Understanding Post-Intensive Care Syndrome (PICS)

Post-intensive care syndrome (PICS) refers to a group of health problems that may occur in people who get hospital care for a severe illness or health threat. PICS often affects people who are in or have been in the intensive care unit (ICU).

PICS can cause physical and mental problems. It may lead to muscle weakness, trouble with brain function, and mood changes. These problems can delay a person’s full recovery from illness or injury.

PICS may also affect family members who have a loved one in the ICU. The intense stress of the situation may lead to sleep problems, anxiety, or depression. In this case, it is called PICS-family (PICS-F). When a child who has been in the ICU develops PICS, you may hear it called PICS in pediatrics, or PICS-p.

What causes PICS?

Experts don’t know what causes PICS. But it is more likely to occur in people who have been in the ICU for a long time. How often PICS occurs is not fully known. But it is estimated that over half of all people in the ICU have at least 1 of the problems seen with PICS.

Other things that may raise the risk for PICS include:

• Needing a machine to breathe (ventilator)

• Having mental or physical problems before going into the ICU

• Being on bed rest for a long time

• Having a severe infection called sepsis

What are the symptoms of PICS?

The symptoms of PICS vary from person to person. They can affect the body, mental health, or thinking (cognition), or a combination of all 3 areas. These health problems can start while in the ICU. Or they may occur weeks or months after leaving the hospital. They can include:

• Muscle weakness that impairs activities like walking or dressing

• Trouble with balance

• Problems thinking, focusing, or remembering

• Trouble sleeping (insomnia) and nightmares

• Depression

• Anxiety

• Posttraumatic stress disorder (PTSD)

PICS can be very disabling and last for a long time.

How is PICS treated?

The many health problems caused by PICS is best treated with a team of healthcare providers. Occupational and physical therapists can help with muscle weakness and problems with daily living. A mental health provider can help with depression and anxiety.

Can problems related to PICS be prevented?

If you have a loved one in the ICU and they have signs of PICS, you may be able to prevent some of the problems related to PICS. While they are in the hospital:

• Talk with them about past events and people.

• Remind them often of the day and time.

• Bring in pictures or favorite things from home.

• Help with exercises or other care if allowed.

To help protect yourself and family members from PICS, make sure to take care of yourself and each other. Getting enough rest, exercising, and eating healthy foods can help. Also reach out for support if you need help.

When to call the healthcare provider

If you or a loved one has spent time in the hospital for a major illness or injury, talk with a healthcare provider if you notice symptoms of PICS. Also call the healthcare provider right away if any of these occur:

• Fever of 100.4°F (38°C) or higher, or as advised by the provider

• Symptoms that don't get better or that get worse, such as anxiety, depression, or weakness

• New symptoms