【コラム】COVID-19とPICS—長期予後を見据えた治療戦略の一環としてのPICS予防

COVID-19 and post-intensive care syndrome

ICUで治療された患者とその家族に生じ得るpost-intensive care syndrome（PICS）は，新型コロナウイルス感染症（COVID-19）患者も例外ではなく，パンデミックの終焉を待たずして懸念すべき重要問題である。COVID-19患者に特有のPICS発症因子についてはまだ明らかではないが，PICSに関するこれまでの知見をもとに，想定される要因と対策について考えたい。

Post-intensive care syndrome （PICS） is the primary cause of poor long-term outcomes, including mortality rate, activities of daily living, and quality of life after a patient leaves the intensive care unit （ICU）. It is a collection of physical, mental, and cognitive symptoms that persist after critical illness such as sepsis and adult respiratory distress syndrome. PICS in COVID-19 survivors and their families is a prominent issue and will possibly be the next public health crisis after the current pandemic. Even though risk factors particular to COVID-19 are still not clarified, COVID-19 survivors admitted to and treated in the ICU may be at increased risk of developing PICS due to many reasons including exposure to cytokine storm, prolonged mechanical ventilation with large doses of sedatives, development of delirium, limited rehabilitation, being quarantined, restricted family visitation and so on. Despite the challenges associated with the pandemic, implementation of the ABCDEFGH bundle to reduce the incidence of risk factors which may lead to the development of PICS is still crucial. A flexible approach and establishment of systematic interventions may be required considering the current resource scarcity and workload in our county.