Post-Intensive Care Syndrome

The book Post-Intensive Care Syndrome represents a timely focused analysis of a hot topic for intensive care unit (ICU) clinicians and is part of the “Lessons from the ICU” series, published under the auspices of the European Society of Intensive Care Medicine. The editors are university professors and have extensive background in intensive care (Jean-Charles Preiser, Brussels; Margaret Herridge, Toronto; Elie Azoulay, Paris). The 68 authors come from all around the world, and their experience includes critical care, surgery, rehabilitation, neurosciences, and nutrition. The so-called postintensive care syndrome (PICS) includes physical, cognitive, and psychological sequelae, occurring independently of the reason for ICU admission. Up to one-third of ICU survivors may develop PICS, with significant burden and costs for patients, caregivers, and society. The post-ICU trajectory has only recently become a topic of interest for intensivists: this book, with its up-to-date chapters relating to the state-of-the-art, outlooks, and challenges in the field of PICS, provides effective background for ICU physicians. This book offers detailed evidence on PICS: physical, cognitive, and psychological impairments are exhaustively described throughout the text. The importance of rehabilitation/therapeutic programs and preventive strategies is duly highlighted, as well as the need for a well-structured follow-up and a prompt identification of patients at risk for PICS. The book is divided into 4 parts: an introduction and 3 main sections regarding physical impairment, cognitive/psychological impairment, and rehabilitation. In turn, each section is divided into numbered chapters; each chapter starts with some “learning objectives” and ends with a few “take-home messages,” which help the physician focus on key aspects. The style is clear, and the writing structure is easy to read. There is a detailed and updated bibliography at the end of each chapter. The Introduction embraces the historical perspective of PICS: at the beginning of critical care, the main, limited concern was patient’s survival to ICU discharge. It is very interesting to know that the first paper ever to include a follow-up of ICU survivors was published in the New England Journal of Medicine in 1976. This was just an exception, because we need to wait until the mid-1980s to have a more systematic follow-up of ICU survivors. The standardization of measurements for health-related quality of life, through the introduction of validated questionnaires, is another milestone that is properly emphasized. The second section focuses on physical impairment. It explores the pathophysiology of ICU-acquired weakness and critical illness neuromyopathy, caused by skeletal muscle loss and/or dysfunction of neural axis, and possible therapeutic approaches. It also describes the endocrinopathy of critical patients, the post-ICU diabetes, and the ICU-acquired immunosuppression. An interesting topic is discussed in Chapter 6, “Functional Outcomes Following Critical Illness”: the need for multidimensional outcomes (functional, neuropsychological and of mental health) and their combination with health-related quality of life is once again appropriately remarked. The third section includes the analysis of cognitive/psychological impairment. The posttraumatic stress disorder (PTSD) is an emotional distress that occurs in people following a trauma, and critical illness and ICU admission act as a major trauma: Chapter 12 not only explores the risk factors and biological mechanisms for PTSD in ICU survivors but also suggests strategies for the prevention of the distress such as the use of ICU diaries. Another crucial topic is addressed in Chapter 16, “Behavioral Therapies”: patients can be taught coping skills to “manage and reduce symptoms on their own.” At the end of this section, the authors explore the impact of PICS on relatives of critically ill patients: anxiety, depression, and PTSD can be common in families and caregivers. The fourth section focuses on rehabilitation: first, it shows modalities for physical rehabilitation; then, it emphasizes the importance of a well-balanced nutritional support to enhance the synthesis of muscle proteins after the breakdown due to the critical illness and to prevent gut diseases which facilitate bacterial translocation. Chapters 22 and 23 highlight the importance of follow-up consultations after ICU discharge: this continuity of care is highly valued by patients and relatives, and it is an important opportunity to discuss their concerns, provide feedback of their experiences, and orientate the subsequent treatments. To sum up, Post-Intensive Care Syndrome is complete and clear, and it can be recommended for both trainees and board-certified specialists. This book is a true “eye-opener,” raising the awareness about the importance of improving long-term functional, psychological, and cognitive outcomes of critical patients, and providing new insights on how our interventions during and after ICU stay may impact the quality of life of survivors and their families. Giovanni Landoni, MDDepartment of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilan, ItalyVita-Salute San Raffaele UniversityMilan, Italy[email protected]Margherita Tozzi, MDDepartment of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilan, ItalyLuca Cabrini, MDDipartimento di Biotecnologie e Scienze della VitaUniversità degli Studi dell’InsubriaAzienda Ospedaliera Ospedale di Circolo e Fondazione Macchi di VareseAzienda Socio-Sanitaria Territoriale dei Sette LaghiVarese, ItalyCarlo Leggieri, MDDepartment of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilan, ItalyAlberto Zangrillo, MDDepartment of Anesthesia and Intensive CareIRCCS San Raffaele Scientific InstituteMilan, ItalyVita-Salute San Raffaele UniversityMilan, Italy

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