Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jan 12;12(1):107.
doi: 10.3390/life12010107.

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

Charikleia S Vrettou  1 , Vassiliki Mantziou  1 , Alice G Vassiliou  1 , Stylianos E Orfanos  1 , Anastasia Kotanidou  1 , Ioanna Dimopoulou  1
Affiliations
Review

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

Charikleia S Vrettou et al. Life (Basel). .

Abstract

Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as "new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization". A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.

Keywords: COVID-19; anxiety; depression; post-intensive care syndrome; post-traumatic stress disorder; quality of life.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Commonest symptoms that characterize the post-intensive care syndrome in non-COVID-19 and COVID-19 patients, and their effect on HRQOL. COVID-19, Coronavirus disease 2019; HRQOL, Health-related quality of life; ICU, Intensive care unit; PICS, Post-intensive care syndrome; PICS-F, PICS family; PTSD, Post-traumatic stress disorder.
Figure 2
Figure 2
ICU delirium has a complex and multifactorial pathophysiology at the cellular and molecular level that affects the clinical level with significant overlap. This complexity explains the observed difficulty in delirium treatment and highlights the importance of prevention. GABA, Gamma-aminobutyric acid; ICU, Intensive care unit; NMDA, N-methyl-D-aspartate.
Figure 3
Figure 3
Post-intensive care syndrome (PICS) (blue rectangle) and “Long COVID” (yellow rectangle) overlap. The two conditions present with many symptoms that show significant overlap shown in the middle green section. COVID, Coronavirus disease; PICS, Post-intensive care syndrome; PTSD, Post-traumatic stress disorder.
Figure 4
Figure 4
Post-intensive care syndrome (PICS) prevention and treatment. The ABCDEFGH bundle is a bundle of interventions that can assist in PICS and PICS family (PICS-F) prevention and is mainly instituted during intensive care unit (ICU) stay, while PICS treatment is extended after ICU discharge at the rehabilitation facilities or when the patient returns home and can be supported by specialized follow-up clinics.
See this image and copyright information in PMC

References

    1. Jackson J.C., Pandharipande P.P., Girard T.D., Brummel N.E., Thompson J.L., Hughes C.G., Pun B.T., Vasilevskis E.E., Morandi A., Shintani A.K., et al. Depression, Post-Traumatic Stress Disorder, and Functional Disability in Survivors of Critical Illness in the BRAIN-ICU Study: A Longitudinal Cohort Study. Lancet Respir. Med. 2014;2:369–379. doi: 10.1016/S2213-2600(14)70051-7. - DOI - PMC - PubMed
    1. Needham D.M., Davidson J., Cohen H., Hopkins R.O., Weinert C., Wunsch H., Zawistowski C., Bemis-Dougherty A., Berney S.C., Bienvenu O.J., et al. Improving Long-Term Outcomes after Discharge from Intensive Care Unit: Report from a Stakeholders’ Conference. Crit. Care Med. 2012;40:502–509. doi: 10.1097/CCM.0b013e318232da75. - DOI - PubMed
    1. Serrano P., Kheir Y.N.P., Wang S., Khan S., Scheunemann L., Khan B. Aging and Postintensive Care Syndrome– Family: A Critical Need for Geriatric Psychiatry. Am. J. Geriatr. Psychiatry. 2019;27:446–454. doi: 10.1016/j.jagp.2018.12.002. - DOI - PMC - PubMed
    1. Needham D.M., Dinglas V.D., Morris P.E., Jackson J.C., Hough C.L., Mendez-Tellez P.A., Wozniak A.W., Colantuoni E., Ely E.W., Rice T.W., et al. Physical and Cognitive Performance of Patients with Acute Lung Injury 1 Year after Initial Trophic versus Full Enteral Feeding EDEN Trial Follow-Up. Am. J. Respir. Crit. Care Med. 2013;188:567–576. doi: 10.1164/rccm.201304-0651OC. - DOI - PMC - PubMed
    1. Pandharipande P.P., Girard T.D., Jackson J.C., Morandi A., Thompson J.L., Pun B.T., Brummel N.E., Hughes C.G., Vasilevskis E.E., Shintani A.K., et al. Long-Term Cognitive Impairment after Critical Illness. N. Engl. J. Med. 2013;369:1519–1544. doi: 10.1056/NEJMoa1301372. - DOI - PMC - PubMed

LinkOut - more resources