Breaking it Down: Post Intensive Care Syndrome and Prevention - Part I

We will break our conversation about preventing Post Intensive Care Syndrome into two parts. This month in Part I, we will focus on steps that the health care team will take to prevent PICS. Next month in Part II, we will focus on preventative steps that loved ones can take.

As prior posts in this series have highlighted, there is still much yet to learn about Post Intensive Care Syndrome including what specific interventions work best for prevention. At this moment as a medical community, we know that delirium - which can be seen as the development of inattention or confusion - is strongly associated with post-ICU difficulties that can lead to PICS. Therefore, many of the interventions that the critical care team may implement, are directed at preventing the development of delirium while in the ICU. These interventions may include:

• Evaluating pain. The healthcare team will routinely assess pain levels of all patients. Ensuring that pain is well managed - while acknowledging that complete elimination of pain is sometimes not possible - is an important step that the team will focus on. The healthcare team may make medications changes as needed to adjust to pain needs of the patient.
• Wake up and breathe. For patients requiring help breathing by the use of a breathing machine, the critical care team will routinely assess if the patient is ready to breathe on his or her own. This is done by turning off any medications that are being used for sedation, allowing the patient to wake up to see if they can breathe without the help of the machine. This helps to minimize both the time needed on the machine as well as time spent on sedating medications, both of which can have negative side effects.
• Choosing medications wisely. Many patients who experience critical illness also experience pain or need sedative medications to help them tolerate specific life saving treatments. The critical care team will discuss the medications that the patient is receiving for both pain and sedation needs, and ensure that the right medications at the right doses for the right amount of time are prescribed.
• Normalizing the sleep wake cycle. Sleep disturbance and deprivation can be a big risk factor for the development of delirium. Attempts are made to keep the patient awake during daytime hours and allow for restful sleep during the nighttime hours. Keeping the lights on, curtains and doors open during the day, while turning lights off and minimizing noise and interruptions during the night are helpful steps. The healthcare team will closely evaluate medications that may disrupt the sleep wake cycle, as well as consider adding on others that may help with regulation.
• Early mobility. Gone are the days when patients in the ICU stayed in bed for days on end. Much focus and effort is being placed on getting patients out of bed and moving as early as is safely possible. Physical and occupational therapists as well as nurses are playing a key role in getting patients moving. Even patients on breathing machines can be walked around the units! Maintaining physical strength is crucial to optimizing and accelerating recovery from critical illness.
• Family involvement. Much like bedrest, visiting hours are also quickly becoming a thing of the past. Critical care teams recognize the power that loved ones have in the healing process of critically ill patients. Much more on this next month!

Stay tuned to next month's blog to learn about steps loved ones can take to prevent Post-Intensive Care Syndrome.

In the meantime, join our conversation online. Have you or a loved one experienced critical illness/injury? You're not alone. Share your story and connect with others who have been on the same journey:

Post-Intensive Care Syndrome (PICS) - Let's Talk