Medical facilities have advanced immensely since times due to ever increasing demands related to health issues and sudden tragedies involving accidents, burns, etc. The critical care is one such medical department that treats cases with extreme illnesses and serious conditions. But, the treatments in the critical care units are not the only effect left on patients being treated. Rather, the complex technical equipment used for treatment, the high dosage medicines administered to treat the medical conditions and a longing to be with the loved ones may leave a long term impact on the patient’s mental framework. It does have effects on their families as well. Post-intensive care syndrome is an accumulation of such health conditions that persist while a patient resides in the intensive critical care unit (ICU) and also when he reaches home. It includes the problems associated with physical health, thoughts, judgment, cognizance and mind that result from surviving the extreme level hospitalization conditions (SCCM, 2013).
PICS: An illness after illness!
People from every corner of the globe try real hard to be healthy and hearty through exercising, eating the right calories, adapting good habits of waking and sleeping at right time and much more. But, still medical conditions related to illnesses or accidental do arise in people’s lives that pave way straight to the ICU. Only the blessed ones are able to thrive well out of the ICU and get their condition cured after a furious struggle with clinical treatment. Even after such a victory, it is an ironical if the person and his family are not able to be healthy in terms of physical, cognitive and mental health. A research showed that ~110 survivors of acute respiratory distress syndrome and their family members were not healthy enough physically and psychologically even after 5 years (SCCM, 2013). Cognitive impairment is very common amongst patients experiencing sepsis and those undergoing brain related treatments that persist from one to five years.
Why an ICU?
Intensive Care Units are specialized rooms in the hospitals meant to treat seriously ill patients by specialized medical staff. It accommodates patients with critical conditions of diseases that are not treatable through routine medications. The patient is monitored all the time and is surrounded by high end equipment to analyze the medical parameters like blood pressure, heart rate, respiratory rate, etc (CPMC, 2014). The view of an ICU varies from patient to patient as it depends on the individual condition.
How ICU leads to PICS?
A journey into an ICU and out has never been easy for any patient and their families. Undoubtedly, the continuous medical treatments and sturdy machines all around take a toll out of the admitted sufferer. It is evident through the fact that the survivors out of 8, 00,000 patients admitted to the ICU in United States every year, 40% suffer with post-intensive care syndrome (Hoffman and Guttendorf, 2015). The stress and trauma of being under such surrounding is hard for anyone to escape. It is evident that ICU conditions do not allow patient’s family members to visit them at random but have a small fixed timing for the visits. A lack of loved ones around all the time and being treated anytime with harsh and tedious medical treatments, render a person and their families prone to post-intensive care syndrome (Patient Safety Partnership, 2010). ICU is a busy place whereby many other serious conditions are being treated simultaneously. Thus, the sleep deprivation and discomfort too adds up worsening the patient’s mental health. Amazingly, the occurrence of PICS is independent of the period of stay of a patient in the ICU. This arena has gained attention lately and professionals have started considering this firmly and attempting to relieve patients and their families from PICS (SCCM, 2013).
PICS is readily observable in its victims due to their behavioral and physical weaknesses. Depression, muscular fatigue, anxiety, reduced performance; forgetting things are the most common symptom that develop in patients during and after discharge from the critical care as well as their family members (Davidson et al, 2013b).
Plausible Preventions to PICS
It’s not just the sufferer, but the closed one also needs to be treated before going home after surviving the ICU conditions because the motive of treatment should be returning the individual in his/ her pre ICU state and not just curing the disease for which he was admitted to the critical unit. This is only possible if the post-intensive care syndrome is taken under consideration by every medical facility provider and should be treated well. The affected are seen to be traumatic and have nightmares due to some or the other reason for instance that happened during their ICU stay. The distance of patients and their relatives is more stressful and frightening compared to the fear of death or suffering from disease. The foremost attempt should be to include the nearest family members while the treatment of critical patients goes on. A family member being alongside the affected individual will surely boost the mental health of both (SCCM, 2013). Also, it will aid in benefitting the post discharge recovery if a family member is involved pre discharge during treatment of the patient. A well-documented information communicated to the patient and their family members is extremely helpful in preventing adverse post- discharge effects (Davidson et al, 2013a).
The amendments need to be made at the researcher and clinical practitioners levels whereby the patients and their families are taken care of from the time they enter the hospital till they leave. A better co-ordination amongst all is a mandate to improve the mental health of the families and the survivor.
Moreover, counseling and spreading education regarding post-intensive care syndrome should be mandatory in healthcare industry. The patients, caregivers and family members should be made aware of the factors leading to PICS. Also, they need to be educated regarding the most prevailing symptoms and signs related to PICS ((Hoffman and Guttendorf, 2015). There should be plans set up for the patient as soon as he is admitted to the ICU to make him mobile and keep him exercising along with maintaining an ICU diary by the families for the patients.
A very popular approach is to implement ABCDEFGH strategy to prevent the occurrence of PICS (SCCM, 2013). ABCDE is the basic approach meant to deal with the issues concerned with the patient in ICU and FGH are the further advancements added to this approach keeping the patient and their families in viewpoint. The initials ABC refers to awakening, breathing and co-ordination. It insists on the minimal usage of sedation for treatment of patients so as to reduce the cognitive and immobility issues to great extents. The patient should be conscious and fully aware of the happenings around to reduce the anxiety and discomfort amongst the sufferers. The initials D and E refer to delirium assessing and early mobility respectively. Delirium is one the major problems being dealt with the critical care patients. It can be reduced by preventing the use of benzodiazepines in patients except the ones for alcohol abuse (Davidson et al, 2013a). The target here is to induce mobility by exercising to eradicate the problem of confusion arising in the patients. ABCDE is followed by FGH whereby F refer to family follow up, G to good hand off conversations and H to handing over the written information. FGH elements are meant for patient post discharge care and concern. It monitors any PICS related symptoms in the survivor or his family members. A detailed follow up is provided for the following team to care the best for the patient and his mobility. Along with all this, a thorough conversation is set up to enable the survivors and their relatives know the similar situations faced by their fellow survivors and dealing in the best way about their fears and traumatic thoughts.
Conclusion
An individual admits to the critical care department of any healthcare unit not by his choice but due to the situation that prevails. Under such circumstances, it is important for the medical caregivers to consider the earlier status of the person and arrange for the best possibilities to prevent PICS along with treating the serious illnesses. It is significant to include counseling services along with medical facilities to the patients and their families for their overall wellbeing. Regular monitoring of post intensive care patients and their families for any prevailing conditions is significant in aiding their quick recovery. Many clinical manifestation need to be considered for the same (Volk and Grassi, 2009). More research work is required to improve the post-discharge care and for delivering the same to the family members. The most important factor is that the comfortable healthcare facilities should be offered to the sufferers and their family relatives.
References
CPMC. (2014). What is the ICU? Sutter Health. Accessed at http://www.cpmc.org/learning/documents/icu-ws.html on 2 March 2016.
Davidson, E, J., Harvey, A, M., and Schuller, J. (2013a). Post-Intensive Care Syndrome: What it is and How to help prevent it. American Nurse Today. Accessed at http://www.americannursetoday.com/post-intensive-care-syndrome-what-it-is-and-how-to-help-prevent-it/ on 3 March 2016.
Davidson, E, J., Hopkins, O, R., Louis, D., and Iwashyna, J, T. (2013b). Post-Intensive Care Syndrome. Society of Critical Care Medicine. Accessed at http://www.myicucare.org/Adult-Support/Pages/Post-intensive-Care-Syndrome.aspx on 1 March 2016.
Hoffman, A, L., and Guttendorf, J. (2015). Post intensive Care Syndrome: Risk Factors and Prevention Strategies. AHC Media. Accessed at http://www.ahcmedia.com/articles/134820-post-intensive-care-syndrome-risk-factors-and-prevention-strategies on 2 March 2016.
Patient Safety Partnership. (2010). When your Patient is admitted to the ICU. The Safe Patient Resource Center. Accessed at http://www.patientsafetypartnership.org/When_Your_Patient_Admitted_to_the_ICU.html on 2 March 2016.
SCCM. (2013). Post-Intensive Care Syndrome: Improving the Future of ICU Patients. 42nd Critical Care Congress Review. Accessed at http://www.sccm.org/SiteCollectionDocuments/CC-Iwahyna-June-2013.pdf on 1 March 2016.
Volk, B., and Grassi, F. (2009). Treatment of the Post-ICU Patient in an Outpatient Setting. American Family Physician. 79(6); 459-464.
