Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

Nobuto Nakanishi¹, Keibun Liu², Daisuke Kawakami³, Yusuke Kawai⁴, Tomoyuki Morisawa⁵, Takeshi Nishida⁶, Hidenori Sumita⁷, Takeshi Unoki⁸, Toru Hifumi⁹, Yuki Iida¹⁰, Hajime Katsukawa¹¹, Kensuke Nakamura¹², Shinichiro Ohshimo¹³, Junji Hatakeyama¹⁴, Shigeaki Inoue¹, Osamu Nishida¹⁵

Affiliations

¹ Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
² Critical Care Research Group, Faculty of Medicine, University of Queensland and The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD 4032, Australia.
³ Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan.
⁴ Department of Nursing, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
⁵ Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
⁶ Osaka General Medical Center, Division of Trauma and Surgical Critical Care, 3-1-56, Bandai-Higashi, Sumiyoshi, Osaka 558-8558, Japan.
⁷ Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi 441-0105, Japan.
⁸ Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo 060-0011, Japan.
⁹ Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
¹⁰ Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi 440-8511, Japan.
¹¹ Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo 102-0073, Japan.
¹² Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan.
¹³ Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
¹⁴ Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
¹⁵ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.

PMID: 34501316
PMCID: PMC8432235
DOI: 10.3390/jcm10173870

Review

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

Nobuto Nakanishi et al. J Clin Med. 2021.

. 2021 Aug 28;10(17):3870.

doi: 10.3390/jcm10173870.

Authors

Affiliations

¹ Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
² Critical Care Research Group, Faculty of Medicine, University of Queensland and The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD 4032, Australia.
³ Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka 820-8505, Japan.
⁴ Department of Nursing, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
⁵ Department of Physical Therapy, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
⁶ Osaka General Medical Center, Division of Trauma and Surgical Critical Care, 3-1-56, Bandai-Higashi, Sumiyoshi, Osaka 558-8558, Japan.
⁷ Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi 441-0105, Japan.
⁸ Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Kita 11 Nishi 13, Chuo-ku, Sapporo 060-0011, Japan.
⁹ Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan.
¹⁰ Department of Physical Therapy, Toyohashi SOZO University School of Health Sciences, 20-1, Matsushita, Ushikawa, Toyohashi 440-8511, Japan.
¹¹ Department of Scientific Research, Japanese Society for Early Mobilization, 1-2-12, Kudan-kita, Chiyoda-ku, Tokyo 102-0073, Japan.
¹² Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan.
¹³ Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
¹⁴ Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
¹⁵ Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.

PMID: 34501316
PMCID: PMC8432235
DOI: 10.3390/jcm10173870

Abstract

Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28-87% of cases pertaining to physical impairments, 20-57% pertaining to cognitive impairments, and 6-60% pertaining to mental health problems after 1-6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection.

Keywords: ABCDEF bundle; COVID-19; PICS; cognitive impairments; delirium; family; mental health problems; nutrition; physical impairments; rehabilitation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Concept of post-intensive care syndrome (PICS). PICS includes physical impairment, cognitive impairment, and mental health problems of intensive care unit (ICU) survivors. PICS-F refers to mental health problems of the patient’s family.

**Figure 2**
Pathophysiology of coronavirus disease 2019 (COVID-19) infection. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) (highly expressed in lung epithelial cells) via the receptor-binding domain of the spike protein. The consequent inflammatory responses cause a systemic cytokine storm and organ damage, thus leading to PICS.

**Figure 3**
Concept of ABCDEF bundle. ABCDEF bundle includes A to F components shown in the figure.

See this image and copyright information in PMC

References

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Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

Affiliations

Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources