Post-intensive care syndrome: Recent advances and future directions

Post-intensive care syndrome: Recent advances and future directions

2024 | Shigeaki Inoue, Nobuto Nakanishi, Fumimasa Amaya, Yoshihisa Fujinami, Junji Hatakeyama, Toru Hifumi, Yuki Iida, Daisuke Kawakami, Yusuke Kawai, Yutaka Kondo, Keibun Liu, Kensuke Nakamura, Takeshi Nishida, Hidenori Sumita, Shunsuke Taito, Shunsuke Takaki, Norihiko Tsuboi, Takeshi Unoki, Yasuyo Yoshino, Osamu Nishida
Post-intensive care syndrome (PICS) encompasses physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU), occurring during or after ICU discharge. It significantly affects long-term prognosis and impacts families. Over the past decade, research on PICS has expanded, focusing on its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatment. PICS domains include physical impairment (e.g., ICU-acquired weakness), cognitive impairment (e.g., delirium, memory issues), and mental health problems (e.g., depression, anxiety). Chronic pain is also common in ICU survivors and is closely linked to PICS. PICS-related disorders include persistent inflammation, immunosuppression, and catabolism syndrome (PIICS), which worsens long-term outcomes. The prevalence of PICS is 50%–70% at 6 months post-ICU discharge. Risk factors include patient background, illness severity, medical care, and environmental stress. Assessment tools such as the Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) are recommended. Prevention strategies include the ABCDEF bundle, early rehabilitation, and nutrition support. Delirium management, ICU diaries, and rehabilitation after ICU discharge are also important. Future directions include telemedicine, return-to-work support, and community-based care. Research is needed to understand the mechanisms of PICS and develop new interventions. The review highlights the importance of multidisciplinary approaches and long-term follow-up to improve outcomes for ICU survivors.Post-intensive care syndrome (PICS) encompasses physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU), occurring during or after ICU discharge. It significantly affects long-term prognosis and impacts families. Over the past decade, research on PICS has expanded, focusing on its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatment. PICS domains include physical impairment (e.g., ICU-acquired weakness), cognitive impairment (e.g., delirium, memory issues), and mental health problems (e.g., depression, anxiety). Chronic pain is also common in ICU survivors and is closely linked to PICS. PICS-related disorders include persistent inflammation, immunosuppression, and catabolism syndrome (PIICS), which worsens long-term outcomes. The prevalence of PICS is 50%–70% at 6 months post-ICU discharge. Risk factors include patient background, illness severity, medical care, and environmental stress. Assessment tools such as the Montreal Cognitive Assessment (MoCA) and Hospital Anxiety and Depression Scale (HADS) are recommended. Prevention strategies include the ABCDEF bundle, early rehabilitation, and nutrition support. Delirium management, ICU diaries, and rehabilitation after ICU discharge are also important. Future directions include telemedicine, return-to-work support, and community-based care. Research is needed to understand the mechanisms of PICS and develop new interventions. The review highlights the importance of multidisciplinary approaches and long-term follow-up to improve outcomes for ICU survivors.
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