Post–intensive care syndrome: A crash course for general practice

The inflammation, cerebral atrophy and reduced white matter integrity associated with delirium are hypothesised to underpin this process.3 Physical features ICU-acquired weakness is a serious complication affecting up 50% of patients admitted the ICU for at least one week.4 It characterised by diffuse symmetrical limb and/or diaphragmatic increased mortality long-term functional impairment.5 Major risk factors prolonged mechanical ventilation, sepsis, organ failure immobility.5 Undernutrition another contributing factor, typically receiving only 60-80% their enteral energy requirements.6 Rapid loss weight muscle bulk decreased mobility, patient fatigue hospital length stay.7 Malnourishment also impairs immune function, increasing nosocomial infection mortality.7 Furthermore, critical illness can lead vitamin D deficiency bone hyperresorption, survivors exhibiting mineral density significantly elevated Fracture Risk Assessment Tool (FRAX) scores one-year follow-up.8 Long-term pulmonary dysfunction key issue. Lung measured spirometry, improves six months but remain compromised as long five years.1 trauma result in debilitating chronic pain, prevalence estimated 77%.9 Studies examining health-related quality life have consistently shown pain-related interference activities daily living three 12 months.9 Patients physical sequelae experience impairment, consequent agency exacerbate psychological distress. abnormal cognitive processing feeling ongoing threat vulnerability.12 Predisposing younger age, female gender, pre-existing psychiatric conditions socioeconomic variables such unemployment lower education level.1 Quality amalgam physical, symptoms PICS profoundly limit survivors' independence societal integration. COVID-19 PICS-F Cognition1819 * Potential virus-induced damage central nervous system Secondary effects systemic common severe Environmental exacerbating Depersonalised interactions staff frightening personal protective equipment Limited human touch Isolation from support networks, absence reorientation reassurance loved ones, lack shared Iatrogenic Prolonged deep sedation, immobilisation management often involves protracted neuromuscular blockade, proning bed rest, for:1 - post-extubation dysphagia malnutrition Chronic pain more likely acute COVID-19:9 painful disease myalgia, arthralgia, headache, abdominal chest iatrogenic invasive procedures neuropraxia Overstretched inpatient rehabilitation teams potentially delaying crucial early treatment Psychological Patient-caregiver disconnect infrequent communication or perceived empathy overburdened Fear infecting others, fear social stigma, uncertainty regarding impact global pandemic20 Survivor's guilt20 Disruptions religious pastoral care services PICS-F19 separation due visiting restrictions Inability attend understand patient's environment systems distancing Discussing difficult distressing subject health professionals via telephone teleconferencing 'say goodbye' if bereaved, complicating grief ICU, intensive unit;PICS, post-intensive syndrome;PICS-F, syndrome-family correspondence [email protected] References 1.