臨床整形外科58巻12号

2023年12月発行

境界領域/知っておきたい

今押さえておきたいPICS(集中治療後症候群)

著者： 伊藤惇亮¹ 川上途行¹

所属機関： ¹慶應義塾大学医学部リハビリテーション医学教室

ページ範囲：P.1504 - P.1508

はじめに

　集中治療室(intensive care unit：ICU)における急性期治療は集中治療科や救急救命科，麻酔科が担うことが一般的となっている．ICU退室後については，各診療科が主治医として診療を引き継ぐことが多い．整形外科領域では外傷患者がそれにあたる．本稿では，重症患者が急性期治療後も長期にわたって抱え得る集中治療後症候群(post intensive care syndrome：PICS)について，リハビリテーションの視点を交えつつ概説する．

参考文献

1）Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit:report from a stakeholders' conference. Crit Care Med 2012;40(2):502-9.

2）Kamdar BB, Suri R, Suchyta MR, et al. Return to work after critical illness:a systematic review and meta-analysis. Thorax 2020;75(1):17-27.

3）日本集中治療医学会．PICS　集中治療後症候群　①PICSとは．　https://www.jsicm.org/provider/pics/pics01.html(2023年8月31日アクセス)

4）Stevens RD, Marshall SA, Cornblath DR, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med 2009;37(10 Suppl):S299-308.

5）Appleton RT, Kinsella J, Quasim T. The incidence of intensive care unit-acquired weakness syndromes:a systematic review. J Intensive Care Soc 2015;16(2):126-36.

6）Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014;370(17):1626-35.

7）Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med 2013;369(14):1306-16.

8）Unoki T, Sakuramoto H, Uemura S, et al. Prevalence of and risk factors for post-intensive care syndrome:multicenter study of patients living at home after treatment in 12 Japanese intensive care units, SMAP-HoPe study. PLOS ONE 2021;16(5):e0252167. doi:10.1371/journal.pone.0252167.

9）Johnson CC, Suchyta MR, Darowski ES, et al. Psychological sequelae in family caregivers of critically III intensive care unit patients. A systematic review. Ann Am Thorac Soc 2019;16(7):894-909.

10）Hiser SL, Fatima A, Ali M, et al. Post-intensive care syndrome (PICS):recent updates. J Intensive Care 2023;11(1):23. doi:10.1186/s40560-023-00670-7.

11）Kawakami D, Fujitani S, Morimoto T, et al. Prevalence of post-intensive care syndrome among Japanese intensive care unit patients:a prospective, multicenter, observational J-PICS study. Crit Care 2021;25(1):69. doi:10.1186/s13054-021-03501-z.

12）Marra A, Ely EW, Pandharipande PP, et al. The ABCDEF bundle in critical care. Crit Care Clin 2017;33(2):225-43.

13）日本集中治療医学会早期リハビリテーション検討委員会．集中治療における早期リハビリテーション—根拠に基づくエキスパートコンセンサス．日集中医誌2017；24：255-303．

14）Renner C, Jeitziner MM, Albert M, et al. Guideline on multimodal rehabilitation for patients with post-intensive care syndrome. Crit Care 2023;27(1):301. doi:10.1186/s13054-023-04569-5.

15）Mikkelsen ME, Still M, Anderson BJ, et al. Society of Critical Care Medicine's International Consensus Conference on prediction and identification of long-term impairments after critical illness. Crit Care Med 2020;48(11):1670-9.

16）日本集中治療医学会PICS対策・生活の質改善検討委員会．本邦の診療現場におけるICU退室後のフォローアップに関する実態調査．日集中医誌2022；29：165-76．