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Post Intensive Care Syndrome

Post Intensive Care Syndrome
Cheryl Esbrook, OTR/L, BCPR, Marla R. Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA
July 24, 2015
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Learning Objectives

Our learning objectives are to:

  • Identify the scope of PICS (Post Intensive Care Syndrome) and its implications for OT practitioners in various settings from acute care, rehab, home health, outpatient, and long-term care.
  • Understand the impact PICS may have on cognitive, psychosocial and physical functioning for individuals.
  • Describe the current gaps and barriers to meeting the needs for this patient population.
  • Identify occupational therapy interventions and application to clinical practice for this patient population.

Marla Robinson: I want to give a little background of my involvement with this topic.  In 2010, the Society for Critical Care Medicine created a task force that looked at long-term issues for patients surviving an ICU stay.  I was invited to be the AOTA representative on this task force.  We first met in 2010 and then we met again in 2012.  There are two publications that came out of these meetings, both of them are in Critical Care Medicine.  One addresses the long-term outcomes and was published in 2012.  The second one was published in December 2014  and looked at exploring the scope of Post Intensive Care Syndrome therapies. 

Post Intensive Care Syndrome (PICS)

What came out of this task force was the term Post Intensive Care Syndrome.  This is a constellation of disorders that affect ICU survivors, and these include such things as ICU-acquired weakness, mental health problems, as well as cognitive dysfunction or impairments.  It is a relatively new, recognized diagnosis and has implications for patients going to rehab settings. 

There is a limited amount of information available regarding the disorder.  More and more is coming up in the evidence and in the literature on a monthly basis.  It affects a person’s ADLs, IADLs, mobility, and limits their ability to participate in daily roles. 

Post Intensive Care Syndrome Family (PICS-F)

Post Intensive Care Syndrome Family, or PICS-F, describes what happens to the caregivers.  They experience a lot of anxiety, depression, impaired sleep, and a lot of these individuals, 30% of them, report these issues over an extended period of time. 

Intensive Care Prevalence

Five million patients are admitted to the ICU each year.  About half of those patients are over the age of 65.  Four million patients survive the ICU each year and half of those are over 65.  Up to 40% of these patients require mechanical ventilation.  Cheryl will talk to us more about those implications and what that means for those patients.  The mortality after discharge from ICU for patients over 65 is 14% at one year and 40% three years later.  If they required mechanical ventilation, mortality is significantly increased with it being 30% at six months and 58% at three years. 


cheryl esbrook

Cheryl Esbrook, OTR/L, BCPR

Cheryl Esbrook earned a degree in Occupational Therapy from Western Michigan University.  She has been practicing as an occupational therapist at the University of Chicago Medical Center focusing her treatment and research on the critical care patient populations in both the medical and surgical ICUs for 11 years.  She is also the coordinator of the occupational therapy fieldwork program for students at the University of Chicago as well as the first occupational therapy residency program in acute care.  She is involved with local occupational therapy programs to increase knowledge of the OT role in critical care.  Cheryl has presented at national and international conferences including the American Physical Therapy Association, the American Occupational Therapy Association, NTI, the American Thoracic Society and the Society for Critical Care Medicine.  Cheryl has made research contributions to the field of early mobility in the ICU with published articles in The Lancet and Critical Care Medicine.  Cheryl is an advocate and mentor for increasing OT presence in the ICUs participating in international roundtable programs and presenting associated topics to occupational therapy programs.  Her current emphasis is on developing methods to assess therapist competency in the ICU and increasing assessment of delirium and cognition in patients experiencing critical illness. She recently received her Board Certification in Physical Rehabilitation from AOTA.


marla r robinson

Marla R. Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA

Marla Robinson is the assistant director of inpatient therapy at the University of Chicago Medical Center.  She oversees the day-to-day operations for inpatient acute pediatric and adult acute care hospitals.  Her clinical work is with pediatric and adult acute care burn rehabilitation. She has research interests in burn rehabilitation.  She served on the development committee for the Burn Therapist Certification for the American Burn Association and was part of the first cohort of Burn Therapists-Certified. Marla has served on the Illinois Occupational Therapy Licensure Board as chair and as co-chair of the Chicago Area Council of OT Directors.  Marla has served AOTA in many capacities.  She served on the AOTA Board for Advanced and Specialty Certification as a member and chair, Chair of the Commission of Continuing Competence and Professional Development, AOTA representative for National Quality Forum for Patient-Reported Outcomes, AOTA representative for the Joint Commission Professional Technical Advisory Committee for Hospitals, AOTA representative for Society of Critical Care Medicine Task Force Long Term Consequences of PICs, Fellowship Site Reviewer, Chair of the Taskforce on Mentoring and as co-chair of the Chicago Area Council of OT Directors. 

Marla speaks nationally on burn rehabilitation and OTs role in preventing hospital readmissions.  She is passionate about continuing competence and ongoing professional development for occupational therapy practitioners.  She has authored book chapters on continuing competence, leading and managing in healthcare systems, and acute care management of gastrointestinal issues.



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