PICS: Post-intensive care syndrome
For many people who have been admitted to a hospital intensive care unit, recovery does not end once they are released to go home. For most, life after an ICU stay is filled with unexpected challenges.
Doctors are now learning more about patients with PICS, or post-intensive care syndrome, and the best ways to help them recover.
Connie Bovier enters the hospital with open arms to hug the medical staff that saved her. Last May, she walked into the emergency room and collapsed. The first thing she remembered?
"My oldest son looking at me and saying, 'Mom do you know where you are?'" she recalled.
Connie spent 22 days in the intensive care unit with pneumonia, sepsis and blood clots in her lungs.
"Her respiratory failure was so severe that she needed to be paralyzed and flipped onto her belly in the hospital bed in order to increase the oxygen so we could deliver it to her bloodstream," Dr. Brad W. Butcher said.
Connie survived the deadly infection. She's used to beating the odds, breaking barriers in the 1970s as one of the first female telephone splicers. This single mother of five hates feeling afraid and weak.
"I can't even put a water pitcher in my fridge," she said.
Butcher says U.S. experts are just beginning to recognize the combination of physical, cognitive and mental health issues like depression and anxiety that plague patients once they are discharged from the ICU.
"Cognitively, they may have a difficult time remembering things, difficulty concentrating or paying attention to something," Butcher said.
Last year, Butcher developed a critical illness recovery center. ICU patients are evaluated shortly after discharge and then referred to specialized physical therapy, occupational therapy or speech therapy. It's critical support for patients on the very long road to recovery.
"This is the journey to my best life," Connie said.
She's here to enjoy her family's big days.
Butcher said the clinic in Pittsburgh is one of a handful in the U.S. They address the group of symptoms that plague patients with post-ICU syndrome, issues that most family care practitioners don't have the time to cover in a 30-minute visit.
He says hospitals in Europe began addressing it several years ago by developing clinics to evaluate these patients.
TOPIC: PICS: POST INTENSIVE CARE SYNDROME
REPORT: MB #4563
BACKGROUND: Post-intensive care syndrome, or PICS, is made up of health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient's body, thoughts, feelings, or mind and may affect the family. PICS may show up as an easily noticed drawn-out muscle weakness, known as ICU-acquired weakness; as problems with thinking and judgment, called cognitive (brain) dysfunction; and as other mental health problems. Up to 50 percent of patients may return to work within the first year, but some may not be able to return to the jobs they had before their illness. Patients may need help with activities after leaving the hospital. (Source: https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome)
AILMENTS: Brad W. Butcher, MD, Director and founder, Critical Illness Recovery Center, Medical Surgical Intensive Care Unit at UPMC Mercy Hospital said patients may feel a variety of affects. He says, "Physically, patients may notice that they have deficits in strength endurance and balance. And this may be manifested by the inability to button a shirt for example with a loss of fine motor coordination or an inability to prepare a meal because they don't have the endurance to do so cognitively. They may find that they have difficulty remembering things that they could easily remember in the past or they may have difficulty concentrating or paying attention to something and psychologically they may feel anxiety, depression or even symptoms of post-traumatic stress disorder."
(Source: Brad W. Butcher, MD)
CRITICAL ILLNESS RECOVERY CENTER: Dr. Butcher said the Critical Illness Recovery Center began in June 2018. "The clinic is multidisciplinary, including pharmacists, respiratory therapists, physical therapists, occupational therapists, speech and language pathologists, social workers, and ICU physicians. Patients with prolonged stays in the ICU are evaluated shortly after hospital discharge using a holistic approach that evaluates that person as a whole rather than as one organ system or body part. Based on that evaluation, a comprehensive rehabilitation plan is developed to help the patient achieve the goals that they set for themselves. This often means referral to specialized physical therapy, occupational therapy, or cognitive therapy, but also includes other medical specialists like pulmonologists and psychiatrists, referral to our peer support group, and addressing how they want their future medical care to look like."
(Source: Brad W. Butcher, MD)