The Intensive Care Service of Hospital Universitario La Paz (Madrid) has started the program for the detection and follow up of Post Intensive Care Syndrome (PICS). PICS is an entity recently described, that affects to a significant number of patients and that covers a wide group of health problems maintained after the critical disease. In general, we can divide these health alterations between physical (persistent pain, acquired weakness, malnutrition, pulmonary morbidity…) and psychological (anxiety, depression, nightmares, post-traumatic stress, loss of memory and mental speed…).
The components of the project are:
• The preventive measures during the ICU stay.
• The monitoring on ward hospitalization after ICU discharge of patients with risk of PICS.
• The review after hospital discharge (we have created a open agenda exclusively to this).
Patients are cited three months after hospital discharge. The activities to perform in the follow up consultation are: anamnesis and review on the patient situation after discharge, physical exploration, evaluation of respiratory function, evaluation of muscle force, evaluation of the quality of life, psychological and cognitive valuation as well as family valuation. Depending on the characteristics of each patient, we will rewiew them again at three, six or twelve months or we proceed to discharge if they don´t have alterations requiring successive reviews. Also, depending on the alterations found, the patients can be derived to the corresponding specialists. We work together with the Psychiatry and Rehabilitation services for the implementation of this programme.
Although PICS and follow-up consultation are concepts that are being implemented in countries such as United Kingdom, United States or Canada, in our country this is still an issue on which work and investigate. Our project is framed in the program 6 “Prevention, Management and Follow-up of Post Intensive Care Syndrome ” included the ICU Humanisation Plan of the Goverment of Madrid.
We are starting a job that, until now, was not a part of the scope of Intensive Care Medicine. Fortunately the conceptual changes in our specialty has made the intensivist not only is specialist locked in the walls of the ICU. Within this philosophy, the project aims to offer the best quality of care to the critical patient not only before and during but also “after” have overcome the critical illness and “to ensure” total integration into everyday life in optimal conditions of health both physical and psychologycal.
By José Manuel Añon, head of section of the ICU of Hospital Universitario the Paz-Carlos III IdiPaz