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Post-intensive care syndrome

Date: 17 April 2020 Tags: Miscellaneous

Issue

Studies have pointed out that, after leaving the ICU, people may suffer from what is known as post-intensive care syndrome (PICS), which can happen to any person who has been in the ICU.

 

Background

 PICS comprises impairment in cognition, psychological health and physical function of a person who has been in the ICU.

 

Details

  • As per the WHO-China Joint Mission report that examined 55,924 laboratory-confirmed cases of Covid-19, over 6.1 per cent were classified as critical, which means they experienced respiratory failure, shock and multiple organ failure.

  • Many critical cases need ICU admissions. Critically ill Covid-19 patients are older, and have more comorbidities such as hypertension and diabetes.

  • Significantly, Acute Respiratory Distress Syndrome (ARDS), one of the manifestations of Covid-19, is a common reason for ICU admission and such a person may need mechanical ventilation to deliver oxygen and remove carbon dioxide from the body.

  • PICS is defined as new or worsening impairment in physical (ICU-acquired neuromuscular weakness), cognitive (thinking and judgment), or mental health status arising after critical illness and persisting beyond discharge from the acute care setting,” the article notes.

  • Psychological disability may arise in a person in the form of depression, anxiety and post-traumatic stress disorder (PTSD).

  • The most common PICS symptoms are generalised weakness, fatigue, decreased mobility, anxious or depressed mood, sexual dysfunction, sleep disturbances and cognitive issues. These symptoms may last for a few months or many years after recovery.

  • Patients who develop this may take at least a year to fully recover, until which time they may have difficulty in carrying out everyday tasks such as grooming, dressing, feeding, bathing and walking.

  • Further, after leaving the ICU, over 30-80 per cent may develop problems related to cognitive function and other mental health issues, including difficulty in falling and staying asleep.

  • It is recommended that to avoid PICS, patients’ use of deep sedation is limited and early mobility is encouraged, along with giving them “aggressive” physical and occupational therapy.

  • Further, patients should be given the lowest dose of pain medications when possible, and should be put on lung or cardiovascular rehabilitation treatments along with treatments for depression, anxiety and PTSD.

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