Post Intensive Care Syndrome in Two-Thirds With Major Burns

Despite recent progress, the management of patients with burns remains challenging, especially for those who are severely burned. In 2012, investigators described Post Intensive Care Syndrome (PICS) in critical illness survivors, which was defined as new or worsening changes in physical, cognitive, or men-tal health status that occurred during or after an ICU hospitalization and persisted for 5-15 years thereafter. Patients with severe burns often have a combination of primary risk factors associated with PICS, including delirium, pain, prolonged mechanical ventilation, and sedation. “Understanding the unique risks and outcomes for this population is crucial to developing recommendations and interventions to help limit the development of PICS and improve long-term outcomes for survivors of burns,” says Dan Carel, MScN, RN.

For a study published in Burns, Carel and colleagues sought to identify the prevalence of PICS symptoms after ICU discharge in patients with severe burns and to detect associations between PICS and clinical characteristics. “Our study is particularly important, because this population of burn survivors has not been well represented in previous analyses on PICS,” Carel says. The primary inclusion criteria were major burns covering more than 20% of body surface area (BSA%) and ICU admission. PICS components were assessed using three questionnaires. If at least one of these components was abnormal, PICS was deemed to be present.

PICS Prevalence High Among Patients With Burns

Among the 288 patients admitted during the study period, 132 met the inclusion criteria and 53 were enrolled. “Our most important finding was that patients with burns who required intensive care were at higher risk for developing PICS when compared with other populations, with a prevalence of 66%,” says Carel. The study also showed that more than one component of PICS (functional, cognitive, or mental health) was altered in 60% of patients. About 25% of patients with severe burns had simultaneous impairment of all three PICS components when assessed several years after sustaining their injury, suggesting greater vulnerability for individuals with these characteristics.

In a comparison of patients with and without PICS, the researchers observed longer ICU stays in those with PICS (Figure), as well as more septic episodes. “We identified four major risk factors for PICS, including use of more than three general anesthetics and prolonged mechanical ventilation (>4 days), ICU stay (>8 days), and hospital stay (>25 days),” Carel says.

Of note, persistence of PICS symptoms for several years was significantly associated with severity of the condition. Among the three components of PICS, mental health symptoms were most frequently observed, occurring in 47% of participants. Approximately 43% had perceived impairment of memory, and 47% exhibited symptoms of anxiety and/or depression several years after their injury. “These data suggest that PICS can significantly impact QOL and highlight the need to implement preventive measures in the ICU specifically for patients with burns,” says Carel.

Efforts Needed to Enhance Preventive Care & Post Discharge Support

According to Carel, clinicians who treat patients with burns should be aware of the high prevalence of PICS and recognize that symptoms may persist for years after the injury. “Clinicians should actively monitor patients for symptoms in functional, cognitive, or mental health domains and take a holistic approach to treatment,” he says. “To reduce PICS risk, clinicians can implement strategies to minimize ICU and hospital stays and reduce the need for invasive procedures. These strategies include early rehabilitation and management of pain and other complications to reduce needs for prolonged mechanical ventilation and general anesthesia. Post-discharge physical and psychological support is also critical to helping mitigate the long-term effects of PICS.”

Overall, the study findings emphasize the importance of taking a proactive and multidisciplinary approach to treating patients with burns and reducing risks for PICS. “Future research should focus on understanding the long-term outcomes of PICS in patients with burns, including the persistence of symptoms and their impact on QOL,” says Carel. “We also need to investigate the effectiveness of interventions to prevent or mitigate PICS, including rehabilitation programs, psychological support, and medications. These interventions could help reduce the risk for PICS and improve the long-term outcomes for patients with burns.”