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Table 1 Major post-intensive care complications

From: Management of COVID-19 ICU-survivors in primary care: - a narrative review

Sequelae Description Key symptoms Example risk factors Screening Diagnosis Treatment Prognosis
Pulmonary function • Obstruction, restriction and impaired diffusing capacity
• Mostly following ARDS
• Shortness of breath
• Reduced exercise capacity
Duration of mechanical ventilation No consensus on recommended measure [6] • Spirometry
• Lung volumes
• Diffusion capacity
Pulmonary rehabilitation program [5] Generally:
• mild impairment
• improves during first year
Neuro-muscular function • Joint contractures
• Muscle weakness, including:
-CIP
-CIM
-Disuse atrophy
• Reduced joint range of motion
• Symmetric, distal and flaccid limb weakness
• Reduced or absent deep tendon reflexes
• Loss of peripheral sensation
• Relative preservation of cranial nerve function
• Sepsis
• Mechanical ventilation
• Hyperglycemia
• Use of glucocorticoids or neuromuscular blocking agents
• Immobility/ bed rest
• Hand grip and/or Manual Muscle Test [11]
• MRC scale [12]
• Nerve conduction study
• Electromyography
• Muscle ultrasound
• Creatine kinase level (in ICU)
• Tailored rehabilitation across healthcare continuum, including PT and OT [5]
• Home exercise [13]
• Nutritional advice in case of malnutrition
• Assistive devices
• CIP may recover more slowly than CIM
• Abnormalities extend beyond five years
• May not return to pre-ICU baseline status [5]
Physical function Impairment in activities of daily living and walking distance • Older age
• Preexisting impairment
6MWT [14],4MGS [15]
ADL/ IADL, (ICF) [16]
Dysphagia Swallowing impairment • Prolonged intubation
• Gastrointestinal comorbidity
• ICUAW
Early consultation to a SLP [17] Swallowing exercises with SLP [17] Recoveries typically take more than 6 month
Mental Health Depression • Depressed mood
• Loss of interest, fatigue
• Sedation
• Traumatic/delusional memories of ICU
• Pre-ICU psychiatric history
• Female gender
• Poverty
• Not associated with severity of illness
HADS [18]*
PHQ-2/9 [19]
DSM-5 diagnostic criteria, [20] semi-structured interview • Psychotherapy
• Antidepressants
May persist over first year [21]
Anxiety • Excessive worry, difficult to control HADS [18]*
OASIS [22]
GAD2/7 [23]
• CBT [5]
• Anxiolytics
May have little improvement over first year [24]
PTSD • Intrusive memories
• Avoidance of stimuli associated with the ICU
• Dissociative reactions
• Irritable behavior
IES-6 [25]*
PTSS-10 [26]
• Talking about ICU experiences
• Psychotherapy
• Avoid benzodiazepines
• Onset may be
delayed [27]
• Little improvement in first year
Cognition Impairments in
• memory • attention
• executive function • mental processing
• visuo-spatial ability speed
• Prior cognitive deficit
• Duration of ICU delirium
• Older Age
• Cerebral Hypoxia
• Hypotension
• Hypoglycemia
MoCA [28]
MoCA
Blind*
Exclusion of reversible causes for dementia as:
• Hypothyroidism
• Cognitive rehabilitation
• Assistance in organizing daily life
• May improve during first year
• Residual deficits up to six years later
Family PICS-F includes
• Anxiety
• Depression
• PTSD
• Complicated grief
see “Mental Health” • Female gender
• Younger age
• Less education
• Pre-ICU psychiatric history
• Distance to hospital
• Dissatisfaction with ICU communication
see “Mental Health” • See “Mental Health”
• Inclusion of family member into decision making
• Involvement of trained nurse or social worker
PTSD and complicated grief may persist longer (over years) than
depression and anxiety
  1. Selected key symptoms, risk factors, screening instruments and treatment options of major post-intensive care complications. Modified from Mikkelsen et al. [29, 30], Desai et al. [31] and Schmidt et al. [32] without claim to completeness. Further scales are provided by Smith et al. 2020 [33].
  2. * internationally agreed upon for acute respiratory failure survivors [6]