Post-Intensive Care Syndrome (PICS) In the Era of COVID-19: Psychiatric Morbidity, Long-Term Outcomes, and Models of Care

Saturday, November 12, 2022

9:15 AM – 10:45 AM

Location: Room 206-207

CE: 1.5 CME

Lead Speaker(s)

George E. Sayde, MD, MPH (he/him/his)

C-L Psychiatry Fellow
Columbia University
New York, New York

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Speaker(s)

Joe Bienvenu, MD, PhD

Professor of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine
Baltimore, Maryland

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James Jackson, PsyD

Director of Behavioral Health, ICU Recovery Center
Vanderbilt Medical Center
Nashville, Tennessee
Erin Dean, MD

Staff Psychiatrist
Cleveland Clinic
Cleveland, Ohio

Moderator/Discussant(s)

Rachel Hammer, MD

Associate Professor
Tulane University
New Orleans, Louisiana

Abstract: Patients enduring critical illness have high rates of mortality, morbidity, and increased healthcare utilization following discharge. A rise in intensive care unit (ICU) survivorship, particularly during this era of COVID-19, has created a rapidly growing population of patients and family members suffering from the long-term consequences of critical illness. 50-70% of ICU survivors will acquire Post-Intensive Care Syndrome (PICS): new or worsening dysfunction in physical weakness, cognitive impairment, or psychological disturbance. Within this cohort, the prevalence rates of post-traumatic stress disorder and depression are about 40% and 30%, respectively. How do we best care for this vulnerable population faced with many unmet needs and distress in the ICU setting and beyond?

ICU survivors carry complex, multifaceted impairments across physical, cognitive, and psychological domains which require a carefully coordinated, interdisciplinary approach. Existing evidence-based guidelines for ICU follow-up and recovery are limited. Additionally, there may be features of COVID-19 survivorship that are unique and distinct from what we currently understand about PICS. However, we seek to highlight common features among existing multidisciplinary programs, such as coordination among physical medicine and rehabilitation, social work, pharmacy, primary care, and psychiatric departments.

In this workshop, we present an overview of PICS with special attention to adaptations made since the pandemic began, including: trauma-focused frameworks, the question of long-COVID, attention to physical recovery and somatization, processing of near-death experiences, and persistent delusional memories and delirium. As consultation-liaison psychiatrists specializing in PICS, we have a unique role to understand and define the syndrome, and to integrate ourselves into care models that serve this population.

George Sayde MD, MPH is a chief resident at Tulane University's internal medicine-psychiatry combined program. Dr. Sayde will present on ICU-related psychological morbidity within two cohorts, pre- and post-COVID-19 pandemic. He will also discuss the efficacy of various interventions - including ICU diaries, bedside psycho-education, and PICS recovery models.

O. Joseph Bienvenu, MD, PhD is a Professor of Psychiatry and Behavioral Sciences at Johns Hopkins. Dr. Bienvenu will present on the epidemiology of distress-related psychiatric morbidity (e.g., post-traumatic stress and depressive states), including prevalence, risk factors, and consequences. He will discuss the utility of preventive efforts, particularly in patients at high risk for prolonged psychiatric morbidity.

James Jackson, PsyD is a neuropsychologist and professor at Vanderbilt University. Dr. Jackson will present on long-term cognitive and mental health outcomes in ICU survivors, in addition to neuropsychological issues arising after COVID-19.

Erin Dean, MD is a consultation-liaison psychiatrist at Cleveland Clinic. Dr. Dean will present on her institution's Post-ICU Recovery Clinic model and mental health outcomes in ICU survivors.

Rachel Hammer, MD, MFA is an Associate Professor of Psychiatry and Assistant Professor of Internal Medicine at Tulane University. Dr. Hammer will be moderating this workshop.

Learning Objectives:

Define and recognize post-intensive care syndrome (PICS) and the multifaceted impairments patients endure across multiple symptom domains.
Interpret the epidemiology of ICU-related psychiatric morbidity, including prevalence, risk factors, and consequences both pre- and post-COVID-19 pandemic.
Discuss post-ICU recovery models of care, and how the existing framework can be adapted by C-L psychiatrists to incorporate a burgeoning ICU survivor population in the age of COVID-19.