Post-Intensive Care Syndrome (PICS) Treatment

Effective treatment for post-intensive care syndrome (PICS) is available. At Neural Effects, we treat PICS with a multidisciplinary approach, including the use of physical therapy, cognitive therapy, vestibular therapy, and more. Here, we explain what PICS is, which symptoms it causes, how it’s diagnosed, and what treatment is most effective for recovery.


What Is Post Intensive Care Syndrome (PICS)?

Post-ICU syndrome (PICS) occurs when ICU patients develop cognitive, emotional, and physical symptoms after treatment in an intensive care unit (ICU). PICS can last for weeks, months, or even years after hospital discharge.

blub.svg More than half of patients who need hospitalization in an ICU unit develop PICS.

A variety of circumstances can cause PICS, including:

  • The medical condition that sent the patient to ICU, such as respiratory failure, COVID-19, or sepsis.

  • The use of life-sustaining equipment such as endotracheal tubes and mechanical ventilators.

  • The use of sedatives, pain meds, and other medications with serious side-effects.

To be considered PICS, symptoms must be new or get significantly worse after the patient stayed in an ICU. If the symptoms derive from a pre-existing condition and stay the same after ICU, they are not considered to be PICS.

Post Intensive Care Syndrome (PICS)
Cognitive Symptoms
Emotional Symptoms
Physical Symptoms
Effects on Caregivers
  • Impaired memory 

  • Deficits in executive functioning

  • Difficulty processing information

  • Difficulty communicating with others

  • Difficulty focusing and concentrating

  • Difficulty completing tasks

  • Difficulty learning new information

  • Difficulty with decision-making

  • PTSD (causing nightmares, unwanted memories, and stress)

  • Anxiety

  • Depression

  • Muscle weakness, primarily in the arms and legs (called ICU-acquired weakness) 

  • Fatigue

  • Poor mobility

  • Difficulty breathing and other respiratory problems

  • Sleep disturbances 

  • Poor immune response

  • Increased risk of bone fractures

  • Swallowing problems

  • Hormonal issues

  • Chronic pain

  • Excessive weight loss

  • Anxiety 

  • Depression

  • Feeling overwhelmed

  • Stress

  • Post-traumatic stress disorder (PTSD)

  • Changes in sleep

  • Grief

Cognitive Symptoms

Cognitive symptoms affect about 3 out of 4 ICU survivors with PICS. Without treatment, poor cognitive function can persist for years and can significantly lower the patient’s quality of life and interfere with activities of daily living (ADLs). Cognitive impairment from PICS can limit a patient’s ability to work and impact relationships with carers and family members.

Emotional Symptoms

About 2 out of 3 patients also experience emotional and behavioral symptoms of PICS, such as depression and post-traumatic stress disorder (PTSD). These symptoms are more likely to develop in critically ill patients who don’t remember their time in ICU or who have limited or frightening memories. This is not surprising given that facing imminent death and dealing with multiple medical issues can be extremely traumatic.

Physical Symptoms

Physical impairments affect at least 1 in 3 patients after a period in intensive care. These symptoms can reduce mobility and severely affect how patients perform daily activities, such as showering or getting dressed. Without treatment, patients may take years to fully recover their physical function.

Effects on Family Members

A critical illness doesn't just affect the patient; it impacts the whole family. For example, feeling stressed and worried often causes family members to stop looking after their own health. It can also be overwhelming for family members to make important decisions about their loved one’s health, especially if it potentially involves end-of-life care. As a result, up to 40% of family members experience their own mental health problems. This is often referred to as PICS-Family or PICS-F. 

Which Patients Are at Risk of Developing PICS?

PICS can affect any patient who spends time in an ICU unit, including those who were healthy prior to their hospital stay. However, patients are more likely to develop PICS if they have any of the following risk factors:

  • Pre-existing health problems, such as lung disease or muscle disorders

  • Pre-existing cognitive dysfunction or dementia 

  • Depression or anxiety before or during their time in ICU

  • Serious sequelae during their time in ICU, such as severe infections, acute respiratory distress syndrome, delirium, low oxygen levels, low blood pressure, or any other conditions with high morbidity 

  • A lengthy amount of time spent on mechanical ventilation

  • Older age

  • An extensive stay in ICU, especially if heavily sedated

  • Multi-organ failure or sepsis

  • A heavy medication load

Can Patients with COVID-19 Suffer PICS?

Not surprisingly, patients with COVID-19 who were in ICU are at high risk of developing PICS symptoms, including fatigue, poor cognitive function, muscle weakness, anxiety, and depressive symptoms. Limited visits from friends and family, prolonged use of mechanical ventilation, and lack of physical therapy due to the risk of disease transmission likely aggravate symptoms.

How Is PICS Diagnosed?

Because PICS can cause so many different symptoms, there’s no specific test to diagnose it. Typically, diagnosis is done based on the patient’s history and the development of new or worsening symptoms after a period in ICU.

Hospitals do screen for PICS at discharge, but since PICS usually develops after ICU discharge, patients need to rely on their own primary care provider who may not have the necessary ICU experience. Often, it’s the patient or family members who first recognise the symptoms of PICS.

At Neural Effects, we evaluate patients based on:

  • The patient’s medical history, with a strong focus on their ICU stay.

  • The patient’s responses to a detailed symptom questionnaire.

  • The results of an in-depth cognitive and physical examination.

Problems with Common Treatment Approaches

Most facilities offer treatments and interventions for individual PICS symptoms—not for the condition as a whole. For example, if patients experience muscle weakness after a long time in bed, they’re referred to a physical therapist or occupational therapist. If they experience depression or anxiety, they get a psychiatry referral for psychotherapy. If they notice a cognitive decline, they receive cognitive and memory therapy. 

While this approach can help, it requires patients to visit multiple clinicians and other healthcare providers who often don’t communicate with each other about the patient’s progress. This leads to patients getting “lost” in the healthcare system and suffering delays in accessing the follow-up care they need. 

Treatment for Post-ICU Syndrome at Neural Effects

At Neural Effects, we believe a better approach is to target PICS head-on. We offer a multidisciplinary treatment regimen that combines cardio exercise and cognitive therapy, vision and vestibular rehabilitation, and neuromuscular therapy. Multiple studies have shown that combining therapies to address PICS as a whole produces better results than addressing each symptom in isolation.


Therapy Sessions

Once the initial examination is finished, our team can combine all the results and devise a treatment plan for each patient. Most patients come in for three, one-hour sessions spanning two weeks. Each session may include a combination of exercises from the following disciplines:

Physical therapy

Sessions start with a short burst of aerobic exercises, usually on a stationary bike or treadmill. The aim is to improve blood flow in the brain and trigger a mechanism called the post-exercise cognitive boost (PECB). PECB promotes the release of important neurochemicals, including a chemical called brain-derived neurotrophic factor (BDNF), which helps the brain adapt to change and boosts the impact of subsequent therapies.

Cognitive and occupational therapy

Patients engage in a series of cognitive exercises such as logic puzzles, memory games, and pattern-finding puzzles. These exercises can improve cognitive deficits in patients suffering from PICS, such as memory loss, brain fog, and difficulty concentrating.

Vision therapy

Symptoms associated with vision are common in PICS patients. Our therapists guide patients through a series of exercises to improve vision symptoms, such as eye strain, which can cause headaches, and blurry vision.

Vestibular therapy

Our therapists also use various exercises to treat vestibular dysfunction, a condition that can cause dizziness, lightheadedness, and difficulty balancing.

Neuromuscular therapy

Patients receive massage and engage in therapeutic exercises to relieve muscle pain caused by trigger points, muscle soreness, and other problems.

After-Treatment Support for Patients and Families

After each session, patients receive a series of exercises to complete at home. Typically, these include aerobic exercises, cognitive activities, and relaxation techniques. Completing these exercises significantly boosts your chances of a fast and complete recovery.

Educating and supporting carers and loved ones is also a big part of our treatment. Often, families suffer from their own emotional issues, such as anxiety and depression, and need our help. We offer counseling and recommend local resources for these family members.

We provide rapid and reliable PICS treatment directed by a team of multidisciplinary specialists

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What Can I Do to Help My Recovery at Home?

The road to recovery for survivors of critical illness can be long and difficult. Here are some steps you can take at home to improve long-term outcomes and reduce incidence of further symptoms:

  • Engage in regular physical activity. This will help you sleep better and recover from muscle weakness. 

  • Follow a healthy diet.

  • Take frequent breaks during the day to rest.

  • Follow a healthy sleep pattern.

  • Keep the brain active by engaging in cognitive activities and games.

  • Seek psychiatric help if you’re experiencing mental health problems, such as anxiety and depression.

  • Keep in touch with loved ones. You may find that talking to close friends about how you feel will help you get back to normal.

  • Check with your doctor regularly, especially if you’re experiencing new symptoms.

  • Find a support group in your area. Talking with other patients in similar situations may help you come to terms about what happened to you in ICU.

We provide rapid and reliable PICS treatment directed by a team of multidisciplinary specialists
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