When you think about a person going into an intensive care unit (ICU), you probably picture someone who’s very ill and likely fighting for their life. They may be on a ventilator or other equipment that’s keeping them alive. When you’re in that situation, surviving would be a win. But what happens after these people survive? Do they recover and go back to life as it was? What’s the road to recovery look like?
What Is Post-Intensive Care Syndrome?
Fortunately, medical advances have led to higher survival rates for people who end up in intensive care units – it’s now between 71% and 90%. But, survival is not the end goal, and getting out of the ICU is not the end of the battle. Many patients show significant losses of physical, mental, and cognitive abilities after discharge. It makes sense – if you don’t use it, you lose it! This cluster of problems is called Post-Intensive Care Syndrome or PICS.
PICS is now recognized as a public health burden. Interventions against PICS need to start in the ICU and continue after discharge.
The Long Term Impact of Physical Decline that Starts in the ICU
Physical declines often include significant losses of strength, endurance, and mobility. These physical declines can lead to serious difficulty completing basic daily tasks like getting to the bathroom, preparing a meal, or walking to the mailbox. This may keep some people from returning home. Others will need a caregiver to safely return to their previous setting.
Fifty percent of ICU survivors have limitations in daily activities one year later – PICS is a serious and long-lasting problem.
Mental Health Concerns for PICU Survisors
Mental health is also a genuine concern for ICU survivors. They show significant rates of depression, anxiety, and PTSD.
- 28% – the mean rate of depression among PICU survivors
- 24% of PICU survivors have anxiety
- 21% report PTSD
These conditions have a tangible impact on the quality of life after leaving the ICU.
Cognitive Decline in PICU Survivors
Declines in cognitive abilities are widespread in ICU survivors. 77% have cognitive impairments at 3 months post-discharge and 71% have impairments 1 year out. Cognitive issues after discharge can include poor memory, slower thinking, problems making decisions, and difficulty concentrating.
Physical therapists play a significant role in the fight against PICS. Physical therapy typically begins while the patient is in ICU. The focus is on getting the patient up and walking early. Patients begin a progressive exercise program as soon as it’s safe for them.
We expect a rise in PICS due to the number of people who COVID-19 put into critical care and/or on a ventilator.
While we can’t prevent every problem that critical illness causes, recognizing the losses that remain after discharge from the ICU is an important step. Physical therapists play an important role in combating the effects of PICS and helping people return to higher-quality lives.