Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges,Annals of Intensive Care

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Chronic critical illness and post-intensive care syndrome: from pathophysiology to clinical challenges
Annals of Intensive Care ( IF 8.1 ) Pub Date : 2022-07-02 , DOI: 10.1186/s13613-022-01038-0
Guillaume Voiriot ₁ , Mehdi Oualha ₂ , Alexandre Pierre _{3,

4,

5} , Charlotte Salmon-Gandonnière ₆ , Alexandre Gaudet _{4,

5,

7} , Youenn Jouan ₆ , Hatem Kallel ₈ , Peter Radermacher ₉ , Dominique Vodovar _{10,

11,

12} , Benjamine Sarton _{13,

14} , Laure Stiel _{15,

16} , Nicolas Bréchot _{17,

18} , Sébastien Préau _{3,

6} , Jérémie Joffre _{19,

20,

21} ,

Affiliation

Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Paris, France.
Pediatric Intensive Care Unit, Necker Hospital, APHP, Centre - Paris University, Paris, France.
Institut Pasteur de Lille, U1167 - RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, 59000, Lille, France.
Department of Intensive Care Medicine, Critical Care Center, CHU Lille, 59000, Lille, France.
Faculté de Médecine de Tours, Centre d'Etudes des Pathologies Respiratoires, INSERM U1100, University Lille, Tours, France.
Service de Médecine Intensive Réanimation, CHRU de Tours, Réseau CRICS-TRIGGERSEP F-CRIN Research Network, Tours, France.
Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, 59000, Lille, France.
Service de Réanimation, Centre Hospitalier de Cayenne, French Guiana, Cayenne, France.
Institut für Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinikum Ulm, 89070, Ulm, Germany.
Centre AntiPoison de Paris, Hôpital Fernand Widal, APHP, 75010, Paris, France.
Faculté de Pharmacie, UMRS 1144, 75006, Paris, France.
Université de Paris, UFR de Médecine, 75010, Paris, France.
Critical Care Unit, University Hospital of Purpan, Toulouse, France.
Toulouse NeuroImaging Center, ToNIC, Inserm 1214, Paul Sabatier University, Toulouse, France.
Service de Réanimation Médicale, Groupe Hospitalier de la Région Mulhouse Sud Alsace, Mulhouse, France.
INSERM, LNC UMR 1231, FCS Bourgogne Franche Comté LipSTIC LabEx, Dijon, France.
Service de Médecine Intensive Réanimation, Sorbonne Université, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
College de France, Center for Interdisciplinary Research in Biology (CIRB)-UMRS INSERM U1050 - CNRS 7241, Paris, France.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, 94143, USA.
Medical Intensive Care Unit, Saint Antoine University Hospital, APHP, Sorbonne University, 75012, Paris, France.
Sorbonne University, Centre de Recherche Saint-Antoine INSERM U938, 75012, Paris, France.

Background

Post‐intensive care syndrome (PICS) encompasses physical, cognition, and mental impairments persisting after intensive care unit (ICU) discharge. Ultimately it significantly impacts the long‐term prognosis, both in functional outcomes and survival. Thus, survivors often develop permanent disabilities, consume a lot of healthcare resources, and may experience prolonged suffering. This review aims to present the multiple facets of the PICS, decipher its underlying mechanisms, and highlight future research directions.

Main text

This review abridges the translational data underlying the multiple facets of chronic critical illness (CCI) and PICS. We focus first on ICU-acquired weakness, a syndrome characterized by impaired contractility, muscle wasting, and persisting muscle atrophy during the recovery phase, which involves anabolic resistance, impaired capacity of regeneration, mitochondrial dysfunction, and abnormalities in calcium homeostasis. Second, we discuss the clinical relevance of post-ICU cognitive impairment and neuropsychological disability, its association with delirium during the ICU stay, and the putative role of low-grade long-lasting inflammation. Third, we describe the profound and persistent qualitative and quantitative alteration of the innate and adaptive response. Fourth, we discuss the biological mechanisms of the progression from acute to chronic kidney injury, opening the field for renoprotective strategies. Fifth, we report long-lasting pulmonary consequences of ARDS and prolonged mechanical ventilation. Finally, we discuss several specificities in children, including the influence of the child’s pre-ICU condition, development, and maturation.

Conclusions

Recent understandings of the biological substratum of the PICS’ distinct features highlight the need to rethink our patient trajectories in the long term. A better knowledge of this syndrome and precipitating factors is necessary to develop protocols and strategies to alleviate the CCI and PICS and ultimately improve patient recovery.

中文翻译：

慢性危重病和重症监护后综合征：从病理生理学到临床挑战

背景

重症监护后综合征 (PICS) 包括在重症监护室 (ICU) 出院后持续存在的身体、认知和精神障碍。最终，它显着影响长期预后，包括功能结果和生存。因此，幸存者往往会发展成永久性残疾，消耗大量医疗资源，并可能遭受长期痛苦。本综述旨在介绍 PICS 的多个方面，破译其潜在机制，并突出未来的研究方向。

正文

本综述删减了慢性危重病 (CCI) 和 PICS 多个方面的转化数据。我们首先关注 ICU 获得性虚弱，这是一种以恢复期收缩力受损、肌肉萎缩和持续肌肉萎缩为特征的综合征，包括合成代谢阻力、再生能力受损、线粒体功能障碍和钙稳态异常。其次，我们讨论了 ICU 后认知障碍和神经心理障碍的临床相关性，其与 ICU 住院期间谵妄的关联，以及低度持续炎症的推定作用。第三，我们描述了先天和适应性反应的深刻而持久的定性和定量变化。第四，我们讨论了从急性肾损伤发展为慢性肾损伤的生物学机制，为肾脏保护策略开辟了新领域。第五，我们报告了 ARDS 和长期机械通气的长期肺部后果。最后，我们讨论了儿童的一些特殊性，包括儿童的 ICU 前状况、发育和成熟的影响。