Neuropsychiatric assessment and management of the ICU survivor

Dean, Erin; Biehl, Michelle; Bash, K.; Weleff, Jeremy; Pozuelo, Leopoldo

doi:10.3949/ccjm.88a.20169

Cited by 9 publications

(5 citation statements)

References 61 publications

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“…12 Several factors contribute to this risk, including the duration of delirium during the ICU stay, acute brain dysfunction like stroke or alcoholism reduced oxygen supply (ARDS or cardiac arrest) blood pressure (sepsis or trauma) disruption in glucose regulation prolonged mechanical ventilation due to respiratory failure, severe sepsis, use of renal replacement therapy and acute respiratory distress syndrome (ARDS). 13,14 Other factors that increase the risk are related to age or previous health conditions. Cognitive decline can have an impact, on aspects of thinking, including memory, focus, problemsolving skills, language abilities, and spatial awareness.…”

Section: Discussionmentioning

confidence: 99%

Overview and management of post-intensive care syndrome

Nassar,

Hamed,

Alkhudhair

et al. 2023

Int J Community Med Public Health

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Any patient suffering from critical life-threatening illnesses in most cases require hospitalization, in the care unit (ICU) where they can receive essential life-sustaining treatments. This has created an impact including more than 50 million individuals world-wide. Although advancements, in technology and healthcare have increased survival rates many individuals who survive these illnesses experience long-term impairments known as post-intensive care syndrome (PICS). PICS encompasses cognitive and emotional challenges that significantly affect patients' quality of life and ability to return to their normal routines. Caregivers may also face similar emotional hurdles, a condition referred to as PICS-family (PICS-F). The prevalence of PICS varies but can affect up to 50% of ICU survivors. Cognitive difficulties can be noticed in, around 70% of instances impacting abilities like memory, focus, and decision-making. These difficulties can lead to emotions such, as sadness worry, and a condition known as traumatic stress disorder (PTSD). Multiple factors, such as delirium, sedation, and pre-existing health conditions play a role, in the emergence and severity of PICS. Diagnosing PICS involves comprehensive assessments covering physical, cognitive, and emotional dimensions. Screening should ideally commence during the ICU stay and continue post-discharge. Assessment tools such as the Montreal cognitive assessment (MoCA) and emotional functioning screenings aid in identifying PICS. This manifests physically through muscle weakness and fatigue, impacting mobility and daily activities. Effectively managing ICUs requires the implementation of models and strategies that optimize resource utilization. However, these strategies may entail challenges such as data integration and stakeholder involvement. Preventing PICS involves proactive measures like reducing sedation, promoting early mobility, and offering rehabilitation services. Addressing PICS necessitates a proactive approach, comprehensive patient care, and collaboration among multidisciplinary teams. The successful implementation of these strategies depends on thorough evaluation and active engagement with all stakeholders involved in ICU management.

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Section: Discussionmentioning

confidence: 99%

Overview and management of post-intensive care syndrome

Nassar,

Hamed,

Alkhudhair

et al. 2023

Int J Community Med Public Health

View full text Add to dashboard Cite

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“…While the diagnosis of PICS is primarily based on a comprehensive evaluation of clinical signs, symptoms, and patient history, several diagnostic methods may be employed to assess and confirm the presence of this syndrome [34,35]. First, gathering a detailed medical history, including the duration of ICU stay, the severity of illness, and treatment received, helps provide insight into the potential risk factors and timeline of PICS development.…”

Section: Diagnostic Approachmentioning

confidence: 99%

“…Then, a thorough physical exam has to be conducted to evaluate the patient's overall functionality. Neurologic assessment should focus on detecting signs or symptoms suggestive of PICS, such as muscle weakness, cognitive deficits, or psychological distress [34,36].…”

Section: Diagnostic Approachmentioning

confidence: 99%

“…Manual muscle testing (MMT) or dynamometry can help quantify muscle strength and identify muscle weakness associated with PICS. Mobility testing can provide insights into functional mobility limitations, including measures like the Timed Up and Go (TUG) test or the 6-Minute Walk Test (6MWT) [34,35,39]. Spirometry may be conducted in individuals with respiratory muscle weakness or persistent lung impairments following ICU admission to evaluate pulmonary function.…”

Section: Journal Of Anesthesia and Intensive Care Medicinementioning

confidence: 99%

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Insights into Post-Intensive Care Syndrome, A Complex and Multifaceted Condition

Bonilla la Rosa,

Faisal,

Flores

et al. 2023

JAICM

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Post-intensive care syndrome (PICS) is a complex and multifaceted condition that affects a significant proportion of patients who have survived critical illness and received intensive care. The prevalence of PICS is substantial and has been reported to range from 30% to 80% of ICU survivors. PICS has been associated with increased mortality, hospital readmissions, and healthcare utilization, emphasizing the need for comprehensive post-ICU follow-up care. There is a multitude of risk factors that predispose an individual to develop PICS. However, the educational level has been proven protective against developing the condition. Clinical presentation of PICS includes physical impairments, cognitive deficits, and psychological conditions, with some symptoms lasting from months to years post-recovery. The diagnosis is primarily clinical and requires an interdisciplinary medical team to tailor the diagnostic approach and a global health assessment. PICS multidisciplinary team involves critical care physicians, rehabilitation specialists, mental health professionals, and social support networks. Since no treatment is entirely adequate, controlling the underlying cause and prevention is the most used strategy. A multidimensional approach of the "ABCDEF" bundle is recommended for preventing PICS alongside other non-pharmacological practices. Early mobilization, delirium prevention, and tailored rehabilitation programs have shown promising outcomes for these patients. The long-term prognosis of PICS varies extensively and depends on numerous individual factors, including overall health, pre-existing conditions, age, and access to follow-up care. It is also possible to have a recurrence of symptoms after initial recovery, particularly during physical or emotional stress periods. The recovery rates for PICS depend on multiple factors, and the recovery process is usually gradual. Long-term consequences of the syndrome extend beyond the physical, cognitive, and psychological domains. Increased public awareness about PICS is essential to diagnose the condition early before it progresses. This article provides a comprehensive overview of PICS encompassing its characteristics, epidemiology, risk factors, clinical presentation, diagnosis, prevention, management, and prognosis. Further research is needed to refine risk stratification, optimize interventions, and develop novel approaches to mitigate the burden of PICS.

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“…The number of ICU admissions is as high as 4 million per year, which is higher than other countries. Therefore, the occurrence of PICS-F psychology The number of people with functional impairment is higher [30] . In terms of study type, the reported incidence of PICS-F psychological dysfunction in the cohort study was 26%, which was similar to the results of other studies.…”

Section: The Incidence Of Psychological Dysfunctionmentioning

confidence: 99%

The incidence and risk factors of syndromic psychological dysfunction in family members after ICU: A meta-analysis

zhang

cheng

xia

et al. 2022

Preprint

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Objective To summarize the risk factors of Post Intensive Care unit-family (PICS-F) mental dysfunction in family members, and to provide evidence for clinical medical staff to identify the risk factors of PICS-F mental dysfunction in advance.Methods Embase, PubMed, Cochrane Library, EBSCO, Web of Science, China Biomedical Database (CBM), CNKI, WanFang Database and VIP database were systematically searched from database establishment to May 2022. Literature on the risk factors of PICS-F mental dysfunction was included. After screening, extraction and quality evaluation, stata17.0 and RveMan5.4 were used to conduct meta-analysis on the incidence and risk factors of PICS-F.Results a total of 10692 subjects were included in 15 literatures. The incidence of pics-f mental dysfunction was 28% (95%CI 0.22 to 0.35). Subgroup analysis showed a 30% incidence in the United States and 27% in other countries. The incidence was 26% in cohort studies, and 43% in case-control and cross-sectional studies. The incidence was 26% at 3 months and 13% at 6 months. Meta-analysis results showed patient age (OR=1.06,95%CI 1.01 to 1.10), gender of family members (OR=4.07,95%CI 2.52 to 6.60) and relationship between family members and patients (OR=2.24,95%CI 1.00 to 4.99), family history of mental illness (OR=3.77,95%CI 1.58 to 8.97), length of ICU stay (OR=4.72,95%CI 2.10 to 10.64), and severity of disease (OR=5.95,95%CI 2.09 to 16.94), death (OR=1.90,95%CI 1.31 to 2.77), family education level (OR=1.07,95%CI 1.02 to 1.12) were the influencing factors of PICS-F psychological dysfunction. It is not clear whether the mode of admission and attendance at family meetings have an effect on PICS-F mental dysfunction.Conclusion The risk factors for PICS-F mental dysfunction are young age, female family member, spouse, history of mental illness, long ICU stay, severity of illness, death and low education level of family members. Clinical medical staff should pay attention to the above risk factors and take corresponding measures to reduce the incidence of PICS-F psychological dysfunction. Relevance to clinical practiceThe results of our meta-analysis have important consequences for ICU nurse managers. Our finding of high rate of PICS-F Psychological dysfunction among ICU patients. That more attention should be devoted to develop and apply prevention programs for ICU nurses to manage this global issue.

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Neuropsychiatric assessment and management of the ICU survivor

Cited by 9 publications

References 61 publications

Overview and management of post-intensive care syndrome

Overview and management of post-intensive care syndrome

Insights into Post-Intensive Care Syndrome, A Complex and Multifaceted Condition

The incidence and risk factors of syndromic psychological dysfunction in family members after ICU: A meta-analysis

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