Surviving a critical illness requiring intensive care unit (ICU) admission often marks the beginning of a prolonged recovery process. Patients hospitalized in the ICU for severe COVID-19 are at a particularly high risk for long-term physical, cognitive, and mental health issues after leaving. Conditions like anxiety, depression, insomnia, and PTSD are common elements of post-intensive care syndrome (PICS). To manage these symptoms, clinicians often prescribe psychoactive drugs, but the long-term patterns and clinical impacts of these prescriptions are not well understood.
In this recently published study, researchers identified 1,486 COVID-19 ICU survivors in Alberta, Canada, with no prior history of psychoactive medication in the six months before admission. Within 30 days of hospital discharge, 17.6% were prescribed a new psychoactive medication, most commonly benzodiazepines (41.0%) and opioids (28.3%). A full year later, over half (51.7%) remained on these drugs, with opioid use showing the highest rate of 1-year persistence.
Patients starting new prescriptions also faced worse 1-year clinical outcomes compared to non-recipients, including higher all-cause mortality, increased emergency department visits, and more frequent hospital readmissions. Independent risk factors for receiving a new prescription included pre-existing hypertension and lower socioeconomic status, with the latter potentially reflecting disparities in access to specialized follow-up care and rehabilitation services.
Ultimately, these findings underscore the need to closely examine the circumstances surrounding post-ICU prescribing. The researchers call for structured post-discharge monitoring, routine medication reconciliation, and proactive deprescribing to ensure psychoactive therapies remain clinically appropriate throughout recovery.
This study was a multicenter collaboration led by first author Andrea Shysh, MD and senior author and CVC faculty member Sean van Diepen, MD, MSc. Additional co-authors include CVC faculty Finlay McAlister, MD, MSc; Jason Weatherald, MD, MSc; and Fernando Zampieri, MD, PhD; alongside Luan Manh Chu, PhD; Sean Bagshaw, MD, MSc; Ken Kuljit Parhar, MD, MSc; Jacob Jentzer, MD; Erik Youngson, MMath; Sameer Kadri, MD, MSc; and Padma Kaul, PhD.
