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Vol. 44. Issue 8.
Pages 522-523 (November 2020)
Vol. 44. Issue 8.
Pages 522-523 (November 2020)
Letter to the Editor
DOI: 10.1016/j.medine.2020.08.001
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Post-intensive care syndrome after SARS-CoV-2 pandemic
Síndrome post-cuidados intensivos después de la pandemia por SARS-CoV-2
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A. González-Castroa,
Corresponding author
, A. Garcia de Lorenzob, P. Escudero-Achaa, J.C. Rodriguez-Borregana
a Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
b Servicio de Medicina Intensiva, Hospital Universitario La Paz/Carlos III, IdiPAZ, Madrid, Spain
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Sir,

The worldwide SARS-CoV-2 pandemic is taking health systems to the edge of collapse and Intensive Care Units (ICUs) to work burdens that exceed their capacity. In the first wave of the pandemic, maximum priority has focused on keeping mortality as low as possible, and in this regard critical care has become a crucial factor.

However, the future of the SARS-CoV-2 pandemic comprises different horizons: a second wave is to be expected because of resource restrictions in relation to non-SARS-CoV-2 urgent disease conditions, with a rise in mortality due to a saturated system.1 Likewise, although reasonably not on an immediate basis, the pandemic will have an impact upon our more chronic patients, who have suffered a decrease in their quality of care during this situation. Lastly, significantly higher levels of exhaustion, psychological problems and posttraumatic stress are to be expected among our professionals,2 with the consequent impact upon work performance (Fig. 1).3

Figure 1.

Graphic representation of the possible time horizons as a result of the SARS-CoV-2 pandemic. Reproduced with permission from Tseng V3.

(0.19MB).

In this general scenario, the Departments of Intensive Care Medicine must stay alert to identify the “tail of the first wave”, which will comprise a post-intensive care syndrome (PICS) of great magnitude and with special features.

Although the magnitude of the PICS in numerical terms cannot be predicted at this time, it undoubtedly will be large. Under normal circumstances, PICS affects 30–50% of our patients,4 and its sequelae may persist even beyond 5 years after hospital discharge, particularly in the case of patients recovering from acute respiratory syndrome.5

It is reasonable to assume that the characteristics of post-SARS-Cov-2 PICS will have a special affective component. In this context, family-PICS will be of specific relevance. On a daily basis, our “COVID hospitals” are witnessing the way in which the pandemic is causing important family ruptures, impeding adequate care of the ill relative, and with atypical situations of grief and burial of the victims. If other conditions have shown us that up to 16% of all patient relatives have been unable to reduce their levels of depression one year after discharge,6 will we be prepared for post-SARS-Cov-2 PICS?

References
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Working experiences of nurses during the Middle East respiratory syndrome outbreak.
Int J Nurs Pract., 24 (2018),
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Tseng V. As our friends and colleagues brave the font lines, we must also get ready for a series of aftershocks. It's very hard to plan this far ahead while we’re in survival mode. We must prepare early and strategize our response. Available from: https://twitter.com/VectorSting/status/1244671755781898241 [Accessed 2 April 2020].
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M.C. Martín Delgado, Y. García de Lorenzo, A. Mateos.
Surviving the intensive care units looking through the family’s eyes.
Med Intensiva., 41 (2017), pp. 451-453
[5]
M. Herridge, C. Tansey, A. Matté, G. Tomilson, N. Diaz-Granados, A. Cooper, et al.
Functional disability 5 years after acute respiratory distress syndrome.
N Engl J Med., 364 (2011), pp. 1293-1304
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One-year outcomes in caregivers of critically ill patients.
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Please cite this article as: González-Castro A, Garcia de Lorenzo A, Escudero-Acha P, Rodriguez-Borregan JC. Síndrome post-cuidados intensivos después de la pandemia por SARS-CoV-2. Med Intensiva. 2020;44:523–524.

Copyright © 2020. Elsevier España, S.L.U. and SEMICYUC
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