Risk factors for the 3 main domains of post-intensive care syndrome

PICS component	Risk factors
Cognitive dysfunction	Major: Delirium, prior cognitive deficit, sepsis, ARDS, sedative medications, hypoxemia, glucose dysregulation. Others: Acute brain dysfunction (eg, alcoholism), hypoxemia, hypotension, respiratory failure, congestive heart failure, sepsis trauma, cardiac surgery, cardiac arrest, obstructive sleep apnea, acute in-hospital stress/inflammation, blood transfusions, sedative medications, delirium, and use of renal replacement therapy.
Psychiatric dysfunction (eg, anxiety, depression, PTSD)	Major: Pre-existing psychiatric illness, sepsis and ARDS, respiratory failure, trauma, hypoglycemia, and hypoxemia, early symptoms of mental health impairments after critical illness, recollection of frightening experiences in the ICU, impaired physical function. Others: Female sex, tall stature in males, age <50 years, lower education level, pre-existing disability/unemployment, premorbid alcohol abuse, ICU sedative and analgesia use, agitation or physical restraint, prolonged illness, unemployment.
Physical dysfunction	Major: Pre-existing functional disability, frailty, pre-existing cognitive impairment, ICU-acquired illnesses, prolonged illness, older age. Others: Prolonged mechanical ventilation (>7 days), prolonged immobility/bedrest, sepsis, multisystem organ failure, ARDS, glucose dysregulation, hyperoxia, malnutrition, sensory disorders, and use of vasoactive agents and corticosteroids. NOTE: Previous pulmonary impairment in diffusing capacity and prolonged duration of mechanical ventilation may predispose to lung function impairment after critical illness.

While glucocorticoid use may increase the risk of ICU-acquired weakness, it may reduce the risk for PTSD.

PICS: post-intensive care syndrome; ARDS: acute respiratory distress syndrome; PTSD: posttraumatic stress disorder; ICU: intensive care unit.

Information from:

Bienvenu OJ, Gellar J, Althouse BM, et al. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychol Med 2013; 43:2657.
Schelling G, Stoll C, Kapfhammer HP, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder and health-related quality of life in survivors. Crit Care Med 1999; 27:2678.
Schelling G, Briegel J, Roozendaal B, et al. The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors. Biol Psychiatry 2001; 50:978.

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Risk factors for the 3 main domains of post-intensive care syndrome