelpyouthroughtheseconditions.  PublicationDate:2013  PageCreatedBy:JudyE.Davidson,RN,CNS,DNP,FCCM;RamonaO.Hopkins,PhD;DeborahLouis,RN,MSN;TheodoreJ.Iwashyna,MD,PhD​​​​​ Tweet