Most intensive care unit (ICU) patients admitted due to an illness will recover without complications and return to their everyday lives. However, some may experience long-term physical, psychological, and cognitive symptoms, such as post-traumatic stress disorder, which make it difficult to return to previous quality of life for months, and even years.

A study published in the Journal of Critical Care Medicine entitled Long-term Complications of Critical Care found that 80% of ICU survivors may experience an incidence of up to one or more symptoms of Post-Intensive Care Syndrome (PICS) in the few months following discharge from hospital. One factor that contributes to experiencing PICS includes the length of time spent in the ICU. A longer stay in the hospital due to a critical illness has been found to lead to an increased prevalence of loss of body mass and infections, both, which increase the risk of mortality for patients. Another factor impacting health outcomes, from a stay in the ICU is age and the presence of previous medical conditions.

One research study entitled Improving Long-term Outcomes After Discharge from Intensive Care Unit in The Journal of Critical Care Medicine suggests that critically ill patients who struggle with Post Intensive Care Syndrome often have limitations in physical and mental health outcomes when compared to the quality of life of those without Post Intensive Care Syndrome. In addition to a lower quality of life, those with PICS can require additional support, including primary care and acute care, both of which have been associated with increased costs in order to meet healthcare needs.

A key difference between PICS and other conditions is the variety of presenting symptoms. PICS can result in neuromuscular weakness, cognitive impairment, psychiatry-based health struggles, and functional limitations. The psychological health of family members may also be affected, with 50% of caregivers feeling overburdened and experiencing a lower quality of life. This has been termed as PICS-Family or PICS-F (Post Intensive Care Syndrome-Family)

The Role of The Limbic System

Research from Post-ICU Symptoms, Consequences, and Follow-up: An Integrative Review in the Journal of Nursing in Critical Care discusses a significant difference between PICS and other similar conditions due to the underlying cause of PICS. This growing body of evidence suggests that the hyperarousal of the limbic system following admission to the ICU as a result of a critical illness or severe sepsis can lead to a higher chance of developing PICS. Stress and trauma release high levels of cortisol, thus stimulating the Fight or Flight response through the Sympathetic Nervous System.

When the nervous system is hyperstimulated and the Fight or Flight response is activated, small proteins called cytokines are produced by the immune system. If not treated in a correct and timely manner, this can contribute to the development of limbic system dysfunction, anxiety, depression, and post-traumatic stress disorder (PTSD).

In this article, we will cover everything you may need to know about PICS, including more about a neuroplasticity-based treatment program, which has helped many people to clear themselves of symptoms to return back to an active quality of daily living with an improved mental health status.

Symptoms of Post-Intensive Care Syndrome

Critical care survivors affected by PICS can experience a range of different physical impairments, long-term cognitive impairment, and psychological symptoms upon hospital discharge from ICU, including:

• Muscle weakness
• Fatigue
• Muscle Wasting
• Deconditioning
• Difficulties With Attention
• Memory Impairment
• Executive Functioning Impairment
• Anxiety
• Depression
• PTSD
• Other mental health problems
• Sleep disturbances
• Medication sensitivity
• Noise and Light Sensitivity
• Ongoing Or Chronic Pain

The range and severity of symptoms will dictate a person’s personal experiences with PICS. Worsening symptoms like physical impairment and weakness can make it difficult to perform typical daily tasks, while cognitive impairments can impact a patient’s ability to return to work. Ongoing stress can lead to anxiety and depression, requiring further ongoing medical treatment and reducing the chances of regaining daily independence.

A traumatic experience from spending time in the ICU can develop PTSD symptoms, including nightmares, flashbacks, and avoidant behavior within 10-50% of people. Evidence from The Journal of Intensive and Critical Care Nursing agrees that a multitude of symptoms in PICS can create sleep disturbances, contributing to an initial presentation or exacerbation of chronic pain. For patients who are generally quite active, limitations may not be as severe, but the possibility of overall weakness, fatigue, and difficulty getting out of bed in the morning are still possible.

This multifactorial condition can be exacerbated by a number of factors, including ongoing stress dysregulating the limbic system. Not only can this impact everyday life, but also, over time, this chronic stress can lead to a dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) Axis, leading to an increase in the stress hormone cortisol. Hormonal changes like this can then lead to inflammation, exacerbating the symptoms of PICS.

If you are struggling with PICS, focusing on the root factors of your symptoms through a neuroplasticity brain training program can be a powerful method, providing an optimistic opportunity for your symptoms to gradually improve and help you to regain independence.

Causes and Risk Factors of Post-Intensive Care Syndrome

The limbic system is a group of structures within the brain playing a key role in the development of PICS with functions in the formation of memory and the regulation of emotions. A key structure within the limbic system includes the Amygdala, which is involved in the processing of information and regulating the Fight or Flight stress response. When the body is exposed to a range of stressors including, physical trauma and increased inflammation, an overreaction in the Amygdala may occur, thus exacerbating symptoms of PICS.

Certain groups of people may be at a higher risk of developing PICS, including:

• Age Impacting The Body’s Ability To Recover
• Increased Length Of Stay In Hospital
• Severity Of Illness During Time In ICU
• If Prolonged Mechanical Ventilation Was Required During Time In ICU
• Delirium Complicating Illness Recovery
• Experience Of A Systemic Inflammatory Response During Stay In ICU
• Use of Sedation And Analgesia
• Impact on Muscles Leading To General ICU Acquired Weakness
• A Lack Of Social Support From Family Members or Friends Once Discharged
• Pre-existing Psychological Conditions Impacting Rate of Recovery

How Post Intensive Care Syndrome is Treated

Due to the multifaceted nature of PICS, there is no one-size-fits-all treatment approach. There is hope for those who want to improve their quality of life after an ICU stay by following some typical approaches. By focusing on the aspects of physical, cognitive, social, and mental health, the symptoms of PICS can begin to improve. Before we take a deeper look into PICS from a neuroplasticity perspective, let’s understand some of these different typical approaches along with some of the advantages and disadvantages of each approach.

Physical and Occupational Rehabilitation

A study entitled Functional Outcomes in ICU – What Should We Be Using? – An Observational Study by Parry et al. found that participating in Physical Therapy with licensed physical therapists produced significant improvements in physical function and quality of life after battling a critical illness. Occupational therapy can also help to regain the ability to perform activities of daily living, such as dressing and grooming, while also working on improving global cognitive function.

One disadvantage to consider is that both can be challenging and intense, so preventing overexertion is critical to maintaining consistent improvements. Forgetting to prioritize rest and recovery can stall progress, so being mindful during this process and not pushing yourself too hard each and every day can make all the difference.

Psychological Support

Counseling or behavioral therapies with mental health care providers can be an effective treatment approach for PICS. In addition, medication such as antidepressants and antipsychotics can also be used to help manage more acute symptoms of anxiety and depression once discharged. A disadvantage to psychological support may be the stigma attached to it. For this reason, normalizing mental health support can play a huge part in both the physical and psychological aspects of PICS.

Social Support and Education

It can be common to feel disconnected once discharged from the ICU with feelings of isolation and loneliness. Struggles with concentration and difficulties with executive functioning can make appointments and procedures stressful without sufficient support. Finding a support group that understands what you are going through may be helpful.

In addition, asking a family member or friend to help can be incredibly beneficial. It is important to encourage your support systems to take care of themselves during the recovery process as well so as not to develop PICS-Family.

How We Approach Post-Intensive Care Syndrome

A traumatic stay in the ICU after being critically ill can create deeply ingrained, disempowering habits. Prolonged stress can dysregulate the limbic system, causing chronic inflammation, thus leading to changes in the brain’s neural connections and creating a negative association with symptoms or current circumstances.

Through the deliberate use of self-directed neuroplasticity, you can shift your focus from previously conditioned thoughts and behaviors and calm the overactive stress response. These are both key practices to create new, empowering behaviors that may allow for a return to a full quality of life.

What The Research Says

On a positive and hopeful note, growing evidence has demonstrated that a full recovery from the symptoms of PICS is possible. Engaging in different neurocognitive tasks and activities can help the brain and body to regulate the limbic system and restore well-being.

In order to fully benefit from neuroplasticity techniques, it is important to believe in your ability to take control of your own return to health. Re-origin provides a self-directed approach to brain rewiring. We equip you with the skills and tools to help balance your limbic system so you can heal symptoms of PICS and facilitate long-lasting recovery.