Postintensive Care Syndrome: Right Care, Right Now…and Later

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Since critical care began over 50 years ago, there have been tremendous advances in the science and practice that allow more severely ill and injured patients to survive. Each year, millions of people are discharged back to the community. The recognition of long-term consequences for ICU survivors and their families is a growing concern. Critical care practitioners have always known that the patients have a long road to recovery after discharge from the ICU. In the 2 past decades, research has revealed how remarkably common and devastating long-term consequences of critical illness can be and how much some patients and their families suffer (1–9). These consequences in patients are referred to as postintensive care syndrome (PICS) and in families as postintensive care syndrome-family (PICS-F) (1).The research findings are disturbing and a source of distress to critical care practitioners. In response, they are working hard to identify the risk factors for PICS and are rapidly implementing ways to mitigate their impact. Although the critical care community is becoming increasingly aware of PICS, patients, families, and the posthospital care community need more information. They are the ones who are deal most directly PICS and PICS-F.There are three key emerging concepts driving these initiatives: a focus on safe transitions and handoffs, an emphasis on family-centered care, and the acceptance that critical care is defined by the whole episode of care, not just the ICU stay. It is clear that those in the field of critical care have a responsibility to increase the awareness and to work with those who care for patients post-ICU to identify and treat the consequences of critical illness in patients and families.INCREASING AWARENESS OF PICSOne of the ways the Society of Critical Care Medicine (SCCM) chose to address PICS was to hold stakeholder conferences in 2010 (1) and 2012 (2). Stakeholders included SCCM and international experts, representatives from national noncritical care organizations such as the Joint Commission, National Institutes of Health, primary care, rehabilitation, physical therapy, occupational therapy, speech-language-hearing, long-term care, palliative care, case workers, and large healthcare systems, and patients, families, and patient advocacy groups. Representatives that attended these conferences have begun to increase the awareness of PICS in their peers via publications, presentations, and initiatives.It is also important to increase the awareness of the possible long-term consequences of intensive care among ICU survivors and their families. Awareness can decrease their fear of the unknown, decrease feelings of being unique or of something else being terribly wrong with them, and alert them to the possible need for out-patient follow-up assessments and referrals. They need to know they are not alone or abandoned. Steps taken by SCCM toward improving awareness in patients and families include establishing a section in Wikipedia on PICS, creating several videos with patients and families describing their experiences for YouTube, and offering a pamphlet on PICS on SCCM’s website (10). Johns Hopkins University Medical Center has created the Outcomes After Critical Illness and Surgery open-access webpage, which has very useful information on PICS as well (11).SCCM has further demonstrated a commitment to addressing PICS by establishing a fund that will award grants of up to $50,000 to members conducting research aimed at improving patient and family support and recovery after critical illness. This initiative is called “Thrive” (12).PREVALENCE OF PICS AND PICS-FPICS is defined as new or worsening impairment in physical, cognitive, or mental health status arising and persisting after hospitalization for critical illness (Fig. 1) (1).

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