PICS

No, this is not a bunch of pictures. Between my surgical cap, dirty scrubs, and homemade mask with a HEPA filter, you don’t want to spend too much time looking at me!

PICS is the acronym for Post Intensive Care Syndrome. This is the clinical syndrome that patients experience when they have spent a long time immobilized for whatever reason in the ICU. We didn’t hear about this for a long time, but that didn’t mean it wasn’t happening. It just wasn’t recognized that it was a true clinical syndrome.

The symptoms of PICS are three-fold:

  • Physical
  • Cognitive
  • Emotional

According to the Cleveland Clinic (where a LOT of research is performed on PICS!) Post Intensive Care Syndrome can consist of:

Cognitive symptoms:

  • Memory Impairments
  • Speech Impairments
  • Poor concentration
  • Executive Function Impairments (problem-solving and organization)

Emotional symptoms:

  • PTSD
  • Anxiety
  • Depression
  • Decreased Motivation

Physical symptoms:

  • Muscle weakness, specifically core and small muscle weakness for COVID-19 patients.
  • Fatigue
  • Immobility
  • Difficulty breathing
  • Insomnia
  • SPECIFIC TO COVID-19 PATIENTS: Significant measurable muscle loss
    • prolonged lack of O2 to the muscle tissue?

I don’t know about you, but I can see several places here where PTs and other rehab clinicians can intervene. So if it’s so clear where we should intervene, why does PICS happen? Check out this video to see what does in to mobilizing a patient in the ICU.

It really takes a team. You can see that there are at least five clinicians here plus the additional onlookers who are physicians. PT and OT are working on mobilization, RT has the vent, Nursing monitoring the EKG and managing lines, CNA assisting… But that’s not all. Did you notice the patient is awake? With all that going on, he is awake. He is an active participant in the mobilization.

So think about our COVID-19 patients. They are hooked up very similar to this with IVs everywhere, ventilator running, and nutrition support in place… They are likely chemically sedated because they are proned. So now we have to consider calling anesthesia in to wake them for this type of activity and add to the number of people on our team. Many hospitals don’t have this type of team with this type of experience, so you can see why PICS happens.

But when PTs and other rehab professionals are able to get involved as they do in the video, miracles happen. The video below is from 10 YEARS AGO. That means we had this ability and technology and skills 10 YEARS AGO! Think of where we are now! It’s time to get these people up, get them moving, and avoid PICS.

When our patients with COVID-19 come home from their ICUs and step-down units, we need to anticipate PICS and intervene where we can. This includes providing interventions for the emotional and cognitive effects as well as the physical presentation. That may mean calling in a consult for your OT, speech, and social worker colleagues. This patient has needed a team up to this point, and they still do. Call on your social workers, nurses, speech paths, dieticians, and any other services you have available in your company that might help combat the effects of PICS.


Do you have a story about treating a patient with PICS? Please share it with us in the comments!

More Than Just A Respiratory Disease: The Tools You Need to Rehab COVID-19

Isn’t COVID-19 just a respiratory disease? If only that was true. We are good at treating respiratory infections. We have lots of drugs for viral, bacterial, parasitic, and fungal infections of the lungs. Most of them work really well! We also have several back-up treatments, inhaled medications, and adjuvant therapies (like rehab!) that make primaryContinue reading “More Than Just A Respiratory Disease: The Tools You Need to Rehab COVID-19”

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References

https://my.clevelandclinic.org/health/diseases/21161-post-intensive-care-syndrome-pics

Bauer, N., & Bartlo, P. (2020) Pulmonary Rehabilitation Post-Acute Care for COVID-19. PACER Project. Retrieved from https://www.youtube.com/watch?v=XjY_7O3Qpd8.

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