Post-intensive care syndrome (PICS) describes a collection of symptoms related to physical, psychosocial, and cognitive health and function that are new or worsened in patients who survive critical illness (e.g., severe infection, heart attack, cardiac arrest, stroke, etc.) and/or life-threatening traumatic injuries and admission to intensive care. The range of symptoms that PICS describes falls under three broad categories: physical impairment, cognitive impairment, and psychiatric impairment. A person with PICS may have symptoms from one or multiple of these categories. Additionally, family members are also simultaneously affected by their loved ones' intensive care unit (ICU) experience and caregiving for them afterwards. This has been recognized as post-intensive care syndrome-family (PICS-F). Improvements in survival after a critical illness have led to research focused on long-term outcomes for these patients. This improved survival has also led to the discovery of significant functional disabilities that many survivors of critical illness experience. Because the majority of literature in critical care medicine is focused on short-term outcomes (e.g. survival), the current understanding of PICS is relatively limited. Recent research suggests that there is significant overlap among the three broad categories of symptoms. Also, sedation and prolonged immobilization seem to be common themes among patients who have PICS. The term PICS arose around 2010, at least in part, to raise awareness of the important long-term dysfunctions resulting from treatment in the intensive care unit (ICU). Awareness of these long-term functional disabilities is growing, and research is ongoing to further clarify the spectrum of disabilities and to find more effective ways to prevent these long-term complications and to more effectively treat functional recovery. Increased awareness in the medical community has also highlighted the need for more hospital and community-based resources to more effectively identify and treat patients with PICS after surviving a critical illness. Grouping these impairments together within a syndrome was done to increase awareness of post-critical illness issues. However, an updated definition was required to accommodate new knowledge on PICS. A current and holistic definition of PICS is the new or worsening impairment to the physical, mental, cognitive, employment, and/or social domains of health following critical illness. These five impairments are the defining characteristics of PICS.
Origins Before the term PICS was created, there was recognition of the ramifications of critical illness. In 1892, Osler was the first to note the "rapid loss of flesh", or muscle wasting, in patients with prolonged sepsis (Osler, 1892, as cited in Jolley et al., 2016, p. 1129). In 1998, researchers found that critically ill patients experienced poorer mental health and more post-traumatic stress disorder (PTSD) symptoms, than non-critically ill patients. In 1999, it was discovered many survivors of critical illness had cognitive impairments. As research on the impairment to physical, mental, and cognitive health resulting from critical illness accumulated, the significance and relationship of these long-term issues was recognized. This resulted in the 2010 multidisciplinary conference where the term PICS was created. The impairments to physical, mental, and cognitive health grouped within PICS increased awareness, research, and education on consequences observed in survivors of critical illness. As intended, PICS research continued and additional impairments became evident. In the 2010s, researchers noted social dysfunction in survivors of critical illness. Impaired employment following critical illness has appeared in the literature since 1995. However, the recognition that unemployment due to critical illness can negatively affect well-being and quality of life, is a recent finding. Despite the evidence of impairment to employment and social health following critical illness, there has been a reluctance to include these impairments within the PICS definition. This demonstrates the original PICS definition is outdated and overly focused on the biomedical model of health. In order to care for PICS, clinicians and researchers need to recognize all impairments experienced by survivors of critical illness. Using a holistic perspective, these social and employment impairments can be recognized within PICS and attended to appropriately.
Conditions The most recognized form of the syndrome is the physical dysfunction commonly known as ICU-acquired weakness. The other physical, cognitive, and mental health impairments are less well recognized and need further research to be better understood.
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