To report the prevalence of physical, psychological, and cognitive impairment among COVID-19 intensive care unit (ICU) survivors receiving follow-up ...

What We Do at PostICU, Inc. We are a nonprofit agency founded to educate former ICU patients about post intensive care syndrome. PostICU syndrome affects millions of former ICU patients annually worldwide. WHAT WE DO AT POST ICU PROGRAMS & PROJECTS . FOR ALL WEBSITE VISITORS Join PostICU for Free PICS Resource Library Collection of articles, research and other materials about PICS. Advocacy Once we have enough members, we hope to be in a position to advocate on behalf of PICS sufferers and future treatment of ICU patients PICS Experts Q & A PostICU Blog FOR MEMBERS POSTICU MEMBERS PostICU Forum Unofficial PICS Test, Help you to assess whether you have PICS? PICS Support Groups Online PICS Webinars & Meetings Join PostICU, Inc. Board or Participate on a Committee Many Volunteer Opportunities Tracking PICS In the News Collection of PICS & PICS-F Shared Stories Help PostICU Accomplish Its Mission Together, We Can Work to Improve Care for all Post ICU Patient & Their Families TAKE ACTION

Browse the Post ICU's Wall of Heroes. We are a Volunteer Only NonProfit Agency in the US. We are very pleased to honor our first volunteer to be selected for the PostICU Wall of Heroes. Read more. POSTICU WALL OF HEROES PostICU's Wall of Heroes PostICU is a volunteer ONLY operated nonprofit agency. We thank ALL of our volunteers for their kindness and generosity. We created our Wall of Heroes, for those volunteers who go above and beyond the call of duty to assist us with accomplishing our mission. Read More FEBRUARY 1, 2021 THE FIRST VOLUNTEER WINNER OF THE POSTICU WALL OF HEROES AWARD HUY GIANG We are very pleased to honor our first volunteer to be selected for the PostICU Wall of Heroes . Huy is an international student from Vietnam. He recently graduated from Worcester State University with a master's degree in Business Administration. Huy hopes to contribute to the community in times of trial as well as to gain life experience. We selected Huy because of his commitment to assisting us with building our online PICS library. Since joining PostICU's Volunteer Team, Huy has kindly shared hundred hours of volunteer time with our agency. Thank you Huy for your generosity of spirit and kindness of heart, The Board of Directors North American Help Services, Inc. d/b/a PostICU THE SECOND VOLUNTEER WINNER OF THE POSTICU WALL OF HEROES AWARD

A big part of post ICU syndrome (PICS) is post ICU PTSD flashbacks to delirium suffered during medically-induced comas can cause anxiety, ... Hidden Page

Making sure those patients are seen—in every sense of the word—has become a driving passion for Lamas. She is also a researcher in the serious-illness program ... Learn More about Dr. Daniela Lamas Dr. Daniela Lamas Brigham & Women's Hospital Critical Care Physician Pulmonary Critical Care Harvard Medical School Instructor Harvard University Fellowship, Pulmonary Disease, 2016 American Board of Internal Medicine Board Certification, Critical Care Medicine, 2015 American Board of Internal Medicine Board Certification, Pulmonary Disease, 2014 American Board of Internal Medicine Board Certification, Internal Medicine, 2012 New England Journal of Medicine Fellowship, 2012 NY Presbyterian Columbia Campus Residency, Internal Medicine, 2011 New York-Presbyterian University Hospital of Columbia and Cornell Residency, Internal Medicine, 2011 Columbia University College of Physicians and Surgeons Medical School, 2008 Massachusetts General Hospital Fellowship, Pulmonary & Critical Care Medicine Massachusetts General Hospital Fellowship New York-Presbyterian University Hospital of Columbia and Cornell Residency EXCERPTS REPRINTED WITH PERMISSION OF HARVARD MAGAZINE Daniela Lamas and the practice of post-ICU care by LYDIALYLE GIBSON JANUARY-FEBRUARY 2019 THE DOCTOR asked the man to tell her what he remembered, and so he took a breath and began to speak. In the months since he’d left the intensive-care unit where he nearly died, he had been over these events again and again, searching his own memory and the recollections of his wife and daughter, trying to make the puzzle pieces fit. They never quite did. But today was a different kind of exercise. The doctor, Daniela Lamas ’03, is a pulmonary and critical-care physician at Brigham and Women’s Hospital, where James (though that’s not really his name) had been transferred from another hospital when his condition went from bad to worse. After he’d returned home and settled back into daily life, Lamas reached out to ask if he’d be interested in a follow-up appointment, part of a still-evolving clinic she helped start four years ago, for former patients of the Brigham’s ICU. The idea is to see how these patients are faring in the aftermath of critical illness, to identify needs or difficulties, to talk about quality-of-life goals, and to answer any questions they might have about what happened to them in the hospital—because often, like James, they don’t fully remember. (“Why do I have this small hole here?” a woman once asked Lamas, pointing to the spot where a chest tube had been inserted and later removed.) Occasionally patients request tours of the ICU, to see, with a clearer head, the place where they may have spent weeks or months. After each clinic appointment, Lamas types up detailed notes and recommendations to share with the patient’s primary-care doctors and makes referrals to other specialists as needed—social workers, often, or mental-health counselors. “We know that after the ICU, people suffer issues they didn’t have before,” she says. Some experience depression or anxiety or lingering delirium; as many as one-third have post-traumatic stress disorder. Others go home with cognitive changes—minds slowed by the medicines they took or the ordeals they endured. Until recently, ICU physicians have known little about any of this. After patients leave their care, Lamas says, “we don’t see them.” Daniela Lamas Photograph by Stu Rosner Making sure those patients are seen—in every sense of the word—has become a driving passion for Lamas. She is also a researcher in the serious-illness program at Ariadne Labs, a joint project of Harvard and Brigham and Women’s, started by Brigham surgeon Atul Gawande. And she is a medical journalist who writes for The New York Times and The Atlantic and published her first book last spring: You Can Stop Humming Now: A Doctor’s Stories of Life, Death, and In Between. It is a memoir of a decade’s work in intensive-care units, but also an immersive exploration of what patients’ lives are like afterward. “She’s mining a space we haven’t opened up very effectively,” says Gawande, Thier professor of surgery at Harvard Medical School and of health policy and management at the Harvard T.H. Chan School of Public Health. “What Daniela’s ended up really recognizing is that six million people go into intensive care, and five million people are later discharged home. And what it is to return home after often incredible trauma and devastating illness, sometimes lingering difficulties and conditions—we haven’t explained or begun to uncover what that bridge is like, or what the gaps and challenges are. We’re helping people survive who never survived before, and it’s their struggles she’s given voice to.” In a 2013 essay in The Atlantic, Lamas wrote: “As more adults survive intensive care, we’ve inadvertently created a new world populated by the walking wounded....I’ve come to fear that our best interventions are less meaningful, and our counsel to families shallow, if we don’t fully understand what happens to our patients after they leave our units’ doors.” After the ICU AND SO, AT TWO O’CLOCK on a November afternoon, Lamas and James, who is in his sixties, sat down for their appointment. They spoke by video conference call, an arrangement that saved him a journey to the hospital. He was at his desk at home, wrapped in a blanket; Lamas was at the Brigham, squeezed into a tiny office with three colleagues: critical-care physician (and post-ICU clinic co-founder) Gerald Weinstein, social worker Stacey Salomon, and psychiatrist Nomi Levi-Carrick. James and Lamas traded narratives about his time in the ICU. Her version, taken from hospital records (she was not one of the doctors who treated him), went like this: he was first hospitalized in early summer, after feeling weak and falling down at home. The doctors at his local hospital soon realized he was very sick—his blood pressure was dropping and his kidneys malfunctioning, indicating that his body was in shock, likely from an infection. He was transferred to another hospital and then a few days later to the Brigham, where doctors discovered an area in his intestines that had burst open, and operated to repair it. They also found a clot in one lung and administered blood thinners. There were blockages in the passageways from his kidneys to his bladder, which were still being addressed. After several days in the ICU and two weeks on the hospital’s regular floor, James was released to a rehab facility. The breathing tube his doctors had inserted was removed. His health improved, and he went home. James’s version of the story was more fragmentary and much more frightening. He remembered the breathing tube; in fact, he said, “I was absolutely certain I had pulled it out.” (He hadn’t, Lamas assured him, though the sense of having done so is common and entirely normal.) He remembered hearing—or perhaps hallucinating—strange noises outside his room, “and I just knew I had to get out of there.” He also recalled wild, awful dreams that seemed as vividly real as any experience he’d ever had, about being taken against his will to different parts of the hospital, about being told by medical staff that his behavior was erratic and they were worried, about being stranded alone in a strange wing of the building. “These are all things that make sense, even though they seem like they don’t,” Lamas said, reassuring him again. “Your mind was trying to make sense of your situation.” The fear set in once James arrived home and realized how close he had come to dying. Pain and sleeplessness set in, too. His kidneys were still being drained by tubes attached through his back, which were uncomfortable and sometimes excruciating. He longed for the tennis court, where he and his wife had been a doubles team, and for the pub where he used to go for a pint and some conversation. Both were off-limits for now, and he was stuck at home for most of the day, alone, waiting for his wife to come back from work or his grandchildren to come over to visit. He cooked dinner and cleaned up around the house. He watched TV. When it wasn’t too cold out, he took short walks. “I’m OK; it’s nothing I can’t live with,” he kept saying—of the pain, of the broken sleep, of the isolation, of the fragility and fear. “I’m OK. It’s OK.” But 20 minutes into the conversation, he paused. “You know,” he said, “sometimes the feeling I get is, what am I doing here? I’m sick of just sitting here sometimes. And I do get depressed....The big positive for me is that I’m still alive, and I’d rather be alive than dead. But once you get past that, I mean—what am I doing?” His voice trailed off, and then Lamas spoke. “Everything you’ve told us,” she said, “it all gets to the issues we wanted to talk to you about.” She thanked him for his openness. “These are entirely normal things to deal with after what you’ve been through.” She was speaking slowly, choosing words carefully. “Thank you,” he said. He’d have a follow-up appointment with Levy-Carrick and Salomon. Lamas would speak to his regular doctor about the pain and sleep and other issues: “I’m really very hopeful that we can help you.” The Walking Wounded THE PAGES OF You Can Stop Humming Now are full of people like James. Lamas devotes one chapter to an artist who narrowly survived a tear in her aorta—the surgery involved an incision that wrapped around her torso from her navel to her upper back. She left the hospital harrowed by nightmares and post-traumatic stress. Her artwork, and years of therapy, helped her re-enter life. But the book, and Lamas’s post-ICU clinic, also address another kind of “walking wounded”: the chronically critically ill, who, even after they leave the ICU, remain caught in an overwhelming orbit of sickness and care. Lamas writes about a man whose bout with West Nile virus nearly killed him; after several weeks in intensive care, he emerged tethered to a ventilator, a feeding tube, and a urine catheter. She writes about a grandfather with heart failure who stays alive, and relatively active, with the help of an implanted mechanical heart pump. Every night he must plug the device into the wall and wait “like a dog on a leash” for its batteries to charge, and, a fisherman, he can no longer ride in a boat—falling into the water would electrocute him—but he can still fish from the shore with his grandson. Lamas spends time with a 30-something cystic-fibrosis patient living through an adulthood she never expected to reach, and with a young mother who receives a lung transplant just in time to save her life, but finds the road back to health long and bumpy—and scary and sad—in ways she didn’t foresee. At any given time, Lamas writes, there are 100,000 chronically critically ill patients in the country, a population largely created by the breathtaking triumphs of the ICU, where doctors routinely save lives that even a few years ago would have been lost. But these seeming miracles also make possible long-term traumas, and life-saving interventions often turn out to be only the starting point for further interventions and quality-of-life concerns that are, Lamas says, far too little understood. “We’re talking a lot about the end of life these days,” she says, “but this sort of not-dead and not-alive moment of illness and recovery—that story is not as present.” “The impact Daniela is having on the profession is profound,” says Bruce Levy, chief of pulmonary and critical care at the Brigham. “As physicians, we make decisions at a time of stress and crisis. And she’s opened windows to educate us on the downstream ramifications for patients.” Not an Achievable Goal LAMAS’S INTERESTS were always split between medicine and writing. She was born at the Brigham—her father is former Harvard cardiologist Gervasio Lamas, who now practices in Miami. Medicine was always Lamas’s eventual destination, but she loved writing from childhood. She was a high-school-newspaper reporter and in college, she joined The Harvard Crimson. “That was my world, that office,” she says. “I felt like I had a very important job.” One summer she interned at an alternative weekly newspaper in Miami, and the following summer, at The Miami Herald, which later hired her as a full-time reporter. She spent a year driving around the city in her Volkswagen Beetle, looking for stories. After that, she went to medical school at Columbia. “I felt at first like I had made a devastating decision, leaving writing,” she says. Medical school felt like a strange version of college, where the only assignment was to memorize science, “and then when you were done memorizing, you were supposed to be really enthusiastic about playing beer pong.” During residency, though, she fell in love with critical care. The patients in the ICU were the most compelling she saw, and she remembers watching the doctors there navigate decisions and communicate with families in moments of acute stress. “I wanted to be them.” She also returned to writing. She took medical-reporting assignments for The Boston Globe and began writing in The Atlantic, The New Yorker, and The New York Times about her patients and her ICU experiences—thoughtful, affecting, humane essays on the profundities of her daily work: last wishes, home hospital care, the limbo between life and death. She wrote about smuggling a beer in to a dying patient and about spending Christmas in the ICU. A few years ago, when a literary agent urged her to write a book, she started seeking out stories from ICU survivors. Her experience with those survivors has begun influencing Lamas’s work inside the ICU. She notes, for instance, that the ventilator is often a demarcation point for the critically ill, something patients and their families don’t always realize when they are crossing it. “I’ve become better at discussing the tracheostomy decision,” she says, referring to the surgical procedure that creates an opening in the neck that allows a breathing tube to be attached to the trachea. “Before, I really framed it as, ‘Now it’s time for a procedure to offer a more comfortable longer-term connection to the ventilator that will allow your loved one to get better.’ All of that is true, but it’s also true that once you have this thing, you’re probably not going to go home right away.” A more likely destination is a long-term-care facility, and recovery is often slow. “Even in the best-case scenario,” she says, “it’s really hard to get back to where you were—and maybe impossible.” Her goal isn’t to change the decision, but to manage expectations. “We ask patients and their families to make decisions in acute, insane moments,” she says. And it can be tough in those moments to grasp the consequences, even if they’re spelled out. Still, Lamas says, “I think it’s important to set out the risk, so that people have some understanding of what gamble they’re making.” Embedded in dilemmas like this one, and in the narratives in Lamas’s book, are ancient questions: what it means to save a life, or to live one; the connection between health and selfhood; and the murky boundaries of being “OK.” In the book, Lamas recalls a moment in the ICU when a patient’s worried daughter asked, “She’s going to be OK?” Lamas writes: “There it was. I had heard that question so many times, ending with that same word, OK. I had said the same thing to myself. In a way, it was an easy kind of shorthand. And yet I had rarely paused to ask a key question of my own response: What does it actually mean to be OK? The more I looked, the more complicated that answer had become.” Her fellowship at the Brigham offered an early glimpse of the complications. She undertook a project interviewing patients at Spaulding Hospital in Cambridge, a long-term-care facility where people often land after the ICU. She had been studying end-of-life conversations and wondered about the possibility of an adjacent discussion, on goals and values and health expectations of patients with critical illness. She spent weeks at Spaulding, interviewing patients who were on ventilators. What she learned, she says, was dispiriting but not surprising: their expectations for their future health were largely unrealistic, and their quality of life was often terrible. They were enduring in the hope that they would eventually go home and resume functional, independent lives. “Which for many of them is not an achievable goal.” Those interviews stuck with her. Today at Ariadne Labs, she researches conversation tools to help doctors talk effectively with seriously ill patients about feasible goals and quality-of-life recommendations. “Usually people think about that as having a better death,” Gawande explains, “but it’s really about how you live as well as you possibly can in the face of impairment at the very end.” Lamas had one of those conversations a few months ago, with a patient who came to the Brigham for a lung-transplant evaluation. As it became clear that his chances were dim—other health problems made the surgery dangerous—Lamas began nudging him and his family to imagine a life without new lungs. What did “OK” mean to him? Medical interventions could lengthen the time he had left, but would mean more trips to the hospital; forgoing those treatments would allow more comfort at home, but his life would likely be shorter. “It’s easy to come in with a set idea of what a ‘good’ process through the medical system looks like,” she said later. “But what’s tolerable can be very different from one person to another—talking to ICU survivors has taught me that. If anything, their stories have made me more open-minded about what is OK.” Lydialyle Gibson profiled Karen King in “The Bits the Bible Left Out,” in the November-December 2018 issue.

Post-ICU, or post-intensive care syndrome (PICS), can present a range of challenges for individuals recovering from severe illness, including COVID-19. Here are some resources that can offer support and guidance: ICUsteps: ICUsteps is a support group run by and for intensive care patients and their families. They provide resources, support, and information to help those recovering from critical illness, including PICS. Their website offers valuable information and a forum for connecting.. Covid-19 Resources COVID-19_StopSpread_Wash_ENG_1200x675 COVID-19_StopSpread_Wash_ENG_1200x1200 314705-B_SM_COVID-19_Symptoms_MARCH213_1200x675px COVID-19_StopSpread_Wash_ENG_1200x675 1/16

The Post-ICU digital diary: enhancing patient experience, engaging families, and empowering collaboration. Book a Demo Today! ADD ITEM TO THE LIBRARY PAGE import wixData from 'wix-data'; function clearFields(fieldKeys) { fieldKeys.forEach(fieldKey => { let field = $w('#' + fieldKey); if (field.type === $w("#signature").type) { field.clear(); } else { field.value = null; } if (field.validity.valueMissing) { field.resetValidityIndication(); } }); } export function submitButton_click(event) { let toInsert = { "firstName": $w("#firstName").value, "comments": $w("#comments").value, "signature": $w('#signature').value }; wixData.insert("ThankYouNote", toInsert) .then((results) => { let item = results; //see item below $w('#successMessage').show(); clearFields(Object.keys(item)); console.log(item); }) .catch((err) => { let errorMsg = err; }); } /* item: * * { * _id: "41c8ef87-3eec-47bd-a3bd-17a09de9ffee" * _owner: "4c47c608-cfa8-4037-93ac-738f09560ed3" * _createdDate: "2019-11-10T09:27:14.605Z" * _updatedDate: "2019-11-10T09:27:14.605Z" * title: "Mia" * lastName: "Casa" * email: "MiaCasa@SuCasa.com " * signature: "data:image/png;base64,iVBORw0KGgoAAAANSUhEU...AAAASUVORK5CYII=" * } */ On the signature page // API Reference: https://www.wix.com/corvid/reference // “Hello, World!” Example: https://www.wix.com/corvid/hello-world $w.onReady(function () { // Write your JavaScript here // To select an element by ID use: $w("#elementID") // Click "Preview" to run your code }); Allow User to add stuff to a page, like on helpunited.org - signing the thank you card. import wixData from 'wix-data'; function clearFields(fieldKeys) { fieldKeys.forEach(fieldKey => { let field = $w('#' + fieldKey); if (field.type === $w("#signature").type) { field.clear(); } else { field.value = null; } if (field.validity.valueMissing) { field.resetValidityIndication(); } }); } export function submitButton_click(event) { let toInsert = { "firstName": $w("#firstName").value, "comments": $w("#comments").value, "signature": $w('#signature').value }; wixData.insert("ThankYouNote", toInsert) .then((results) => { let item = results; //see item below $w('#successMessage').show(); clearFields(Object.keys(item)); console.log(item); }) .catch((err) => { let errorMsg = err; }); } /* item: * * { * _id: "41c8ef87-3eec-47bd-a3bd-17a09de9ffee" * _owner: "4c47c608-cfa8-4037-93ac-738f09560ed3" * _createdDate: "2019-11-10T09:27:14.605Z" * _updatedDate: "2019-11-10T09:27:14.605Z" * title: "Mia" * lastName: "Casa" * email: "MiaCasa@SuCasa.com " * signature: "data:image/png;base64,iVBORw0KGgoAAAANSUhEU...AAAASUVORK5CYII=" * } */ From page with the card. // API Reference: https://www.wix.com/corvid/reference // “Hello, World!” Example: https://www.wix.com/corvid/hello-world $w.onReady(function () { // Write your JavaScript here // To select an element by ID use: $w("#elementID") // Click "Preview" to run your code });

Permission is granted to temporarily download one copy of PostICU per device for personal, non-commercial transitory viewing only. · modify or copy the materials ... PostICU, Inc. Terms of Service for Mobile App Terms By accessing our app, PostICU, you are agreeing to be bound by these terms of service, all applicable laws and regulations, and agree that you are responsible for compliance with any applicable local laws. If you do not agree with any of these terms, you are prohibited from using or accessing PostICU. The materials contained in PostICU are protected by applicable copyright and trademark law. Use License Permission is granted to temporarily download one copy of PostICU per device for personal, non-commercial transitory viewing only. This is the grant of a license, not a transfer of title, and under this license, you may not: modify or copy the materials; use the materials for any commercial purpose, or for any public display (commercial or non-commercial); attempt to decompile or reverse engineer any software contained in PostICU; remove any copyright or other proprietary notations from the materials; or transfer the materials to another person or "mirror" the materials on any other server. This license shall automatically terminate if you violate any of these restrictions and may be terminated by PostICU, Inc. at any time. Upon terminating your viewing of these materials or upon the termination of this license, you must destroy any downloaded materials in your possession whether in electronic or printed format. Disclaimer The materials within PostICU are provided on an 'as is' basis. PostICU, Inc. makes no warranties, expressed or implied, and hereby disclaims and negates all other warranties including, without limitation, implied warranties or conditions of merchantability, fitness for a particular purpose, or non-infringement of intellectual property or other violation of rights. Further, PostICU, Inc. does not warrant or make any representations concerning the accuracy, likely results, or reliability of the use of the materials on its website or otherwise relating to such materials or on any sites linked to PostICU. Limitations In no event shall PostICU, Inc. or its suppliers be liable for any damages (including, without limitation, damages for loss of data or profit, or due to business interruption) arising out of the use or inability to use PostICU, even if PostICU, Inc. or a PostICU, Inc. authorized representative has been notified orally or in writing of the possibility of such damage. Because some jurisdictions do not allow limitations on implied warranties, or limitations of liability for consequential or incidental damages, these limitations may not apply to you. Accuracy of materials The materials appearing in PostICU could include technical, typographical, or photographic errors. PostICU, Inc. does not warrant that any of the materials on PostICU are accurate, complete, or current. PostICU, Inc. may make changes to the materials contained in PostICU at any time without notice. However, PostICU, Inc. does not make any commitment to update the materials. Links PostICU, Inc. has not reviewed all of the sites linked to its app and is not responsible for the contents of any such linked site. The inclusion of any link does not imply endorsement by PostICU, Inc. of the site. Use of any such linked website is at the user's own risk. Modifications PostICU, Inc. may revise these terms of service for its app at any time without notice. By using PostICU you are agreeing to be bound by the then current version of these terms of service. Governing Law These terms and conditions are governed by and construed in accordance with the laws of Oregon and you irrevocably submit to the exclusive jurisdiction of the courts in that State or location.

Ask our PICS experts any questions about Post Intensive Care Syndrome. At PostICU Inc. we have expert panelists that can answer your questions about PICS. Ask Our PostICU Expert Panelists POSTICU IS VERY FORTUNATE TO HAVE TWO EXPERT PANELISTS, WHO ARE INTERNATIONALLY RENOWNED FOR THEIR PICS RESEARCH & TREATMENT Select an Expert Submit Thanks for submitting your question. Our Experts select a couple of questions to answer once a month. We will post answers on this page and notify you by email as well. Dr. Gerard Weinhouse Brigham & Women's Hospital Medical Director, Respiratory Care Services Pulmonary and Critical Care Harvard Medical School Instructor American Board of Internal Medicine Board Certification, Critical Care Medicine, 1995 Hospital of the University of Pennsylvania Fellowship, Pulmonary Disease, 1995 American Board of Internal Medicine Board Certification, Pulmonary Disease, 1994 Perelman School of Medicine at the University of Pennsylvania Fellowship, Pulmonary Disease, 1994 Boston Medical Center Fellowship, Pulmonary Disease, 1991 Boston University School of Medicine Fellowship, Pulmonary Disease, 1991 American Board of Internal Medicine Board Certification, Internal Medicine, 1990 Boston Medical Center Residency, Internal Medicine, 1989 University of Medicine and Dentistry of New Jersey Medical School, 1986 Learn more about Dr. Weinhouse Dr. Daniela Lamas Brigham & Women's Hospital Critical Care Physician Pulmonary Critical Care Harvard Medical School Instructor Harvard University Fellowship, Pulmonary Disease, 2016 American Board of Internal Medicine Board Certification, Critical Care Medicine, 2015 American Board of Internal Medicine Board Certification, Pulmonary Disease, 2014 American Board of Internal Medicine Board Certification, Internal Medicine, 2012 New England Journal of Medicine Fellowship, 2012 NY Presbyterian Columbia Campus Residency, Internal Medicine, 2011 New York-Presbyterian University Hospital of Columbia and Cornell Residency, Internal Medicine, 2011 Columbia University College of Physicians and Surgeons Medical School, 2008 Massachusetts General Hospital Fellowship, Pulmonary & Critical Care Medicine Massachusetts General Hospital Fellowship New York-Presbyterian University Hospital of Columbia and Cornell Residency Learn more about Dr. Lamas

Learn more about post-intensive care syndrome. Visit the PostICU, Inc Library. Submit your PICS story. Read other people's stories about PostICU syndrome. Find out PostICU's Mission. About PostICU - Post-Intensive Care Syndrome Our Recommendatons POSTICU'S MISSION We stand as the only patient-built advocacy and information 501(c)3 nonprofit corporation. As we move through uncharted waters as nonmedical professionals in a technical world, we hope to grow our ranks, so that we become positioned to advocate on behalf of future ICU patients. PostICU is a division of North American Help Services Alliance, Inc. View our Gold Star rating with GuideStar . OUR PRIMARY MISSIONS IS TO: Provide resources to the public to educate them about PICS and PICS-F; and, Advocate for testing, staging, and treatment of all former ICU patients that are in danger of experiencing PICS. As we grow our ranks, we carry more clout, allowing us as a group to make recommendations to the critical care medical community and insurance companies about ways to improve the likely outcome for most patients who spend time in an ICU. One would be hard-pressed to find medical professionals that would contradict our mission with regards to our core recommendations for changes to the way ICU patients are treated. Of course, our recommendations are tempered by our appreciation of the fact that we are not medical professionals. That is why our core recommendations stretch no further than what commonsense dictates. POSTICU'S COMMONSENSE RECOMMENDATIONS TO THE CRITICAL CARE COMMUNITY ICU patients, their caregivers, and/or family members, as part of their discharge hospital, should be briefed about PICS, PICS-F and PICS symptoms to be aware of. Because it Is more likely than not that they will suffer from one or more of these symptoms. A discharging hospital should assign to all former ICU patients, a PICS specialist, well-versed in PICS medical care, with whom an appointment is scheduled as part of the discharge process. At the follow-up appointment, the PICS Specialists should evaluate former ICU patients to determine whether they are experiencing PICS related symptoms, and if so to what degree. PICS diagnoses should be staged, to assist in determining the severity of former ICU patients' conditions, and to help with the establishment of treatment protocols. For more complex PICS staging, PICS Specialists should convene a multi-disciplinary team of medical professionals, based upon the former ICU patients' needs. The PICS Specialist should lead the group and follow-up with patients' teams and patients, to ensure that recommended testing and treatment occurs. Health Insurance carriers, Medicaid, and Medicare should accept responsibility for payment of all testing and medical care that is recommended by PICS Specialists. POSTICU COMMONSENSE RECOMMENDATIONS TO THE CRITICAL CARE COMMUNITY PostICU 501(c)3 Approval Definition of PICS WHAT IS PICS? Post-intensive care syndrome, or PICS, is made up of health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient's body, thoughts, feelings, or mind and may affect the family. PICS may show up as an easily noticed drawn-out muscle weakness, known as ICU-acquired weakness; as problems with thinking and judgment, called cognitive (brain) dysfunction; and as other mental health problems. ICU-Acquired Weakness ICU-acquired weakness (ICUAW) is muscle weakness that develops during an ICU stay. This is a common problem of being critically ill and occurs in: 33% of all patients on ventilators 50% of all patients admitted with severe infection, which is known as sepsis Up to 50% of patients who stay in the ICU for at least one week Patients who develop ICUAW may take more than a year to recover fully. ICUAW makes the activities of daily living difficult, including grooming, dressing, feeding, bathing, and walking. ICUAW may greatly delay the patient from doing activities in the way he or she used to do them. Cognitive or Brain Dysfunction This refers to problems connected with remembering, paying attention, solving problems, and organizing and working on complex tasks. After leaving the ICU, 30% to 80% of patients may have these kinds of problems. Some people improve during the first year after discharge from the hospital; other people may never fully recover. Cognitive dysfunction may affect whether the patient can return to work, balance a checkbook, or perform other tasks that involve organization and concentration. Other Mental Health Problems Critically ill patients may develop problems with falling or staying asleep. They may have nightmares and unwanted memories. Reminders of their illness may produce intense feelings or strong, clear images in their mind. Their reactions to these feelings may be physical or emotional. Patients may also feel depressed and anxious, and may have symptoms of post-traumatic stress disorder (PTSD). These include having nightmares and unwanted memories, feeling “keyed up,” and wanting to avoid thinking or talking about their stay in the ICU. After Leaving the ICU If you are an ICU patient, the care team may diagnose you with PICS or determine you are at risk for developing it. They may refer you to other caregivers for support services after you leave the ICU. If not, these are possible warning signs: Muscle weakness or problems with balance Problems with thinking and memory Severe anxiety Depression Nightmares Other PostICU Resources HOW DOES PICS AFFECT PEOPLE'S LIVES? How Does PICS Affect Recovery? Up to 50% of patients may return to work within the first year, but some may not be able to return to the jobs they had before their illness. Patients may need help with activities after leaving the hospital. What Can Family Do to Minimize PICS? If you are a family member, you may be able to minimize PICS by helping your critically ill family member stay “oriented”: Talk about familiar things, people, and events. Talk about the day, date, and time. Bring in favorite pictures and items from home. Read aloud at the bedside. You can also keep a diary or journal and later review it with the care team and your family member. This may help your family member understand what happened, clear up some memories, and reduce stress. Lastly, you can ask the care team to teach you how to help with your family member’s bedside exercises. Exercises prevent weakness by keeping the joints and muscles active. Patients should move their bodies as soon as they can and work with physical therapists, even while using a ventilator. Moving is also good for the brain. How Does PICS Affect Family? Critical illness is a family crisis. Feeling worried and confused can cause family members to stop tending to their own health. The care team may ask the family to make decisions about important, sometimes overwhelming matters. Because of this, 30% of family members may experience their own mental health problems, such as depression, anxiety, and PTSD. How Can Family Lower Their Chances of Developing PICS? First and foremost, if you are a family member, take care of yourself. This cannot be stressed enough. Meeting your critically ill family member’s needs is a major part of care, but your needs are just as important. If you are well, you have the physical and emotional strength to support your family member and feel good about it. Eat well, get as much rest as possible, exercise, and seek support. The hospital has social workers, case managers, and pastoral caregivers who can help. Take time to understand your family member’s illness and treatment options. Having this information will help you make decisions, feel confident about the decisions you make, and reduce stress. Ask questions, ask to meet with the care team, and keep a journal. Review the journal with a member of the care team whom you trust to make sense of what has happened and how you are responding to it. These actions can help you and the care team recognize and respect your family member’s wishes, values, and preferences as much as possible. Participating in inpatient care is another way to support your family member and reduce stress. The bedside staff can suggest activities for those who want to be involved. Click Here to Learn More About PICS & PICS-F The Society of Critical Care Medicine ("SCCM") features a tremendous amount of information about PICS on its website. They also have produced a series of articles designed to explain PICS to lay-people. SCCM defines PICS as follows: SCCM DEFINES PICS AS: Post-intensive care syndrome, or PICS, is made up of health problems that remain after critical illness. They are present when the patient is in the ICU and may persist after the patient returns home. These problems can involve the patient's body, thoughts, feelings, or mind and may affect the family. PICS may show up as an easily noticed drawn-out muscle weakness, known as ICU-acquired weakness; as problems with thinking and judgment, called cognitive (brain) dysfunction; and as other mental health problems. SCCM Explains PICS SCCM Explains PICS Spanish Version

Educate yourself about PICS, so you can better understand what you are experiencing, you can find detailed research and other information at: www.aftertheicu. PICS SELF TEST 4.1 Please Click Here to read VALIDATION OF A NEW CLINICAL TOOL FOR POST–INTENSIVE CARE SYNDROME, the research upon which this self-test is based. We thank the authors of this study for their wonderful work.

PostICU has all of the resources that you need to learn about Post Intensive Care Syndrome, PICS. POSTICU RESOURCES FOR EVERYONE We have collected all the articles, studies, charts, graphs, videos, and other media about PICS that we could find and organized these resources into the PostICU PICS Library . In addition, we have set up several other organized PICS resources , see below. Posticu PICS library We have gathered hundreds of mainstream and research articles and other forms of media, which can be found in our searchable database. The developing area of COVID-19 & PICS is also well researched and available at PostICU. Search Our Library Search Our Website Our Library Index PICS & COVID-19 Latest PICS News COVID & PICS News Posticu expert Q & A PostICU is very fortunate to have on staff two internationally renowned experts in the field of critical care and PICS research and treatment, who are available to answer questions asked by our website visitor. Ask Experts a Question About Dr. Weinhouse About Dr. Lamas Posticu blog and forum The PostICU Blog has several contributors who have significant experience in the realms of PICS research and studies. We offer up-to-date news on a regular basis through our blog. Our forum is limited to use by members only. Check Out the Blog Check Out the Forum Make a Blog Entry Make a Forum Entry GREAT POSTICU RESOURCES PostICU offers the only online PICS test offered by a patient operated PICS website. Our PICS 2.0 test is available to everyone who wants to take it. We keep all information and test results private and secure. Take the PICS 2.0 Test Post ICU Clinics ICU Glossary Terms PostICU Founders What is PICS? Patients' PICS Stories SHARE MATERIALS YOU FIND WITH US We need your help, so that we can build the most comprehensive PICS library. This resource could prove to be an invaluable source of for information and research. Or volunteer at PostICU! Add to PICS Library Add to COVID + PICS Volunteer at PostICU Check out all of PostICU's resources