Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit

Abstract

Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.

Long-Term Acute Care Hospitals Extend ICU Capacity for COVID-19 Response and Recovery

“…patients is a primary specialization in LTACHs, which have experienced critical care clinicians and respiratory therapists in an accredited acute care hospital setting. 7 Patients with COVID-19 can develop post-ICU syndrome [8][9][10][11] or chronic critical illness that requires more intensive and prolonged hospitalization, as well as specialized interventions. 12 Although LTACH staff have the skills necessary for treatment of COVID-19 patients, extensive preparations and transformations are required for treating patients with a highly virulent virus.…”

Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

“…Post-intensive care syndrome is a described phenomenon in critically ill patients [ 65 ], and the neuropsychological impact of critical illness is also seen in ECMO patients with or without overt neurologic injury. Although their 36-Item Short Form Survey psychological domain is comparable to the general population [ 66 ], studies have identified that patients surviving to 6-month follow-up or longer have persistent emotional and mental health difficulties [ 61 , 66 – 68 , 69 •, 70 ]: depression (20–42%), anxiety (20–55%), and post-traumatic stress (PTS) symptoms (5–47%).…”

“…Return to work is only seen in 50–65% of patients receiving ECMO for ARDS [ 61 – 63 ]. Moreover, informal caregivers (often family members) suffer from increased rates of depression, anxiety, and PTS disorders as well [ 65 ], with significant correlation between mental health sequelae in patients and their informal caregivers following VV ECMO for ARDS [ 69 •]. These rates of neuropsychological sequelae may not differ substantially when compared with survivors of severe ARDS without ECMO [ 70 ], but they do highlight the need for intense follow-up that includes physiological and psychological evaluation and support for patients and their loved ones [ 71 ].…”

Association between early intensive care or coronary care unit admission and post-discharge performance of activities of daily living in patients with acute decompensated heart failure

“…The BI score at ED visit is a strong independent predictor of allcause 30-day mortality in patients with acute heart failure admitted to ED [24,30], and our results showed that pre-ADL level was also a strong predictor of post-ADL level. For young and physically fit patients, ICU/CCU admission may lead to unnecessary rest or restriction and post-intensive care syndrome [31], counteracting the beneficial effect of rapid ICU-level intervention. These results suggest that pre-ADL level can be a useful tool for the triage of ADHF patients to ICU/CCU admission.…”