Aging and Post-Intensive Care Syndrome: A Critical Need for Geriatric Psychiatry

Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention

Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.

Beyond survival: understanding post-intensive care syndrome

Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.

From the Intensive Care Unit to Recovery: Managing Post-intensive Care Syndrome in Critically Ill Patients

Post-intensive care syndrome (PICS) is the term used to describe the decline in the physical, cognitive, and/or mental condition of individuals who have been discharged from the intensive care unit (ICU). This complication could result in a significant reduction in quality of life, with some patients experiencing symptoms of prolonged weakness, depression, anxiety, and post-traumatic stress disorder (PTSD). Intensive care advancement over the years has resulted in an increase in ICU survival rates and a proportional increase in PICS, creating a need for more in-depth research into the prevention and management of the disease. Hence, this study aims to examine the present body of literature on PICS, encompassing its underlying physiological processes and elements that contribute to its development, methods for evaluating and diagnosing the condition, current treatment choices as well as potential new approaches, and the constraints in managing PICS and the necessity for further investigation. In this article, studies were compiled from several databases, including, but not limited to, Google Scholar, PubMed, and Cochrane Library. These studies were reviewed, and their data were used to highlight important aspects regarding the efficacy of current PICS screening tools, the optimization and limitations of both pharmacologic and non-pharmacologic treatment methods, and the feasibility and safety of emerging treatments and technologies. The major conclusions of this review were centered around the need for multidisciplinary management of PICS. From pharmacological management using analgesia to non-pharmacological management using early mobilization and exercise therapy, the effective treatment of PICS requires a multifaceted approach. Patient follow-up and its importance were touched upon, including strategies and policies to bolster proper follow-up, thereby increasing favorable outcomes. Lastly, the importance of family involvement and the increased need for research into this topic were highlighted.

The critically ill older patient with sepsis: a narrative review

Sepsis is a significant public health concern, particularly affecting individuals above 70 years in developed countries. This is a crucial fact due to the increasing aging population, their heightened vulnerability to sepsis, and the associated high mortality rates. However, the morbidity and long-term outcomes are even more notable. While many patients respond well to timely and appropriate interventions, it is imperative to enhance efforts in identifying, documenting, preventing, and treating sepsis. Managing sepsis in older patients poses greater challenges and necessitates a comprehensive understanding of predisposing factors and a heightened suspicion for diagnosing infections and assessing the risk of sudden deterioration into sepsis. Despite age often being considered an independent risk factor for mortality and morbidity, recent research emphasizes the pivotal roles of frailty, disease severity, and comorbid conditions in influencing health outcomes. In addition, it is important to inquire about the patient's preferences and establish a personalized treatment plan that considers their potential for recovery with quality of life and functional outcomes. This review provides a summary of the most crucial aspects to consider when dealing with an old critically ill patient with sepsis.

A scoping review of older patients' health-related quality of life, recovery and well-being after intensive care

AIMS

In the present study, we aimed to determine how Health-Related Quality of Life (HRQoL), recovery (function and capacity in daily life) and well-being are followed up and characterised in persons ≥65 years of age who were being cared for in an intensive care unit (ICU).

DESIGN

A scoping review.

METHODS

CINAHL, MEDLINE (Ovid) and PsycINFO databases were searched in October 2021. 20 studies met the inclusion criteria. The scoping review followed the principles outlined by Arksey and O'Malley, and the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) checklist and Joanna Briggs Institute (JBI) framework were used.

RESULTS

Results are presented under five subheadings: Study characteristics, Type of studies, Methods for follow-up, health-related quality of life, and Recovery. Time seems to be an important factor regarding HRQoL among older patients being cared for in an ICU, with most elderly survivors perceiving their HRQoL as acceptable after 1 year. Nevertheless, several studies showed patients' willingness to be readmitted to the ICU if necessary, indicating that life is worth fighting for.

PATIENT OR PUBLIC CONTRIBUTION

Due to the design of the study, this study involves no patient or public contribution.

Delirium, depression, and long-term cognition

OBJECTIVES

We examined whether preadmission history of depression is associated with less delirium/coma-free (DCF) days, worse 1-year depression severity and cognitive impairment.

DESIGN AND MEASUREMENTS

A health proxy reported history of depression. Separate models examined the effect of preadmission history of depression on: (a) intensive care unit (ICU) course, measured as DCF days; (b) depression symptom severity at 3 and 12 months, measured by the Beck Depression Inventory-II (BDI-II); and (c) cognitive performance at 3 and 12 months, measured by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) global score.

SETTING AND PARTICIPANTS

Patients admitted to the medical/surgical ICU services were eligible.

RESULTS

Of 821 subjects eligible at enrollment, 261 (33%) had preadmission history of depression. After adjusting for covariates, preadmission history of depression was not associated with less DCF days (OR 0.78, 95% CI, 0.59-1.03 p = 0.077). A prior history of depression was associated with higher BDI-II scores at 3 and 12 months (3 months OR 2.15, 95% CI, 1.42-3.24 p = <0.001; 12 months OR 1.89, 95% CI, 1.24-2.87 p = 0.003). We did not observe an association between preadmission history of depression and cognitive performance at either 3 or 12 months (3 months beta coefficient -0.04, 95% CI, -2.70-2.62 p = 0.97; 12 months 1.5, 95% CI, -1.26-4.26 p = 0.28).

CONCLUSION

Patients with a depression history prior to ICU stay exhibit a greater severity of depressive symptoms in the year after hospitalization.

A protocol for a pilot randomised controlled trial of an Early Psychiatric Assessment, Referral, and Intervention Study (EPARIS) for intensive care patients

BACKGROUND

Up to 80% of Intensive Care Unit patients experience physical, cognitive, and/or psychological complications post-discharge, known as 'Post Intensive Care Syndrome' (PICS). Early diagnosis and intervention are a priority, but while current post-intensive care follow-up processes endorse a multidisciplinary model, incorporating a psychiatric consultation has not been studied.

METHODS

A pilot, open-label randomised controlled trial was developed by a multidisciplinary team to evaluate the feasibility and acceptability of incorporating a psychiatric review into an existing post-ICU clinic. The study will run for 12 months and aim to recruit 30 participants. Inclusion criteria for participants: a) ICU admission greater than 48 hours, b) no cognitive impairment that prevents participation, c) ≥ 18 years old, d) residing in Australia, e) fluent in English, f) able to provide GP information, and g) likely to be contactable in 6 months. Patient recruitment will be at Redcliffe Hospital, Queensland, Australia, and will involve patients attending the Redcliffe post intensive care clinic. Participants will be allocated to intervention or control using block randomisation and allocation concealment. Participants allocated to the control arm will receive the standard cares provided by the clinic, which involves an unstructured interview about their ICU experience and a battery of surveys about their psychological, cognitive, and physical function. Those allocated to the intervention arm will receive these same cares as well as an appointment with a psychiatrist for a single session intervention. The psychiatric intervention will involve a comprehensive review, including comorbid disorders, substance use, suicidal ideation, psychosocial stressors, social/emotional supports. Psychoeducation and initial treatment will be provided as indicated and recommendations given to the patient and their GP about how to access ongoing care. In addition to surveys conducted as part of standard clinic cares, all participants will complete additional questionnaires about their history, hospital experience, mental and physical health as well as employment circumstances. All participants will be followed up 6 months after their appointment and will be invited to complete follow-up questionnaires about their mental and physical health, as well as health service use and employment circumstances. The trial has been registered with ANZCTR (ACTRN12622000894796).

RESULTS

To evaluate the feasibility and acceptability of the intervention to the patient population. Differences between groups will be assessed using an independent samples t-test. Resource requirements to administer the intervention will be evaluated by reporting the mean duration of the EPARIS assessment and approximate cost per patient to provide this service. To estimate the effect size of any treatment effects, changes in secondary outcome measures between baseline and 6 months will be compared between intervention and control groups using Analysis of Covariance regression. As this is a pilot, we will not use p-values or test a null hypothesis, but will give confidence intervals.

CONCLUSIONS

This protocol provides a pragmatic evaluation of the acceptability of introducing early psychiatric assessment into an existing post-ICU follow-up process, and if considered acceptable will inform future research into the efficacy and generalisability of the intervention. The strengths of EPARIS are the prospective, longitudinal design with a control population, and its use of validated post-ICU outcome measures.

The impact of unexpected intensive care unit admission after cancer surgery on long-term symptom burden among older adults: a population-based longitudinal analysis

BACKGROUND

Older adults are at high-risk for a post-operative intensive care unit (ICU) admission, yet little is known about the impact of these admissions on quality of life. The objective of this study was to evaluate the impact of an unexpected post-operative ICU admission on the burden of cancer symptoms among older adults who underwent high-intensity cancer surgery and survived to hospital discharge.

METHODS

We performed a population-based cohort study of older adults (age ≥ 70) who underwent high-intensity cancer surgery and survived to hospital discharge in Ontario, Canada (2007-2017). Using the Edmonton Symptom Assessment System (ESAS), a standardized tool that quantifies patient-reported physical, mental, and emotional symptoms, we described the burden of cancer symptoms during the year after surgery. Total symptom scores ≥ 40 indicated a moderate-to-severe symptom burden. Modified log-Poisson analysis was used to estimate the impact of an unexpected post-operative ICU admission (admission not related to routine monitoring) on the likelihood of experiencing a moderate-to-severe symptom burden during the year after surgery, accounting for potential confounders. We then used multivariable generalized linear mixed models to model symptom trajectories among patients with two or more ESAS assessments. A 10-point difference in total symptom scores was considered clinically significant.

RESULTS

Among 16,560 patients (mean age 76.5 years; 43.4% female), 1,503 (9.1%) had an unexpected ICU admission. After accounting for baseline characteristics, patients with an unexcepted ICU admission were more likely to experience a moderate-to-severe symptom burden relative to those without an unexpected ICU admission (RR 1.64, 95% CI 1.31-2.05). Specifically, among patients with an unexcepted ICU admission the average probability of experiencing moderate-to-severe symptoms ranged from 6.9% (95 CI 5.8-8.3%) during the first month after surgery to 3.2% (95% CI 0.9-11.7%) at the end of the year. Among the 11,229 (67.8%) patients with multiple ESAS assessments, adjusted differences in total scores between patients with and without an unexpected ICU admission ranged from 2.0 to 5.7-points throughout the year (p < 0.001).

CONCLUSION

While unexpected ICU admissions are associated with a small increase in the likelihood of experiencing a moderate-to-severe symptom burden, most patients do not experience a high overall symptom burden during the year after surgery. These findings support the role of aggressive therapy among older adults after major surgery.

Delirium-related psychiatric and neurocognitive impairment and the association with post-intensive care syndrome-A narrative review

INTRODUCTION

Delirium is common among patients admitted to the intensive care unit (ICU) and its impact on the neurocognitive and psychiatric state of survivors is of great interest. These new-onset or worsening conditions, together with physical alterations, are called post-intensive care syndrome (PICS). Our aim is to update on the latest screening and follow-up options for psychological and cognitive sequelae of PICS.

METHOD

This narrative review discusses the occurrence of delirium in ICU settings and the relatively new concept of PICS. Psychiatric and neurocognitive morbidities that may occur in survivors of critical illness following delirium are addressed. Future perspectives for practice and research are discussed.

RESULTS

There is no "gold standard" for diagnosing delirium in the ICU, but two extensively validated tools, the confusion assessment method for the ICU and the intensive care delirium screening checklist, are often used. PICS complaints are frequent in ICU survivors who have suffered delirium and have been recognized as an important public health and socio-economic problem worldwide. Depression, anxiety, post-traumatic stress disorder, and long-term cognitive impairment are recurrently exhibited. Screening tools for these deficits are discussed, as well as the suggestion of early assessment after discharge and at 3 and 12 months.

CONCLUSIONS

Delirium is a complex but common phenomenon in the ICU and a risk factor for PICS. Its diagnosis is challenging with potential long-term adverse outcomes, including psychiatric and cognitive difficulties. The implementation of screening and follow-up protocols for PICS sequelae is warranted to ensure early detection and appropriate management.

Perspectives from designated family caregivers of critically ill adult patients during the COVID-19 pandemic: A qualitative interview study

Background

Family visitation in intensive care units (ICU) has been impacted by the severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic. While studies report on perceptions of families completely restricted from ICUs, little is known about the burden experienced by designated family caregivers allowed to visit their critically ill loved one. This study sought the perspectives of family caregivers of critically ill patients on the impact of one-person designated visitor policies mandated in ICUs during the COVID-19 pandemic.

Methods

Throughout the study period a restricted visitation policy was mandated capturing the first (April 2020) and second (December 2020) waves of the pandemic that allowed one designated family caregiver (i.e., spouses or adult children) per patient to visit the ICU. Designated family caregivers of critically ill patients admitted to ICU September 2020 to November 2020 took part in individual 60-minute, semi-structured interviews at 6-months after discharge from the index ICU admission. Themes from family interviews were summarized with representative quotations.

Results

Key themes identified following thematic analysis from six participants included: one visitor rule, patient advocate role, information needs, emotional distress, strategies for coping with challenges, practicing empathy, and appreciation of growth.

Conclusion

Designated family caregivers of critically ill patients admitted to ICU during the COVID-19 pandemic perceived a complex and highly stressful experience. Support from ICU family liaisons and psychologists may help ameliorate the impact.

Minimizing Post-Intensive Care Syndrome to Improve Outcomes for Intensive Care Unit Survivors

TOPIC

Post-intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/ fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies.

CLINICAL RELEVANCE

To minimize the risk of a patient developing post-intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes. They must also advocate for patients who need additional expert care.

PURPOSE

To describe interventions that critical care nurses can implement to minimize a patient's risk for post-intensive care syndrome.

CONTENT COVERED

This article describes patients who have a high risk of developing post-intensive care syndrome and interventions that are within nurses' purview.

Post-intensive care syndrome and health-related quality of life in long-term survivors of intensive care unit

OBJECTIVE

The objective of this study was to provide preliminary data for improving the health-related quality of life of long-term intensive care unit survivors by identifying the relationship between health-related quality of life and post-intensive care syndrome.

METHODS

Using a descriptive correlation research design, data from patients who visited the outpatient department for continuous treatment after discharge from the intensive care unit were analysed. Post-intensive care syndrome was measured by physical, cognitive, and mental problems. Data were collected from 1st August to 31st December, 2019, and 121 intensive care unit survivors participated in the study.

RESULTS

Health-related quality of life showed a negative correlation with physical, mental, and cognitive problems. The factors associated with health-related quality of life were physical and mental problems, education level, sedatives and neuromuscular relaxants, and marital status.

CONCLUSIONS

To improve the health-related quality of life of intensive care unit survivors, post-intensive care syndrome prevention is important, and a systematic strategy is required through a long-term longitudinal trace study. In addition, intensive care unit nurses and other healthcare professionals need to provide early interventions to reduce post-intensive care syndrome.

Improving Post-Injury Care: Key Family Caregiver Perspectives of Critical Illness After Injury

There is little research about how caregiver experiences evolve from ICU admission to patient recovery, especially among caregivers for patients who have traumatic injuries. In this study, we characterize diverse caregiver experiences during and after ICU admission for injury.

Psychiatric Outcomes in ICU Patients With Family Visitation: A Population-Based Retrospective Cohort Study

BACKGROUND

Lack of family visitation in the ICU can have long-term consequences on patients in the ICU after discharge. The effect of family visitation on the incidence of patient psychiatric disorders is unknown.

RESEARCH QUESTION

What is the association between family visitation in the ICU and incidence of psychiatric outcomes in patients in the ICU 1 year after hospital discharge?

STUDY DESIGN AND METHODS

This study assessed a population-based retrospective cohort of adult patients admitted to the ICU from January 1, 2014, through May 30, 2017, surviving to hospital discharge with ICU length of stay of ≥ 3 days. To be eligible, patients needed to have minimum of 5 years of administrative data before ICU admission and a minimum of 1 year of follow-up data after hospital discharge. An internally validated algorithm that interpreted natural language in health records determined patients with or without in-person family (ie, relatives, friends) visitation during ICU stay. The primary outcome was risk of an incidence of psychiatric disorder (composite outcome), including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders, identified using coding algorithms for administrative databases. Propensity scores were used in inverse probability weighted logistic regression models, and average treatment effects were converted to risk ratios (RRs) with 95% CIs. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder.

RESULTS

We included 14,344 patients with (96% [n = 13,771]) and without (4.0% [n = 573]) in-person family visitation who survived hospital discharge. More than one-third of patients received a diagnosis of any psychiatric disorder within 1 year after discharge (34.9%; 95% CI, 34.1%-35.6%). Patients most often received diagnoses of anxiety disorders (17.5%; 95% CI, 16.9%-18.1%) and depressive disorders (17.2%; 95% CI, 16.6%-17.9%). After inverse probability weighting of 13,731 patients, in-person family visitation was associated with a lower risk of received a diagnosis of any incident psychiatric disorder within 1 year after discharge (RR, 0.79; 95% CI, 0.68-0.92).

INTERPRETATION

ICU family visitation is associated with a decreased risk of psychiatric disorders in critically ill patients up to 1 year after hospital discharge.

Healthy Aging Brain Care Monitor, Caregiver Version: Screening for Post-Intensive Care Syndrome

BACKGROUND

Cognitive impairment is common in intensive care unit survivors, pointing to the potential utility of a caregiver-based tool to screen for post-intensive care syndrome.

OBJECTIVE

To validate the Healthy Aging Brain Care Monitor, Caregiver Version (HABC-M CG), as a caregiver-based tool to screen for post-intensive care syndrome.

METHODS

A total of 116 patients who survived a stay in the intensive care unit completed standardized assessments of cognition, psychological symptoms, and physical functioning, and their caregivers completed the HABC-M CG. The Cronbach α was used to measure the internal consistency of the scale items. Validity of the HABC-M CG versus comparison tests was measured using the Spearman rank correlation. Generalized linear models were used to adjust for age, sex, and education level.

RESULTS

The total scale and all subscales of the HABC-M CG showed excellent internal consistency (Cronbach α = 0.88-0.93). Scores on the psychological subscale correlated with standardized measures of depressive symptoms (Spearman ρ = 0.58). Scores on the cognitive subscale correlated with the Mini-Mental State Examination score (Spearman ρ = -0.33). Scores on the functional subscale correlated with scores on the Physical Self-Maintenance Scale (Spearman ρ = -0.36).

CONCLUSION

The HABC-M CG is a valid informant-based clinical tool for the assessment of symptoms of post- intensive care syndrome.

Post-intensive Care Syndrome

The increasing survival rate after discharge from the intensive care unit (ICU) has revealed long-term impairments in the cognitive, psychiatric, and physical domains among survivors. However, clinicians often fail to recognize this post-ICU syndrome (PICS) and its debilitating effects on family members (PICS-F). This study describes two cases of PICS to illustrate the different impairments that may occur in ICU survivors. The PICS risk factors for each domain and the interactions among risk factors are also described. In terms of diagnostic evaluation, limited evidence-based or validated tools are available to assist with screening for PICS. Clinicians should be aware to monitor for its symptoms on the basis of cognitive, psychiatric, and physical domains. The Montreal Cognitive Assessment is recommended to screen for cognition, as it has a high sensitivity and can evaluate executive function. Mood disorders should also be screened. For mobile patients, a 6-minute walk test should be performed. PICS can be prevented by applying the ABCDEF bundle ABCDEF bundle in ICU described in this paper. Finally, the family members of patients in the ICU should be involved in patient care and a tactful communication approach is required to reduce the risk of PICS-F.

Mental Health Interventions to Improve Psychological Outcomes in Informal Caregivers of Critically Ill Patients: A Systematic Review and Meta-Analysis

Supplemental Digital Content is available in the text.

Determine effect of mental health interventions on psychologic outcomes in informal caregivers of critically ill patients.

Challenges of Delirium Management in Patients with Traumatic Brain Injury: From Pathophysiology to Clinical Practice

Traumatic brain injury (TBI) can initiate a very complex disease of the central nervous system (CNS), starting with the primary pathology of the inciting trauma and subsequent inflammatory and CNS tissue response. Delirium has long been regarded as an almost inevitable consequence of moderate to severe TBI, but more recently has been recognized as an organ dysfunction syndrome with potentially mitigating interventions. The diagnosis of delirium is independently associated with prolonged hospitalization, increased mortality and worse cognitive outcome across critically ill populations. Investigation of the unique problems and management challenges of TBI patients is needed to reduce the burden of delirium in this population. In this narrative review, possible etiologic mechanisms behind post-traumatic delirium are discussed, including primary injury to structures mediating arousal and attention and secondary injury due to progressive inflammatory destruction of the brain parenchyma. Other potential etiologic contributors include dysregulation of neurotransmission due to intravenous sedatives, seizures, organ failure, sleep cycle disruption or other delirium risk factors. Delirium screening can be accomplished in TBI patients and the presence of delirium portends worse outcomes. There is evidence that multi-component care bundles including an analgesia-prioritized sedation algorithm, regular spontaneous awakening and breathing trials, protocolized delirium assessment, early mobility and family engagement can reduce the burden of ICU delirium. The aim of this review is to summarize the approach to delirium in TBI patients with an emphasis on pathogenesis and management. Emerging CNS-active drug therapies that show promise in preclinical studies are highlighted.

Muscle Power is Related to Physical Function in Patients Surviving Acute Respiratory Failure: A Prospective Observational Study

BACKGROUND

Up to 66% of patients admitted to the intensive care unit (ICU) for acute respiratory failure (ARF) develop ICU-acquired weakness, which is diagnosed by muscle strength testing. Muscle power, different from strength, is an important determinant of function that is not a common focus in patients surviving critical illness. Therefore, the purpose of this study is to assess muscle power in survivors of ARF.

METHODS

A cross-sectional observational study performed with survivors of ARF. Muscle power, strength and physical function were assessed 4-8 weeks post-hospital discharge. Cross sectional area and echogenicity of rectus femoris and tibialis anterior muscles were assessed using ultrasonography. Healthy community-dwelling adults were included for comparison.

RESULTS

12 survivors of ARF mean age of 55.6 ± 17.1 (66% male) and 12 healthy adults mean age of 51.6.1 ± 10.3 (66% male) participated in this study. Patients in the post-ARF group had a mean muscle power of 9.9 ± 3.5 W and 63.7 ± 31.6 W for 2-lb and 10% of body-weight loads, respectively. Compared to matched controls, power in ARF group was reduced by 43%. Muscle power in post-ARF group had moderate correlations with 5-times sit-to-stand testing (r = -0.644, P = 0.024), 4-m habitual gait speed (-0.780, P = 0.002), and 6-min walk distance (r = 0.589, P = 0.044).

CONCLUSIONS

Muscle power is significantly reduced in survivors of critical illness and associated with deficits in physical function. These preliminary findings may support therapeutic interventions aimed at improving muscle power to potentially increase functional benefit.

Post-traumatic stress disorder in critical illness survivors and its relation to memories of ICU

BACKGROUND

Stressors in intensive care units (ICUs) are sometimes so severe that they result in Post-traumatic Stress Disorder (PTSD) in ICU survivors. The memories that survivors have from the ICU may play a role in developing PTSD.

AIM

This study aimed to determine the prevalence of PTSD-related symptoms in ICU survivors in Southeast Iran and its relationship with their memories of the ICU.

METHODS

In this descriptive correlational study, 100 people discharged from ICUs in southeastern Iran completed the Impact of Event Scale-Revised (IES-R) and ICU memory tool (ICU-MT).

RESULTS

Findings indicated that, from 100 participants who, on average, were assessed 3.19 ± 5.37 months after discharge, 13% were suffering from PTSD. The total mean IES-R score and the scores of "Intrusion," "Avoidance," and "Hyperarousal" subscales in patients with delusional memories were higher compared with the patients who did not have such memories. In the patients who were mechanically ventilated at the time of their stay in the ICU, the total mean IES-R score was 6.86 times higher (P = .03).

CONCLUSION

This research provided further evidence of the relationship between delusional memories and PTSD in patients who had been discharged from the ICU.

RELEVANCE TO CLINICAL PRACTICE

In the care of patients admitted to the ICU, preventive strategies should be used to minimize delusional memories and PTSD. It is necessary to detect post-ICU psychiatric morbidities and provide early psychological intervention in post-discharge follow-up programmes to improve psychological outcomes after critical illness.

Psychotropic medication use in former ICU patients with mental health problems: A prospective observational follow-up study

PURPOSE

To describe the extent to which patients with mental health problems after admission to an Intensive Care Unit (ICU) initiate and use psychotropic medication.

METHODS

All adult patients who stayed in the ICU of the University Medical Center Utrecht for 48 h or more between 2013 and 2017, alive after 1 year and not admitted to the ICU with brain injury, were eligible. Questionnaires were used to identify mental health problems, depression, anxiety and posttraumatic stress disorder (PTSD) and psychotropic medication use.

RESULTS

Of the 1328 former ICU patients, 24.3% (n = 323) had developed any of the mental health problems. Of this group, 29.7% (n = 96) used psychotropic medication one year after discharge versus the 10.6% (n = 107) of patients without these problems (OR 3.17, 95% CI 2.29-4.38). They were further 4.33 (95% CI 2.62-7.16) times more likely to initiate psychotropic medication (18.7% vs 4.8%) after ICU admission. Similar patterns were observed for individual groups of psychotropics: antidepressants, antipsychotics and benzodiazepines.

DISCUSSION

Former ICU patients with mental health problems were almost four times more likely to use psychotropic medication than former ICU patients without these problems. Future research should investigate whether mental health problems are properly diagnosed and treated in former ICU patients.

Aging and Postintensive Care Syndrome- Family: A Critical Need for Geriatric Psychiatry

Postintensive care syndrome-family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment compared with older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared with other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared with other geriatric populations. Third, evidence for models of care centered on patients with multimorbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multimorbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.