Breaking it Down: Post Intensive Care Syndrome Wrap Up

This month marks one year since we started breaking down the many aspects that encompass Post Intensive Care Syndrome. As a brief recap here are the highlights that we have shared during this series. Click on the links within this recap to visit each blog for a more in depth look.

What is PICS

People with PICS often experience the following:

• Body: Tiredness, weakness, pain
• Mind: Forgetfulness, confusion, decreased concentration
• Emotions: Depression, anxiety, sleep disturbances, flashbacks, and nightmares

Risk Factors

The following is a list and explanation of some of the associated conditions and/or critical care interventions that are currently recognized as risk factors for the development of PICS.

• Delirium. Of all the risk factors that have been examined at this time, the development of delirium during an ICU stay has been most closely associated with the development of PICS.
• Length of time on bedrest. This risk factor is directly related to muscle loss and the development of physical weakness.
• Sepsis. Sepsis is a very serious infection in the body that causes many people to become critically ill. Often times sepsis can cause different organ systems in the body to fail, which in itself is yet another risk factor for PICS.

Signs and Symptoms

People with PICS often experience a wide array of symptoms. The following symptoms are examples of what some people may experience:

• Body: Weakness, trouble with balance, pain, difficulty completing previously routine tasks such as driving and housework
• Mind: Difficulty with thinking or memory, trouble concentrating, confusion, word finding difficulty, mental "fog", and trouble with daily activities and work routines resulting in reduced or loss of work
• Emotions: Depression, anxiety, sleep disturbances, flashbacks, nightmares, irritability, anger, and agitation

Prevention

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 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.
• Choosing medications wisely. 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. 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.
• Early mobility. Maintaining physical strength is crucial to optimizing and accelerating recovery from critical illness.
• Family involvement. Critical care teams recognize the power that loved ones have in the healing process of critically ill patients.

Recovery

• Body - Physical activity is one the most important keys to recovery for the critically ill/injured patient. It is increasingly common now for patients to begin working with therapy while still hospitalized - even starting in the intensive care unit!
• Mind - Working with an occupational therapist is highly suggested for anyone who believes they or a loved one may be experiencing PICS. An occupational therapist is a healthcare provider who helps individuals relearn life skills, such as activities of daily living or complete tasks that are meaningful to them while maintaining independence.
• Emotions - You are not alone in your struggle following critical illness. There is an expanding global network of Peer Support groups focused on ICU recovery sponsored by the Society of Critical Care Medicine. A list of the current groups can be found by following this link: Peer Support Group Directory

The Family

Increased demands placed on family members and loved ones caring for the critically ill can quickly become overwhelming. There are steps that loved ones and family members can take to minimize the negative effects that an ICU environment can have:

• Take breaks. Whether it is a scheduled coffee break or a walk for fresh air, time to yourself is very important.
• Sleep. Consider sleeping in a room outside of the hospital or at least the hospital room if possible.
• Eat. Focus on eating smaller, more nutrient dense meals and snacks during the day. Avoid high sugar, nutrient poor foods. And remember to drink water and stay hydrated.
• Find support. Joining a support group, sharing your thoughts, worries, and emotions with others can be tremendously helpful.

Come back often as we continue to explore recovery from critical illness/injury.

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:  Intensive Care (ICU)