Comparison of the Incidence of Post-intensive Care Syndrome (PICS) Between Elderly and Non-elderly Patients: A Subgroup Analysis of the Japan-PICS Study

Abstract

Aim: The aging society is expanding, and more elderly patients are admitted to intensive care units (ICUs). Elderly patients may have increased ICU mortality and are thought to have a high incidence of post-intensive care syndrome (PICS). There are few studies of PICS in the elderly. This study hypothesized that the elderly have an increased incidence of PICS compared to the non-elderly.

Methods: This is a subgroup analysis of a previous multicenter prospective observational study (Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: The Japan-PICS study) conducted from April 2019 to September 2019. Ninety-six patients were included who were over 18 years old, admitted to the ICU, and expected to require mechanical ventilation for more than 48 hours. Physical component scales (PCS), mental component scales (MCS), and Short-Memory Questionnaire (SMQ) scores of included patients were compared before admission to the ICU and six months later. The diagnosis of PICS required one of the following: (1) the PCS score decreased ≧10 points, (2) the MCS score decreased ≧10 points, or (3) the SMQ score decreased by >40 points. Patients were classified as non-elderly (<65 years old) or elderly (≧65 years old), and the incidence of PICS was compared between these two groups.

Results: The non-elderly (N=27) and elderly (N=69) groups had incidences of PICS: 67% and 62% (p=0.69), respectively.

Conclusion: There is no statistically significant difference in the incidence of PICS in the non-elderly and elderly.

Keywords: abcdef bundle compliance; aging; elderly; japan-pics study; post-intensive care syndrome (pics).

Figure 1. Flowchart of included patients

One hundred and ninety-two patients were included in the J-PICS study, and 96 underwent follow-up. Of these 96 patients, 69 were elderly (≧65 years old), and 27 were non-elderly (<65 years old).

Figure 2. A schema of the Japan-PICS study

PICS: post-intensive care syndrome; ICU: intensive care unit; SMQ: Short-Memory Questionnaire

Figure 3. Daily ABCDEF checklist

SAT/protocolized sedation initiation safety standards: Not using continuous sedation medications for active seizure control Not requiring the use of sedatives for alcohol withdrawal Not using muscle relaxants RASS ≤+2 No myocardial ischemic events within 24 hours No elevated ICP (ICP<20) Not using sedatives to control ICP Not using ECMO Not under open abdominal/thoracotomy management SBT initiation safety standards: Recovering from the primary illness that required a ventilator Able to maintain SpO2 ≥88% under FiO2 ≤50% and PEEP ≤8 cmH2O Hemodynamically stable (no need to increase catecholamine dose) No active ischemic events No use of muscle relaxants No effort breathing Minute ventilation ≤15 L/min RASS +1 to -2 Rehabilitation begins safety standards: 2>RASS>-3 PEEP <10 cmH2O and FiO2 <60 No new catecholamine initiation or dose increase within two hours No new myocardial infarction within two hours No treatment requiring rest restriction (open abdomen/open chest/ICP monitoring during drainage/IABP/ECMO) No contraindications to bed rest (e.g., unstable fracture) SAT: Spontaneous Awakening Trial; RASS: Richmond Agitation-Sedation Scale; ICP: intracranial pressure; ECMO: extracorporeal membrane oxygenation; SBT: Spontaneous Breathing Trial; SpO2: oxygen saturation; FiO2: fraction of inspired oxygen; PEEP: positive end-expiratory pressure; IABP: intra-aortic balloon pump