Table 1 Major post-intensive care complications
From: Management of COVID-19 ICU-survivors in primary care: - a narrative review
Sequelae | Description | Key symptoms | Example risk factors | Screening | Diagnosis | Treatment | Prognosis |
|---|---|---|---|---|---|---|---|
Pulmonary function | • Obstruction, restriction and impaired diffusing capacity • Mostly following ARDS | • Shortness of breath • Reduced exercise capacity | Duration of mechanical ventilation | No consensus on recommended measure [6] | • Spirometry • Lung volumes • Diffusion capacity | Pulmonary rehabilitation program [5] | Generally: • mild impairment • improves during first year |
Neuro-muscular function | • Joint contractures • Muscle weakness, including: -CIP -CIM -Disuse atrophy | • Reduced joint range of motion • Symmetric, distal and flaccid limb weakness • Reduced or absent deep tendon reflexes • Loss of peripheral sensation • Relative preservation of cranial nerve function | • Sepsis • Mechanical ventilation • Hyperglycemia • Use of glucocorticoids or neuromuscular blocking agents • Immobility/ bed rest | • Hand grip and/or Manual Muscle Test [11] • MRC scale [12] | • Nerve conduction study • Electromyography • Muscle ultrasound • Creatine kinase level (in ICU) | • Tailored rehabilitation across healthcare continuum, including PT and OT [5] • Home exercise [13] • Nutritional advice in case of malnutrition • Assistive devices | • CIP may recover more slowly than CIM • Abnormalities extend beyond five years • May not return to pre-ICU baseline status [5] |
Physical function | Impairment in activities of daily living and walking distance | • Older age • Preexisting impairment | ADL/ IADL, (ICF) [16] | ||||
Dysphagia | Swallowing impairment | • Prolonged intubation • Gastrointestinal comorbidity • ICUAW | Early consultation to a SLP [17] | Swallowing exercises with SLP [17] | Recoveries typically take more than 6 month | ||
Mental Health | Depression | • Depressed mood • Loss of interest, fatigue | • Sedation • Traumatic/delusional memories of ICU • Pre-ICU psychiatric history • Female gender • Poverty • Not associated with severity of illness | HADS [18]* PHQ-2/9 [19] | DSM-5 diagnostic criteria, [20] semi-structured interview | • Psychotherapy • Antidepressants | May persist over first year [21] |
Anxiety | • Excessive worry, difficult to control | HADS [18]* OASIS [22] GAD2/7 [23] | • CBT [5] • Anxiolytics | May have little improvement over first year [24] | |||
PTSD | • Intrusive memories • Avoidance of stimuli associated with the ICU • Dissociative reactions • Irritable behavior | IES-6 [25]* PTSS-10 [26] | • Talking about ICU experiences • Psychotherapy • Avoid benzodiazepines | • Onset may be delayed [27] • Little improvement in first year | |||
Cognition | Impairments in • memory • attention • executive function • mental processing • visuo-spatial ability speed | • Prior cognitive deficit • Duration of ICU delirium • Older Age • Cerebral Hypoxia • Hypotension • Hypoglycemia | MoCA [28] MoCA Blind* | Exclusion of reversible causes for dementia as: • Hypothyroidism | • Cognitive rehabilitation • Assistance in organizing daily life | • May improve during first year • Residual deficits up to six years later | |
Family | PICS-F includes • Anxiety • Depression • PTSD • Complicated grief | see “Mental Health” | • Female gender • Younger age • Less education • Pre-ICU psychiatric history • Distance to hospital • Dissatisfaction with ICU communication | see “Mental Health” | • See “Mental Health” • Inclusion of family member into decision making • Involvement of trained nurse or social worker | PTSD and complicated grief may persist longer (over years) than depression and anxiety | |