Postintensive Care Syndrome

Excerpt

While the short-term outcomes of ICU patients have dramatically improved over the last half-century, it is increasingly recognized that many ICU survivors experience declines in physical and cognitive functioning that persist well beyond their acute hospitalization. Psychiatric sequelae, including anxiety, depression, and post-traumatic stress disorder (PTSD) are also prevalent among both ICU survivors and their family members. Attendees of a 2010 meeting of the Society of Critical Care Medicine coined the term Post Intensive Care Syndrome (PICS) to describe new and persistent declines in physical, cognitive, and mental health functioning that follow an ICU stay and for which other causes, such as traumatic brain injury (TBI) or cerebrovascular accident (CVA), have been excluded. The term PICS-F is applied to the close family members of ICU patients who experience subsequent adverse mental health outcomes, the most common of which are sleep deprivation, anxiety, depression, and complicated grief.

In the last few decades, there has been a rise in the rate of pediatric ICU (PICU) utilization. In contrast, the mortality in this population has steadily fallen, resulting in a growing number of pediatric ICU survivors at risk for the impairments of PICS. The impacts of impairments following an ICU stay in pediatric patients deserve special attention as these occur within the already dynamic state of childhood development. Additionally, because even healthy children are inherently dependent upon the support of their parents and other caregivers, a child’s recovery from a PICU stay inevitably impacts the entire family unit. Re-integration into school and other peer groups is a particular challenge for pediatric ICU survivors, while their siblings also face extraordinary social and emotional stressors. At a time that would otherwise represent peak economic productivity, parents of critically ill children often must cut back on work hours or withdraw from employment completely, resulting in financial consequences that persist long after the illness. For this reason, the PICS-pediatric (PICS-p) framework includes the fourth domain of social health applicable to all family members of the PICU patient.