Several measures, such as patient mobilization, pain management and the involvement of relatives, can have a beneficial impact on the prevention of post-intensive care syndrome, indicates the Federal Center for Expertise in Healthcare (KCE ) in a report published this Friday. A syndrome which can also affect Covid patients who have stayed in intensive care. However, the widespread implementation of these measures requires greater staff resources.
Officially recognized since 2012, Post-intensive Care Syndrome (PICS), which affects up to 40% of patients who have had an extended stay in an intensive care unit, is one of the setbacks of Medical progress. Indeed, long-term immobilization, mechanical ventilation and prolonged administration of powerful sedatives can lead to persistent extreme muscle weakness, cognitive problems, such as memory and concentration disorders, or even psychological sequelae, such as anxiety, depression or post-traumatic stress. The latter can also affect the relatives of the patients.
Based on the existing scientific literature, the KCE recommends measures relating to several points. First of all, the management of pain, which is often present even in unconscious patients and which is a factor in the development of post-traumatic stress. The center also advises reducing the duration of mechanical ventilation as much as possible and administering the minimum necessary sedatives, while regularly trying to wake the patient up in order to promote spontaneous breathing.
To reduce the risk of delirium, a frequent state of confusion in patients in intensive care, the KCE suggests keeping the patient in touch with reality, in particular by maintaining the day-night cycle. It is also important to mobilize the patient as soon as possible in order to “maintain muscle strength and functional abilities.”
Finally, contact with relatives plays a decisive role, believes the KCE. He therefore recommends encouraging visits, by extending visiting hours, and maintaining “clear, open and supportive communication with families.” These measures are both useful for the patient and for his relatives, who are also at risk of developing the syndrome, recalls the Center.
In conclusion, The KCE explains that, if these measures are already implemented by some intensive care centers in Belgium, the practice is far from being generalized. He also adds that these require “significant staff resources, in particular an increase in the number of nurses and physiotherapists.” “In addition, elements such as the quality of leadership, communication and coordination between caregivers, and staff stability are also important here, because they are the keys to creating a real motivation for change in the ‘culture ‘ and habits within intensive care units”, concludes the Federal Center.