Understanding Post-Intensive Care Syndrome: Causes, Identification, Treatment, and Future Directions – James Jackson

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Over 5 million individuals are treated in the ICU annually in North America.  While 20% of these individuals will die prior to discharge, those who survive are rarely free of difficulties. Many ICU survivors return home only to find that their lives are now in dramatic contrast with their pre-treatment existences.

Evidence from dozens of investigations suggests that up to half of ICU survivors experience complications, including cognitive impairment, depression, PTSD, and physical debility.  These problems collectively form a condition known as Post-Intensive Care Syndrome or PICS and they cause significant difficulties in areas such as daily functioning, functioning, and overall quality of life.

While PICS impacts literally millions of individuals each year, few professionals are aware of it, and even fewer are familiar with effective treatments for patients who suffer with this common, yet disabling, condition. Using current research and proven clinical examples, this recording will teach clinicians across the disciplines to identify PICS and to utilize evidence-based strategies in its treatment.

In particular, clinicians will learn to individually tailor common clinical approaches to the needs of PICS patients and their families, both during and after hospitalization.

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1. Demonstrate a mastery of key concepts related to PICS, including what it is, how it develops, and how it is treated
2. Recognize the ways that PICS is a driver of poor short-term and long-term health related outcomes
3. List practical “in hospital” strategies to prevent the development of PICS
4. Apply information about PICS and its treatment into routine clinical practice
5. Examine the ways that the care of PICS patients can be integrated into clinical duties
6. Explain the complications that many ICU survivors experience when returning home.

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EPIDEMIOLGY OF CRITICAL ILLNESS IN NORTH AMERICA AND THE WORLD

• What is critical illness/intensive care?
• Who is affected by critical illness?
• Why are the unique needs of ICU survivors of critical illness so often ignored?
• How frequently are rehabilitation professionals involved in the clinical care of critically ill patients?

INTRODUCTION TO COGNITIVE AND MENTAL HEALTH PROBLEMS AFTER INTENSIVE CARE

• Brain injuries/dementia
• Depressions
• Anxiety
• PTSD
• Post-Intensive Care Syndrome (PICS)
• Acute, Post-Acute, and Long Term Symptoms

POTENTIAL RISK FACTOR/CAUSES OF PICS

• Medical illness
  • Sepsis
  • Acute respiratory distress syndrome (ARDS)
  • Pneumonia 
• Medical treatment
  • Hypoxia due to mechanical ventilation
  • Excessive sedation
  • Delirium

BEST PRACTICES IN THE PREVENTION AND TREATMENT OF PICS

• Inpatient prevention and management strategies-an interdisciplinary approach
  • Assessment
  • Early identification
  • Education- setting expectations
• Post-discharge treatment strategies
  • Persisting issues after leaving the ICU
    • Muscle weakness/problems with balance
    • Problems with thinking and memory
    • Severe anxiety
    • Depression
  • Post-acute care facility placement
    • Rehabilitation professional’s role
    • Goal of regaining functional independence
    • Reduction of readmission rates
  • PICS and families
    • How they can help
    • Education
    • Reorient patients
    • Items from home
    • ICU diary
  • Impact
    • Anxiety/PTSD
    • Depression
    • Complicated grief
• New research into PICS
• Implications for treatment of PICS
• Role of professionals from diverse clinical disciplines in addressing PICS
  • “Untapped” opportunities to get involved
  • Developing a “unit” culture responsive to PICS
  • Creating a follow-up clinic
  • Starting a PICS support group

BRINGING IT ALL TOGETHER

• Case study of the Treatment of PICS
• Examples across clinical disciplines
• From admissions to after discharge

HOT TOPICS AND FUTURE DIRECTIONS RELATED TO PICS 

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