Mitigating Postintensive Care Syndrome Among Patients And Caregivers via a Dyadic Intervention

Abstract

Over the last decade, increasing attention has been paid to physical, cognitive, and psychological symptoms that persist among survivors of critical illness who were initially admitted to the intensive care unit (ICU) with non-neurologic diagnoses. 1 The psychological symptoms are collectively referred to as postintensive care syndrome (PICS); studies of these symptoms have focused on the manifestations of long-term anxiety, depression, and posttraumatic stress disorder (PTSD) and have found a high prevalence of each manifestation after discharge from the ICU. Parallel to studies on the psychological aspects of PICS, there has been increasing recognition that family members of critically ill patients are also at high risk for adverse psychological outcomes (referred to as PICS-F) owing to their roles as surrogate decision makers in the ICU and informal caregivers following discharge. 2 Interventions to improve the psychological outcomes of PICS and PICS-F have taken different approaches, some of which have been focused on the patient's time in the ICU and others have been designed for the recovery period after ICU discharge. Most of these interventions have targeted patients or their families; few have taken an approach grounded in the theory that the patient and the main caregiver profoundly impact one another and are an integrated dyad.Vranceanu et al 3 have reported on the outcomes of a pilot randomized clinical trial for Recovering Together, an ICU support program conducted at Massachusetts General Hospital (MGH) that aimed to improve long-term psychological outcomes among patients and their main informal caregivers. In contrast to the non-neurologic population in which the concept of PICS originated, 1Recovering Together was developed among patients in neuroscience ICUs. However, the program was targeted to only those patients whose cognitive impairment was mild enough such that they could still participate meaningfully in sessions with a clinical psychologist. The MGH team developed the content of the support program through extensive preliminary work demonstrating that emotional distress experienced by 1 partner in the dyad (ie, patient or caregiver) impacts the other's distress, and strategies promoting resilience (eg, mindfulness, coping) practiced by 1 partner can positively impact both partners' distress. 4 With this background, the Recovering Together program was developed as a series of six 20-to 30-minute sessions between a clinical psychologist and the dyad members. During the first 2 in-person sessions, the patient and caregiver were taught resiliency strategies for managing emotions such as stress, fear, and anger. The final 4 sessions were conducted via video conferencing after hospital discharge. Sessions were tailored for each dyad from a list of specific skills that focused on adjustment to life at home, including optimizing interpersonal communication, managing household roles, and adhering to treatment.For this feasibility trial, the team enrolled dyads, each of which had at least 1 partner...

Mitigating Challenges to Effective Management of Post-Intensive Care Syndrome (PICS)

“…Coined in 2010 by the Society of Critical Care Medicine, PICS highlights the onset or exacerbation of impairments in physical, cognitive and mental health resulting from the ICU experience [1,2]. The multifaceted nature of PICS, as outlined by Geense [3], Hwang [4], and Wiertzema [5], manifests in symptoms such as muscle weakness, cognitive impairment, anxiety, and depression, presenting complexities in its management.…”

“…Notably, a consensus emerges within the literature regarding the efficacy of interventions across the three main categories of PICS and the associated symptoms. Studies converge on pivotal physical interventions, encompassing physical therapy, early mobilization, nutritional assessment and enhancement, rehabilitation, utilization of recovery manuals, exercise regimens, and nursing interventions such as ongoing monitoring, prescription management, and follow-up care [9,6,20,21,3,22,4,23,1].…”

“…Scholars align on diverse strategies to effectively address the mental and social health dimensions of PICS, encompassing the utilization of ICU diaries, early psychological interventions, nurseled preventative measures, animal-assisted therapy, open visitation policies, internet-based cognitive interventions, and peer and family support networks, alongside rehabilitation programs [9,6,13,4,,1,5] Moreover, there is unanimous acknowledgment of the pivotal role of cognitive interventions, predominantly through cognitive therapy delivered at home and digital cognitive rehabilitation platforms, as emphasized across studies [9,6,20,21,22,4] A consensus emerging from multiple literature sources underscores the effectiveness of interventions facilitated through care coordination and personalized care planning [6,9]. These interventions encompass a range of strategies, including the transition of elderly ICU patients to geriatric wards, the implementation of multifaceted programs, medication management protocols, mobile care coordination initiatives led by nurses, and disease management support services [1,24,25,26,27,28].…”

Post intensive care syndrome across the life course: Looking to the future of paediatric and adult critical care survivorship

“…Recognizing that patient and family cannot be untangled, it has been suggested for clinical interventions to approach the patient and their family as a dyad that recovers together 25 . The exact shape of the survivor family will depend on the patient, and their care network.…”