Need for improved care in and out of ICU to treat patients with PICS, PICS-F

Thanks to advances in modern medicine, more ICU patients are surviving critical illness, but most are unprepared for the challenges ahead for themselves and their families on their journey toward recovery.

A series of articles in the current issue of AACN Advanced Critical Care focuses on the potential crisis related to post intensive care syndrome (PICS), an umbrella term for new or worsening mental health, and physical and cognitive outcomes that linger after a critical illness. When those outcomes affect patients' family members, an "F" is added and the term becomes PICS-F.

In its April-June 2016 issue, the peer-reviewed journal features a symposium collection of four articles with specific examples of how healthcare organizations are addressing PICS and PICS-F.

The symposium is designed as a primer to promote new ideas and programs targeted at improving care in and out of the ICU to prevent and recognize the condition and treat patients with PICS and PICS-F.

One of the symposium articles, "Developing a Peer-to-Peer Support Program to Minimize PICS and PICS-F," discusses the merits of peer support groups as a potential solution to more effectively meet the needs of survivors of critical illness.

The article reviews the initial outcomes from six hospitals selected as inaugural sites for a network of in-person support groups, testing the feasibility of peer support and amassing a body of proven experience and skills to support ICU survivors. The collaborative is funded by the Society of Critical Care Medicine as part of its THRIVE initiative to support survivors of critical illness.

Lead author Mark Mikkelsen, MD, MSCE, is an assistant professor, department of medicine at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

"Millions of ICU survivors are being discharged into the community, unprepared and uneducated about what to expect and how best to cope, adjust and recover. Family members and caregivers are not immune to the psychological trauma of the ICU experience and may develop physical symptoms and social isolation," he said. "Innovative strategies are urgently needed to meet their needs, and peer support groups can do more than help individual survivors. They position the survivors themselves as experts key to finding solutions."

As another element of its THRIVE initiative, the Society of Critical Care Medicine created the MyICUCare website to provide answers to common questions from patients and their families about critical care, including PICS and what to expect after discharge.

Judy Davidson, RN, DNP, an evidence-based practice and research nurse liaison at University of California San Diego Health, with educational consultant Maurene Harvey, MPH, served as symposium editors.

"The science supporting these strategies is young, but in the absence of strong evidence, we have a duty to take action in the best interest of the health of our patients and our community," Davidson said. "We hope that the guidance offered in these articles will provide a compelling impetus for change."

Other articles in the PICS symposium series include:
•"Implementing a Mobility Program to Minimize PICS
•"A Clinic Model: PICS and PICS-F"
•"Developing a Diary Program to Minimize PICS and PICS-F"

In addition to the symposium, two of the regular columns in the journal address PICS and PICS-F. The Drug Update column focuses on medication management options related to PICS, while the Ethics column uses a historical case study to explore the ethics of PICS and PICS-F.