Post‐intensive care syndrome: Recent advances and future directions

Acute Medicine & Surgery, Год журнала: 2024, Номер 11(1)

Опубликована: Янв. 1, 2024

Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated an intensive unit (ICU). It occurs either during the ICU stay or following discharge is related to patients' long-term prognosis. The same concept also applies pediatric patients, it can greatly affect status of family members. In 10 years since post-intensive was first proposed, research has expanded. Here, we summarize recent evidence on regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, treatments. We highlight new topics, future directions, strategies overcome among people ICU. Clinical basic are still needed elucidate mechanistic insights discover therapeutic targets interventions for syndrome.

Язык: Английский

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Two-year trajectory of functional recovery and quality of life in post-intensive care syndrome: a multicenter prospective observational study on mechanically ventilated patients with coronavirus disease-19

Journal of Intensive Care, Год журнала: 2025, Номер 13(1)

Опубликована: Фев. 6, 2025

Post-intensive care syndrome (PICS) affects the quality of life (QOL) survivors critical illness. Although PICS persists for a long time, longitudinal changes in each component and their interrelationships over time both remain unclear. This multicenter prospective study investigated 2-year trajectory its components as well factors contributing to deterioration or recovery mechanically ventilated patients with coronavirus disease 2019 (COVID-19), also attempted identify possible countermeasures. Patients who survived COVID-19 requiring mechanical ventilation completed questionnaires on Barthel index, Short-Memory Questionnaire, Hospital Anxiety Depression Scale, EuroQol 5 dimensions 5-level every six months two-year period. Scores were weighted account dropouts, functional impairment was evaluated alluvial diagrams. The prevalence impairing restoring function examined using generalized estimating equations considering trajectories. Among 334 patients, rates four 72.1, 78.5, 77.6, 82.0%, cognitive being most common lower QOL noted when multiple impairments coexisted. Physical indicated that many exhibited consistent trends either deterioration. In contrast, mental health revealed considerable variability, showing fluctuating ratings later surveys. Delirium associated worse physical poor QOL, while prolonged QOL. Living family all functions extracorporeal membrane oxygenation (ECMO) health. Critically ill had period followed different trajectories component. Based trajectories, known risk such delirium impaired recovery, ECMO presence from PICS. critically management interventions may play an important role promoting UMIN000041276, August 01, 2020.

Язык: Английский

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Phenotypes of Functional Decline or Recovery in Sepsis ICU Survivors: Insights From a 1-Year Follow-Up Multicenter Cohort Analysis

Critical Care Medicine, Год журнала: 2025, Номер unknown

Опубликована: Фев. 24, 2025

Objective: Sepsis often leads to heterogeneous symptoms of post-intensive care syndrome (PICS) composing physical, cognitive, and psychiatric disabilities, resulting in deteriorated quality life (QoL), with limited interventions. This study aimed identify phenotypes sepsis-associated PICS by function QoL at hospital discharge. Design: A prospective observational study. Setting: Twenty-one mixed ICUs. Patients: All consecutive adult patients between November 2020 April 2022, diagnosed sepsis ICU admissions survived discharge, were enrolled. Interventions: None. Measurements Main Results: Phenotyping clusters determined three approaches was performed following variables discharge: Barthel Index (≤ 90 defined physical PICS), Short Memory Questionnaire (< 40 cognitive Hospital Anxiety Depression Scale (≥ 8 Impact Event Scale-Revised 25 EuroQoL 5-dimension 5-level, Clinical Frailty hand-grip strength, Medical Research Council. Each disability, employment, destination, survival, followed over the first year In total, 220 included (median age: 72.5 yr, 129 males (59%), 166 septic shocks (75%), median Sequential Organ Failure Assessment Score: 8). Four identified: group 1 ( n = 62) no PICS, 2 55) mild (physical cognitive), 3 53) moderate (all domains), 4 50) severe domains). Functional decline recovery significantly varied among phenotypes. Physical improved 3-month follow-up, whereas disabilities groups remained year. Psychiatric ameliorated, depression still evident 12-month follow-up. showed persistent reduced low employment (0–50%). The survival continuously decreased. Conclusions: clinical survivors might contribute a deeper understanding post-sepsis trajectories an individualized treatment approach.

Язык: Английский

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Effects of Long COVID in Patients with Severe Coronavirus Disease 2019 on Long-Term Functional Impairments: A Post Hoc Analysis Focusing on Patients Admitted to the ICU in the COVID-19 Recovery Study II

Healthcare, Год журнала: 2025, Номер 13(4), С. 394 - 394

Опубликована: Фев. 12, 2025

Background/Objectives: This study investigated the prevalence of functional impairments and effects long COVID on long-term in patients with severe COVID-19. Methods: We conducted a nationwide multicenter cohort collaboration nine hospitals, collecting data using self-administered questionnaires from participants aged 20 years or older who were diagnosed COVID-19, admitted to intensive care unit (ICU) between April 2021 September 2021, discharged alive. Questionnaires regarding daily life, sequela, mailed August 2022. The examined multivariate logistic regression analysis. Results: survey was completed by 220 patients, mean 416 days after discharge. Among respondents, 20.5% had physical (n = 45), 35.0% mental disorders 77), 42.7% either 94). Furthermore, 77.7% (171/220), most common symptom dyspnea (40.0%). analysis showed that fatigue/malaise, upper respiratory tract symptoms, myalgia, muscle weakness, decreased concentration, sleep disorder, brain fog, dizziness risk factors for at one year. Conclusions: Many COVID-19 ICU still suffered post-intensive syndrome even year, which manifested combination direct symptoms original disease, such as COVID.

Язык: Английский

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One-year outcomes in sepsis: a prospective multicenter cohort study in Japan

Journal of Intensive Care, Год журнала: 2025, Номер 13(1)

Опубликована: Май 1, 2025

Sepsis is a leading cause of death in intensive care units (ICU). survivors are often left with significant morbidity, termed post-intensive syndrome (PICS), impacting post-sepsis life. The aim was to present detailed data on the prognostic and functional long-term outcomes ICU patients sepsis Japan, which currently lacking therefore prevents development targeted solutions. A multicenter prospective study, involving 21 ICUs 20 tertiary hospitals included all consecutive adult between November 2020 April 2022, diagnosed at admission (Sepsis 3). Follow-ups were performed 3, 6, 12 months after hospital discharge by telephone mail. Primary outcome or incidence PICS, defined any physical dysfunction (Barthel Index ≤ 90), cognitive (Short Memory Questionnaire < 40), mental disorder (any subscales for anxiety depression Hospital Anxiety Depression Scale ≥ 8, Impact Event Scale-Revised 25). Secondary Quality Life (QOL), employment, use hospital, emergency, rehabilitation, psychiatric services. multivariable analysis investigated independent factors associated each follow-up. total 339 (median age 74 [67-82] years, 60% male, 77% septic shock, median SOFA 9 [6-12]). Mortality 23% discharge, increasing 37% months. rate those who met PICS Criteria 89%, 73%, 64%, 65% months, respectively. Limited improvements QOL return work (44%), high rates readmissions (40%), frequent emergency service usage (31%), low utilization rehabilitation services (15% 7%) identified over first year. PICS-related consistently an factor same following follow-ups. This study distinct realities life Japanese patients, highlighting unique challenges improving their functions returning daily Trial Registration University Medical Information Network UMIN000041433.

Язык: Английский

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Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis

PLoS ONE, Год журнала: 2025, Номер 20(5), С. e0323311 - e0323311

Опубликована: Май 8, 2025

Background Post-intensive Care Syndrome (PICS) is defined as various physical, psychological, and cognitive, impairments that can arise during an ICU stay, continue after leaving the ICU, or even persist following hospital discharge. It impacts both patients their family’s quality of life. Various primary studies worldwide have reported prevalence PICS among survivors. However, these exhibit inconsistency wide variations. Therefore, this systematic review meta-analysis aimed to estimate pooled post intensive care syndrome unit survivors along with its association length stay. Methods We used Preferred Reporting Items for Systematic Reviews Meta-Analyses (PRISMA) 2020 checklist review. searched PubMed/Medline, CINHAL, Embase, Google scholar retrieve articles. The Newcastle Ottawa Scale (NOS) was assessment random effects model I-squared test To identify source heterogeneity within included studies, meta-regression subgroup analysis were used. employed Egger’s regression funnel plots assessing publication bias. STATA version 17.0 software all statistical analyses. A p-value < 0.05 95% confidence interval declare statistically significant. Results total 19 articles a population 10179 ICU-survivors in found be 54.35% (95% CI = 45.54, 63.15). In sub-group by region, highest observed done south north America overall 61.95% 28.33, 95.62). Among three domains (physical, cognitive mental domains), score physical domain 45.99% 34.66, 57.31). meta-analysis, those who stayed more than four days 1.207 [95% 1.119, 1.295] times likely develop at least one post-intensive period counterparts. Conclusion This demonstrate high survivors, highlight significant between stay development PICS. These findings underscore need targeted interventions mitigate long-term critical illness, particularly prolonged stays.

Язык: Английский

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Nutritional therapy for the prevention of post-intensive care syndrome

Journal of Intensive Care, Год журнала: 2024, Номер 12(1)

Опубликована: Июль 29, 2024

Abstract Post-intensive care syndrome (PICS) is a triad of physical, cognitive, and mental impairments that occur during or following the intensive unit (ICU) stay, affecting long-term prognosis patient also health patient’s family. While severity duration systemic inflammation are associated with occurrence ICU-acquired weakness (ICU-AW), malnutrition immobility treatment can exacerbate symptoms. The goal nutrition therapy in critically ill patients to provide an adequate amount energy protein while addressing specific nutrient deficiencies survive inflammatory response promote recovery from organ dysfunctions. Feeding strategy prevent ICU-AW PICS as involves administering sufficient amounts amino acids proteins later acute phase after hyperacute has passed, attention avoid overfeeding. Physiotherapy help mitigate muscle loss subsequent physical impairment. However, many questions remain be answered regarding potential role methods association PICS, further research warranted.

Язык: Английский

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Das Post-Intensive-Care-Syndrom (PICS)

Zeitschrift für Allgemeinmedizin, Год журнала: 2025, Номер unknown

Опубликована: Март 12, 2025

Язык: Английский

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Gut-Brain Axis-Based Polygala Tenuifolia and Magnolia Officinalis Improve D-gal-Induced Cognitive Impairment in Mice Through cAMP and NF-κB Signaling Pathways

Drug Design Development and Therapy, Год журнала: 2025, Номер Volume 19, С. 1869 - 1894

Опубликована: Март 1, 2025

Polygala tenuifolia Willd. (PT) is commonly used to address cognitive impairment (CI), while Magnolia officinalis Rehd. et Wils (MO) often prescribed for gastrointestinal issues as well CI. This study seeks explore the impacts and mechanisms behind combined therapy of PT MO (PM) in treating CI, based on concept gut-brain axis. The characteristic components PT, MO, PM were identified using ultra-high performance liquid chromatography-tandem triple quadrupole mass Spectrometry (UPLC-MS/MS). A mouse model was established by D-gal induction, effects CI evaluated through behavioral tests, pathological staining, Enzyme-Linked Immunosorbent Assay (ELISA). Subsequently, network pharmacology analyze potential which improves followed validation Western blotting (WB), traditional Chinese medicine (TEM), Immunofluorescence (IF), 16S rRNA. can each alleviate decline neuropathological damage mice varying degrees, reduce expression pro-inflammatory factors (TNF-α, IL-1β, IL-6, IFN-γ, LPS) serum or hippocampal tissue, increase SOD GSH levels. Network analysis molecular experiments confirmed that upregulates tight junction s (TJs), enhances proteins cAMP pathway, inhibits p-NF-κB-p65 expression. reverses D-gal-induced gut microbiota dysbiosis, increases abundance SCFA-producing bacteria, decreases LPS-producing bacteria. alleviates reducing inflammation oxidative stress, protecting blood-brain barrier (BBB) intestinal barrier, inhibiting NF-κB activating regulating microbiota.

Язык: Английский

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Comportamiento ante el dolor de los pacientes críticos con ventilación mecánica durante las intervenciones enfermeras en los hospitales gubernamentales de Sana’a, en Yemen

Enfermería Clínica, Год журнала: 2025, Номер unknown, С. 502216 - 502216

Опубликована: Апрель 1, 2025

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