What types of symptoms do people often experience?
Most people find that it takes time to recover physically and mentally from a critical illness. Physically you may notice differences such as muscle weakness, breathlessness or difficulty swallowing. Mentally you may feel sad, worried, have memory problems or frightening nightmares.
You might be told that you are experiencing Post-Intensive Care Syndrome (PICS). PICS is a term given to a group of symptoms that people may experience after a stay in intensive care. These symptoms may affect your body, your mind, or your emotions, and may also be experienced by members of your family. If this label has been used by a health professional to describe your symptoms, don’t worry they will improve, but it may take some time.
It is important to be patient with yourself and not expect to get completely back to normal straight away. Most people’s recovery from critical illness takes several weeks or months. It is normal for recovery to be gradual, so you may need to pace yourself as you try to return to your daily activities. Your family may also be affected by your time in intensive care, and you may find that relationships have changed, they can access advice and support here.
Your feelings and emotions after critical care
Why do I feel anxious or depressed?
It often takes time to recover psychologically after leaving intensive care. You may feel more worried or panicky than usual, and some people feel quite low in mood once they get home. This can be because your recovery is slower than you expected, or because you are not able to achieve or enjoy everything you want to at first. You may find it harder to get your usual exercise or enough sleep, all of which can affect your mood.
People who were critically ill with COVID may also feel very anxious about their health and look out for signs of getting ill again. You may also worry that people see you as infectious or that you could infect other people with the virus.
You can find out more information on fear and anxiety and low mood here.
What is delirium, and how do I know if I had it?
In the Intensive Care Unit (ICU), sedative medications which help keep you safe when you are very unwell, fever and infection can all cause you to experience vivid hallucinations and frightening beliefs about what is going on. This is confusing and it can be difficult to tell what is real and what isn’t. We call this confusion delirium. This may have made you feel very agitated, or in some cases it can make you feel very withdrawn.
The delirium usually goes away once people start to recover from their illness. But people often take a while to sort out what was real and what was not during their intensive care stay. This is even harder during COVID because your family and friends were not allowed to be with you in the hospital, and the Personal Protective Equipment (PPE) staff needed to wear may have been unsettling and made it difficult to build a rapport with those caring for you. You may be offered an ICU follow-up clinic appointment, and may have been given a patient diary during your stay. This can be a useful opportunity to discuss your ICU stay with the professionals who cared for you, and can help you to make sense of what happened.
What is Post-Traumatic Stress Disorder (PTSD)?
A few people also have troubling memories or nightmares about their time in intensive care. They may be more irritable, have problems sleeping and feel very stressed every time they think about their hospital stay.
If you feel this way, it may be because your stay in intensive care is still affecting you. Intensive care patients often have stressful experiences, such as needing a machine to help them breathe (ventilator) while they recover. These patients receive medicines to keep them calm and comfortable. But the medicines, along with fever and infection, also affect their memory and can make them feel confused.
In some cases, people continue to have nightmares or flashbacks of their experiences during delirium after they go home. They might also feel that their memory or concentration has been affected, you can find out more about these problems here.
If you are having any of these difficult feelings or memories, it usually helps to talk about it to family or friends that you trust. You may also be able to talk about it with your GP or to other healthcare staff if you are given an ICU follow-up appointment at the hospital. More information is provided in the sections on sleep here and managing fear and anxiety here.
Your body following critical illness
Why am I breathless?
Breathlessness is a common symptom following critical illness, especially after a COVID infection because the infection specifically affects your lungs. Being on a ventilator, and prolonged period in bed causes weakness in your breathing muscles, just like your other muscles, they need time to recover and become stronger. Until then, you may feel more breathlessness on less exertion than before your illness. This can be frightening, but it is important not to panic as this can make you feel more breathless. It usually improves as you regain your fitness, but some people will benefit from assessment by their GP or specialist team. They will be able to rule out any complications, and possibly arrange onward referral to an exercise programme or a respiratory physiotherapist if appropriate. You can access more information on how to manage breathlessness here.
Why do I feel weak?
When you are unable to be active and get out of bed, your muscles can become weak. This might make it difficult to do some of the things you did before your illness, such as daily activities, exercise and work. It can take time to strengthen your muscles again, but completing exercises as advised by your physiotherapist, or as part of a guided exercise programme, will help you regain function. If you are finding it difficult to cope with daily activities, speak to your GP who will be able to refer you to the right health professional to support you, or see the Getting Moving Again section for more help. There is also information available to support you returning to work here.
What is fatigue?
Fatigue is another common symptom following a stay in ICU, particularly when you have had COVID. Despite resting, and a good night’s sleep, fatigue occurs after minimal effort, is prolonged and limits usual activity. It can leave people feeling low and finding it difficult to concentrate and remember. Fatigue is very common after viral infections and normally it settles after two or three weeks, but sometimes it can linger for weeks or months. This occurs after COVID. Most people will get better quickly but some will find their fatigue persists for three –six months.
You can find more information on fatigue, and how to manage it here.
Why do I have more aches and pains?
You may experience pain and stiffness in one or more of your joints, which usually improves as you start to get moving again. These effects can be due to prolonged periods in the same position when on ICU, particularly if you were placed in a prone position (lying on your front) to help your oxygen levels. This position can cause pain and stiffness in your shoulders. Please speak to your GP if you experience pain, loss of function, or pins and needles in your arms, they will be able to refer you to a physiotherapist to help with this. You can get more advice on these problems here.
Why do I have scars on my body?
You may notice some scars on parts of your body such as your neck, arms, chest or groin. These are most commonly due to lines which have provided medication, or equipment which has helped your breathing. Some scars may be due to the pressure of being in the same position for long periods of time.
Why is my hair falling out?
It is common for hair to become thinner or fall out after an ICU stay. This may be caused by the medications you received, or a symptom of being very unwell. It usually grows back but it can take a few months and be a little thinner or a slightly different colour than before.
Why is it difficult to swallow?
People on ICU often need a tube to be placed in their windpipe which connects to a machine to support their breathing. This can have an impact on the muscles which help you swallow safely, sometimes things may ‘go the wrong way’ and make you cough or splutter when you eat or drink. Usually your swallowing will get better before you are discharged home, but if you are experiencing problems with swallowing, or are coughing when you eat and drink, speak to your GP who can refer you to a Speech and Language Therapist. You can find out more information on swallowing here.
Why is my voice weak?
If you had a tube in your throat which helped you to breathe, it would have passed through your vocal cords. This can impact on the quality and sound of your voice. This usually recovers on its own over time, but if it is causing you any difficulties you should speak to your GP who can refer you to a Speech and Language Therapist (SLT). You can find out more information on voice here.
What is a tracheostomy, and why would I have one?
A tracheostomy is a small tube which is inserted into the windpipe through a small hole in your neck. It is often attached to a ventilator, and is performed when you need support for your breathing for a prolonged time. You may have a small scar on your neck where the tracheostomy was placed, but this should fade over time.