Prevention of post-intensive care syndrome (PICS)

109 p.ill.,1 INTRODUCTION 7 -- 2 POST-INTENSIVE CARE SYNDROME: DEFINITION, BURDEN, CONSEQUENCES AND RISK FACTORS 9 -- 2.1 PHYSICAL OUTCOMES: ICU-ACQUIRED WEAKNESS 9 -- 2.2 MENTAL HEALTH OUTCOMES 10 -- 2.3 COGNITIVE OUTCOMES 10 -- 2.4 OTHER PATIENT OUTCOMES 11 -- 2.5 CONSEQUENCES ON FAMILY MEMBERS OR INFORMAL CAREGIVERS 11 -- 2.6 RISK FACTORS OF POST INTENSIVE CARE-RELATED OUTCOMES 11 -- 2.6.1 Pre-existing health conditions 12 -- 2.6.2 ICU-associated factors 12 -- 2.6.3 Post-ICU risk factors 12 -- 3 SCIENTIFIC EVIDENCE FOR INTERVENTIONS FOCUSED ON PICS-PREVENTION 14 -- 3.1 AIM 14 -- 3.2 METHODS 14 -- 3.3 RESULTS 15 -- 3.3.1 Pharmacological interventions 15 -- 3.3.2 Mechanical ventilation strategies 23 -- 3.3.3 Environmental interventions 24 -- 3.3.4 ICU diaries as intervention 25 -- 3.3.5 Psychotherapeutic interventions 26 -- 3.3.6 Patient education as intervention 26 -- 3.3.7 Interventions focused towards family and relatives 27 -- 3.3.8 Multi-modal interventions 28 -- 3.3.9 Physiotherapeutic interventions 29 -- 3.3.10 Neuromuscular electrical stimulation (NES) 31 -- 3.3.11 Nutritional interventions 31 -- 3.3.12 Complementary medicine interventions 33 -- 3.4 DISCUSSION 34 -- 4 IMPLEMENTATION OF PICS PREVENTION 34 -- 4.1 AIM 34 -- 4.2 METHOD 34 -- 4.3 IMPLEMENTATION TOOLS 35 -- 4.3.1 Background 35 -- 4.3.2 The PAD guideline 35 -- 4.3.3 The PADIS guideline 36 -- 4.4 THE ABCDE(F) BUNDLES: TRANSLATION OF THE PADIS GUIDELINE INTO PRACTICAL TOOLS 36 -- 4.5 IS THE USE OF THE ABCDE(F) BUNDLE EFFECTIVE? 37 -- 5 BARRIERS AND FACILITATORS TO ADOPT PICS PREVENTION INTERVENTIONS 39 -- 5.1 AIM 39 -- 5.2 LITERATURE SEARCH 39 -- 5.2.1 Databases and date limits 39 -- 5.2.2 Search strategy 40 -- 5.2.3 Inclusion/Exclusion criteria 40 -- 5.2.4 Analysis 40 -- 5.3 FINDINGS 40 -- 5.3.1 Preamble: classification of barriers and facilitators 40 -- 5.3.2 Barriers and facilitators to the adoption of bundles 43 -- 5.3.3 Barriers to specific interventions 45 -- 5.4 LIMITATIONS 68 -- 6 PREVENTION OF PICS IN BELGIUM 68 -- 6.1 INTENSIVE CARE UNITS IN BELGIUM 68 -- 6.1.1 Definition and status 68 -- 6.1.2 Licensing standards for intensive care function 70 -- 6.2 RISK FACTORS OF PICS IN BELGIUM 70 -- 6.2.1 Characteristics of patients at ICU admission 71 -- 6.2.2 Risk factors of PICS during ICU stay 74 -- 6.3 INITIATIVES TO PREVENT PICS IN BELGIUM 77 -- 6.3.1 Introduction 77 -- 6.3.2 Methods 77 -- 6.3.3 Results 77 -- 7 DISCUSSION 80 -- 8 CONCLUSION 8