A Lawyer's Recovery Highlights Post-Intensive Care Syndrome

A 63-year-old lawyer's case illustrates the long-term physical, cognitive, and psychological challenges that can follow critical illness, a reality faced by a significant portion of ICU survivors.

The Incident and Initial Hospitalization

On November 16, Joseph Masterson experienced cardiac arrest while driving in Pittsburgh. His vehicle struck a guardrail. Other drivers stopped, broke a window, and removed him from the vehicle. A volunteer firefighter performed CPR until an ambulance arrived.

Masterson was transported to UPMC Mercy hospital. He spent 18 days in the medical intensive care unit, 14 of which required mechanical ventilation. During his ICU stay, he developed delirium, a condition common in intensive care patients, and was treated with antipsychotic drugs. He lost weight despite receiving nutrition through a feeding tube.

Masterson was discharged from the hospital on February 1 and returned home with family support.

Ongoing Recovery and Symptoms

Since his discharge, Masterson has worked with therapists. He has regained the ability to walk and manage personal care, and his speech has improved. He can prepare a simple meal.

However, screening tests conducted after discharge indicated cognitive impairment and depression. According to his family members, Ron Dedes and Patti Dedes, Masterson experiences memory difficulties, forgetting recent conversations and events. He cannot yet operate a microwave or place a phone call.

In an interview, Masterson stated he is "much, much better than I was," but during the conversation he misstated his age.

Understanding Post-Intensive Care Syndrome (PICS)

Doctors describe Masterson's prolonged symptoms as consistent with post-intensive care syndrome (PICS). The syndrome can involve physical, psychological, and cognitive effects that may persist for months or years after an ICU stay.

• Prevalence: Research indicates more than half of the over 5 million people admitted to ICUs in U.S. hospitals annually experience such aftereffects, with older age increasing the likelihood. The Society of Critical Care Medicine estimates 70% to 90% of adults now survive ICU stays.
• Common Symptoms: Symptoms can include physical weakness, pain, neuropathy, malnutrition, anxiety, depression, and cognitive difficulties with memory and concentration.
• Contributing Factors: Medical professionals note that aggressive, life-saving ICU treatments, such as sedation and mechanical ventilation, can contribute to symptoms like delirium and muscle loss. Environmental factors like constant noise, bright lighting, and historically restricted family visits are also cited as potential contributors.
• Recovery Timeline: Dr. Brad Butcher, Masterson's physician, stated that many patients and families expect a return to normal within weeks of discharge, which he said does not align with typical recovery. A study co-authored by Dr. Lauren Ferrante of Yale School of Medicine found that within six months of discharge, only about half of patients aged 70 and older had returned to their pre-ICU functional ability.

Medical Response: Post-ICU Clinics

Approximately 35 U.S. hospitals have established specialized post-ICU clinics to screen for and manage PICS. Examples include clinics at Vanderbilt University Medical Center (opened 2012), the University of Pittsburgh Medical Center (founded by Dr. Butcher in 2018), and Yale (opened 2022).

These clinics employ multidisciplinary teams and implement practices recommended by the Society of Critical Care Medicine, which include:

• Using lighter sedation protocols.
• Mobilizing patients earlier.
• Conducting daily breathing tests to shorten ventilator use.
• Allowing more family visitation.
• Offering support groups and promoting physical rehabilitation.

Patient Perspectives and Future Care Preferences

Post-ICU clinics often facilitate discussions about patient preferences for future critical care.

• Survey Data: Dr. Butcher reported that in a survey of 117 patients at his clinic, about one-third indicated they would want to limit aggressive medical interventions if faced with another critical illness. Of those respondents, about a quarter requested "do not resuscitate" and "do not intubate" orders, and almost 7% said they would not want to return to an ICU.
• Additional Case: Gregory Matthews, an 80-year-old retired accountant, recounted experiencing vivid hallucinations and disorientation during a month-long ICU stay following a 2014 lung transplant.
• Family Experience: Masterson's brother-in-law, Ron Dedes, stated, "We honestly weren't confident that he would pull through" during the ICU stay. The family has expressed that their biggest current concern is his memory and that they are taking his recovery day by day.

Outlook and Prognosis

Dr. Butcher noted that a patient's health prior to ICU admission often influences recovery from PICS. He stated that Masterson's previous physical fitness and cognitively demanding work as a lawyer are positive factors for his continued progress.

Masterson said he has been mostly homebound but hopes to regain enough strength to resume running, an activity he did several times a week before his cardiac arrest. Dr. Butcher expressed optimism about future improvements in critical care diagnostics, prevention, and therapies.