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Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges
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Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Emergency Medicine".

Deadline for manuscript submissions: closed (20 June 2022) | Viewed by 32860

Special Issue Editors

Prof. Dr. Shigeaki Inoue

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Guest Editor
Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ward, Kobe, Japan
Interests: post-intensive care syndrome; ICU-acquired weakness; aging; immunosenescence; sepsis; end-of life
Special Issues, Collections and Topics in MDPI journals
Dr. Kensuke Nakamura

E-Mail Website
Guest Editor
Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan
Interests: clinical nutrition; critical care; post-intensive care syndrome; protein; PICS; ICU-AW; ICU rehabilitation
Special Issues, Collections and Topics in MDPI journals
Dr. Nobuto Nakanishi

E-Mail Website
Guest Editor
Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
Interests: PICS; ICU-AW; ICU rehabilitation

Special Issue Information

Dear Colleagues,

Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). ICU-acquired weakness (ICU-AW), a syndrome that exhibits acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. For prevention of PICS, it is important to carry out the ABCDEFGH bundle and new therapeutic strategies, including diary, nutrition, nursing care, follow-up system of PICS patients, environmental management for healing. Although PICS will be a new task for intensive care medicine in the 21st century that has reached the end of mature acute care, including several problems regarding end-of-life care, there is lack of clinical evidence remained. The aim of this Special Issue is to highlight recent advances in the context of diagnosis, treatment, and the prediction of prognosis for PICS and PICS-related diseases.

Dr. Shigeaki Inoue
Dr. Kensuke Nakamura
Dr. Nobuto Nakanishi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Intensive care unit
  • Post-intensive care syndrome
  • ICU-acquired weakness
  • Physical impairments
  • Mental impairments
  • Cognitive impairments
  • PICS-p
  • End-of-life

Published Papers (7 papers)

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Editorial

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4 pages, 188 KiB  
Editorial
Post-Intensive Care Syndrome—10 Years after Its Proposal and Future Directions
by Shigeaki Inoue, Nobuto Nakanishi and Kensuke Nakamura
J. Clin. Med. 2022, 11(15), 4381; https://doi.org/10.3390/jcm11154381 - 28 Jul 2022
Cited by 4 | Viewed by 2181
Abstract
With the development of intensive care medicine and the standardization of various therapeutic guidelines and education systems, mortality rates in critically ill patients have improved markedly [...] Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)

Research

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9 pages, 741 KiB  
Article
Incidence and Risk Factors of Worsened Activities of Daily Living Status Three Months after Intensive Care Unit Discharge among Critically Ill Patients: A Prospective Cohort Study
by Kyohei Miyamoto, Mami Shibata, Nozomu Shima, Tsuyoshi Nakashima, Rikako Tanaka, Keita Nakamoto, Yuriko Imanaka and Seiya Kato
J. Clin. Med. 2022, 11(7), 1990; https://doi.org/10.3390/jcm11071990 - 02 Apr 2022
Cited by 2 | Viewed by 1748
Abstract
Background: We aimed to determine risk factors associated with worsened activity of daily living (ADL) status three months after intensive care unit (ICU) discharge. Methods: In this prospective, observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. [...] Read more.
Background: We aimed to determine risk factors associated with worsened activity of daily living (ADL) status three months after intensive care unit (ICU) discharge. Methods: In this prospective, observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. We assessed ADL status by Barthel index score prior to ICU admission and three months after ICU discharge. The primary outcome was worsened ADL status, defined as a ≥10 decrease in Barthel index score. Results: We enrolled 102 patients (median age was 72 years old, 55% were male, and 87% received mechanical ventilation during ICU stay), and 42 patients (41%) had worsened ADL status three months after discharge from ICU. Multivariate analysis revealed that older age (>70 years old; adjusted odds ratio (aOR) 3.68; 95% confidence interval (95%CI) 1.33–10.19), high burden of chronic illness (aOR 4.11; 95%CI 1.43–11.81), and longer duration of mechanical ventilation (≥4 days; aOR 2.83; 95%CI 1.04–7.69) were independent risk factors for worsened ADL status at three months. Conclusions: Almost half of the critically ill adult patients in this cohort had worsened ADL status after ICU discharge. Older age, high burden of chronic illness, and longer duration of mechanical ventilation were risk factors for worsened ADL status. Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)
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10 pages, 504 KiB  
Article
Roles of Early Mobilization Program in Preventing Muscle Weakness and Decreasing Psychiatric Disorders in Patients with Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Cohort Study
by Toru Kotani, Mizuki Sugiyama, Fumika Matsuzaki, Kota Kubodera, Jin Saito, Mika Kaneki, Atsuko Shono, Hiroko Maruo, Maiko Mori, Shin Ohta and Fumihito Kasai
J. Clin. Med. 2021, 10(13), 2941; https://doi.org/10.3390/jcm10132941 - 30 Jun 2021
Cited by 2 | Viewed by 2474
Abstract
Although many coronavirus 2019 patients have experienced persistent symptoms and a long-term decline in quality of life after discharge, the details of these persistent symptoms and the effect of early rehabilitation are still unclear. We conducted a single-center, retrospective observational study to investigate [...] Read more.
Although many coronavirus 2019 patients have experienced persistent symptoms and a long-term decline in quality of life after discharge, the details of these persistent symptoms and the effect of early rehabilitation are still unclear. We conducted a single-center, retrospective observational study to investigate the prevalence of persistent symptoms three months after discharge from the intensive care unit by checking the medical records. All patients received an early mobilization program. Four out of 13 patients (31%) had postintensive care syndrome. No patients had muscle weakness, and 11 patients (85%) returned to their previous work. However, psychiatric disorder, such as anxiety (23%) and posttraumatic stress disorder (15%), were observed. Eleven patients claimed persistent symptoms, including fatigue and numbness in the extremities. Our results suggest that the implementation of an early rehabilitation program plays some role in preventing muscle weakness and that decreasing psychiatric disorders should be a next target of patient care in the intensive care unit. Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)
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11 pages, 738 KiB  
Article
Risk Factors of Patient-Related Safety Events during Active Mobilization for Intubated Patients in Intensive Care Units—A Multi-Center Retrospective Observational Study
by Hajime Katsukawa, Kohei Ota, Keibun Liu, Yasunari Morita, Shinichi Watanabe, Kazuhiro Sato, Kenzo Ishii, Daisetsu Yasumura, Yo Takahashi, Takafumi Tani, Hitoshi Oosaki, Tomoya Nanba, Ryo Kozu and Toru Kotani
J. Clin. Med. 2021, 10(12), 2607; https://doi.org/10.3390/jcm10122607 - 13 Jun 2021
Cited by 9 | Viewed by 5821
Abstract
The aim of this study is to clarify the incidence and risk factors of patient-related safety events (PSE) in situations limited to intubated patients in which active mobilization, such as sitting on the edge of the bed/standing/walking, was carried out. A multi-center retrospective [...] Read more.
The aim of this study is to clarify the incidence and risk factors of patient-related safety events (PSE) in situations limited to intubated patients in which active mobilization, such as sitting on the edge of the bed/standing/walking, was carried out. A multi-center retrospective observational study was conducted at nine hospitals between January 2017 and March 2018. The safety profiles and PSE of 87 patients were analyzed. PSE occurred in 10 out of 87 patients (11.5%) and 13 out of 198 sessions (6.6%). The types of PSE that occurred were hypotension (8, 62%), heart rate instability (3, 23%), and desaturation (2, 15%). Circulation-related events occurred in 85% of overall cases. No accidents, such as line/tube removal or falls, were observed. The highest incidence of PSE was observed during the mobilization level of standing (8 out of 39 sessions, 20.5%). The occurrence of PSE correlated with the highest activity level under logistic regression analysis. Close vigilance is required for intubated patients during active mobilization in the standing position with regard to circulatory dynamics. Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)
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8 pages, 529 KiB  
Communication
A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study
by Megan M. Hosey, Stephen T. Wegener, Caroline Hinkle and Dale M. Needham
J. Clin. Med. 2021, 10(4), 872; https://doi.org/10.3390/jcm10040872 - 20 Feb 2021
Cited by 8 | Viewed by 3781
Abstract
Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms [...] Read more.
Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay. Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)
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Review

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17 pages, 1275 KiB  
Review
Post-Intensive Care Syndrome and Its New Challenges in Coronavirus Disease 2019 (COVID-19) Pandemic: A Review of Recent Advances and Perspectives
by Nobuto Nakanishi, Keibun Liu, Daisuke Kawakami, Yusuke Kawai, Tomoyuki Morisawa, Takeshi Nishida, Hidenori Sumita, Takeshi Unoki, Toru Hifumi, Yuki Iida, Hajime Katsukawa, Kensuke Nakamura, Shinichiro Ohshimo, Junji Hatakeyama, Shigeaki Inoue and Osamu Nishida
J. Clin. Med. 2021, 10(17), 3870; https://doi.org/10.3390/jcm10173870 - 28 Aug 2021
Cited by 46 | Viewed by 13599
Abstract
Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has [...] Read more.
Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28–87% of cases pertaining to physical impairments, 20–57% pertaining to cognitive impairments, and 6–60% pertaining to mental health problems after 1–6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection. Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)
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Other

2 pages, 181 KiB  
Comment
Post-Intensive Care Syndrome: A Problem Cannot Be Ignored in ICU. Comment on Inoue et al. Prevalence and Long-Term Prognosis of Post-Intensive Care Syndrome after Sepsis: A Single-Center Prospective Observational Study. J. Clin. Med. 2022, 11, 5257
by Jiayuan Ni, Yuan Ding, Liying Miao and Bin Zhu
J. Clin. Med. 2023, 12(1), 268; https://doi.org/10.3390/jcm12010268 - 29 Dec 2022
Cited by 1 | Viewed by 971
Abstract
Recently, we read with great interest the article by Inoue et al. [...] Full article
(This article belongs to the Special Issue Post-intensive Care Syndrome: Prevention, Current Status and Future Challenges)
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