Post Intensive Care Syndrome (PICS)

Post Intensive Care Syndrome (PICS、集中治療後症候群、ICU後症候群)という言葉の使用を提案した会議録の論文を紹介します。

Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, Brady SL, Brodsky MB, Denehy L, Elliott D, Flatley C, Harabin AL, Jones C, Louis D, Meltzer W, Muldoon SR, Palmer JB, Perme C, Robinson M, Schmidt DM, Scruth E, Spill GR, Storey CP, Render M, Votto J, Harvey MA. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012 Feb;40(2):502-9.

ICU-acquired weaknessに関しては、すでに診断基準も含めてフレームワークの論文があります。下記のブログで紹介しています。

ICUAW（ICU無力症）の診断基準
http://rehabnutrition.blogspot.jp/2012/07/icuawicu.html

ただし、ICUAWには身体面（四肢筋力）の機能低下しか含まれていません。ICU後には認知障害や精神障害を認める方もいますが、そのような障害を含む概念・言葉は今までありませんでした。そこで、Post Intensive Care Syndromeという言葉を提唱しています。

The term “postintensive care syndrome” (PICS) was agreed on as the recommended term to describe new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization. The term could be applied to a survivor (PICS) or family member (PICS-F).

PICSは、重症疾患後に発症もしくは悪化した身体面、認知面、精神面の機能障害で、急性期病院での入院加療後も持続する障害と定義されています。本人と家族の両者にPICSを認めることがあります。

PICSは廃用症候群と診断されることが大半です。何でもかんでも廃用症候群とラベルをつけてひたすら機能訓練を行うのではなく、その原因をよく考えて、ICUAW、PICS、低栄養、サルコペニアなどと判断して、適切なリハ栄養を行うほうが予後がよくなる可能性があると感じています。

Abstract

BACKGROUND:

Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge.

OBJECTIVES:

To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families.

PARTICIPANTS:

Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge.

DESIGN:

Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems.

MEASUREMENTS AND MAIN RESULTS:

Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member.

CONCLUSIONS:

Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.