Post-Intensive Care Syndrome After Prolonged Mechanical Ventilation: A Narrative Review of Physical, Cognitive and Psychological Recovery
DOI:
https://doi.org/10.5281/zenodo.22237032Keywords:
Post-Intensive Care Syndrome, Mechanical Ventilation, Cognitive Impairment, Delirium, RehabilitationAbstract
Intensive care has become steadily better at preventing death and no better at returning people to the lives they had. A substantial
proportion of survivors leave with cognitive impairment comparable in magnitude to a moderate brain injury, and it is not the
illness they were admitted with.
Objectives: To review the published evidence on post-intensive care syndrome after prolonged mechanical ventilation: what is
known about the physical, cognitive and psychological components, how severe and how persistent they are, and what
rehabilitation trials have and have not shown.
Material and Methods: Narrative review of prospective cohort studies, randomised trials of rehabilitation and follow-up
services, consensus statements and long-term outcome studies indexed in PubMed and the major critical care and general
medical journals. No new patient data were generated; every estimate quoted is one published by the original investigators.
Results: In a prospective cohort of adults with respiratory failure or shock, 40 per cent had global cognition scores at three
months worse than those typically seen after moderate traumatic brain injury, and 26 per cent had scores two standard deviations
below population means, comparable to mild Alzheimer's disease. At twelve months the corresponding figures were 34 and 24 per
cent. Only 6 per cent had documented cognitive impairment before admission. Impairment was not confined to older patients:
those aged 49 or under had median global cognition scores of 78 at three months and 80 at twelve, against a population mean of
100. Longer delirium duration was independently associated with worse cognition.
Conclusion: The syndrome is common, severe, largely new and only partly reversible. Randomised trials of rehabilitation and
follow-up clinics have repeatedly failed to improve these outcomes, which shifts the emphasis towards prevention during the
admission itself, and towards preparing patients and families for what recovery will actually involve.
Abbreviations: ARDS – Acute Respiratory Distress Syndrome, ICU – Intensive Care Unit, PICS – Post-Intensive Care Syndrome,
PTSD – Post-Traumatic Stress Disorder, RBANS – Repeatable Battery for the Assessment of Neuropsychological Status, SD –
Standard Deviation.
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