How to Recognize and Manage Post-ICU Syndrome in Neurological Practice (Podcast)

More than 20% of patients released from a medical or surgical ICU experience some cognitive dysfunction — most at the same level as someone with traumatic brain injury and up to 10% at the same level as someone with Alzheimer’s disease.

Post-ICU syndrome, which also manifests with physical and psychiatric symptoms, is an emerging phenomenon being studied by Joao Gomes, MD, Head of the Neurointensive Care Unit in Cleveland Clinic’s Cerebrovascular Center. He discusses the condition in detail in the newest episode of Cleveland Clinic’s peer-to-peer Neuro Pathways podcast.

This episode touches on:

• How post-ICU syndrome presents and how it can affect a patient’s recovery
• Whether patients recovering from a brain injury are more susceptible to post-ICU syndrome
• Cleveland Clinic’s new post-ICU clinic, which will offer telemedicine visits to screen for depression, anxiety, PTSD, cognitive decline and other conditions
• Why families of patients with post-ICU syndrome may require special attention as well
• Helping patients recover from memory gaps and delirium with ICU diaries

Click the player below to hear the podcast, or read on for a short edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

Excerpt from the podcast

Dr. Alex Rae-Grant (podcast host): What is post-ICU syndrome, and how did it come to be recognized?

Dr. Gomes: One has to go back primarily to literature from medical and surgical ICU populations. Some of our colleagues in those units started noticing that patients who survive an episode of sepsis or severe acute respiratory distress syndrome or respiratory failure would go back to their outpatient clinic with a lot of complaints that were not related to the primary reason for admission. They had a lot of anxiety and post-traumatic stress disorder, cognitive problems, even physical disability that was not explained by the reason for their admission. That conglomerate of symptoms and signs is what has been labeled as post-ICU syndrome.

Now we’ve recognized manifestations in three big areas. One is physical. Many of these patients have difficulty walking, difficulty with balance. Their stamina is certainly decreased after a major critical care episode.

The second area is psychiatric. The incidence of depression, PTSD and anxiety is quite high — up to 30% of patients admitted to a general medical or surgical ICU experience symptoms that would meet diagnostic criteria for one of these major psychiatric disorders.

The third component is cognitive. There is certainly something going on, whether it is sleep deprivation or just a systemic inflammatory response — perhaps hypoxia in some cases. Some of the medications we use for these definitely lead to cognitive decline and other symptoms.