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.

Keywords: Critical care; PICS; PICS-family; Post-intensive care syndrome.

Fig. 1

Patient premorbid and ICU risk factors for long-term cognitive, functional, and psychiatric effects of critical illness, as well as family/caregiver risk factors for long-term psychiatric consequences after the patient’s critical illness. There are important areas of interrelationship between changes seen in patients and caregivers (dashed lines), highlighting the interplay and influence between the two groups. The downstream effect for each group is decreased quality of life. ARDS acute respiratory distress syndrome, PTSD post-traumatic stress disorder, QoL quality of life

Fig. 2

Neurocognitive findings observed following neurological injury requiring ICU level of care exist at the intersection between primary neurological injury and critical illness induced injury (arrow). If even some of the experiential injury related to critical care illness can be mitigated, then perhaps some of the neurocognitive deficits we see in our patient population may be preventable or treatable. Not drawn to scale