Brief description of media:

Almost 6 million patients a year are admitted to an intensive care unit (ICU) in the United States, according to the Society of Critical Care Medicine (SCCM). The majority of those survive to be discharged. But for many of them, though their initial illness or injury may have been resolved, a new challenge awaits—a cluster of health problems commonly referred to as post-intensive care syndrome (PICS).

Brief description of media:

The ICU can be an intimidating and stressful environment. This manual is intended to help support medical students, interns, and residents working in the ICU. Please be mindful that this manual is a guide for care in the ICU. Clinical treatment decisions are variable and nuanced depending on patient, nursing, and attending factors.

Brief description of media:

The ICU can be an intimidating and stressful environment. This manual is intended to help support medical students, interns, and residents working in the
ICU. This manual is a guide for care in the ICU. Clinical treatment decisions are variable and nuanced depending on patient, nursing, and attending factors.

Brief description of media:

Psychiatrists call it post-ICU syndrome, or the development of mental illness after admission to an intensive care unit, which is common in patients around the world.

“In addition to the experience of going into ICU, SA patients live in a society with high levels of crime and trauma and many of us have symptoms of post-traumatic stress disorder (PTSD),” said Dr Sarah Boshoff, a psychiatry registrar studying the triggers of PTSD in ICUs.

Boshoff is involved in research that stems from a larger cohort study which Dr Elizabeth van der Merwe is conducting at Livingstone Hospital in Port Elizabeth.

Brief description of media:

A new study finds that treatment in the intensive care unit has a unique set of terrors -- painful enough to be a precipitating factor in the onset of posttraumatic stress disorder (PTSD). The conclusion comes from a German study of patients who spent at least one month in the intensive care unit (ICU) at the University of Munich and were evaluated for PTSD up to three years later.

Brief description of media:

Patients may suffer extreme psychological reactions in intensive care units (ICU), and post-traumatic stress disorder (PTSD) after leaving hospital. Previous systematic reviews of studies up to 2007 found that the true prevalence of and consistent risk factors for PTSD after ICU were not established, due to methodological shortcomings of studies. Therefore we aimed to conduct a systematic review of observational studies of post-ICU PTSD from 2008-2012, and to compare them to 1997-2007 studies, with regard to quality, prevalence estimates and risk factors.

Brief description of media:

The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD.

Brief description of media:

Purpose: To evaluate the impact of routine follow-up consultations versus standard of care for
intensive care unit (ICU) survivors.

Brief description of media:

Background:The burden of H1N1 among socially disadvantaged populations is unclear. We aimed to synthesize hospitalization, severe illness, and mortality data associated with pandemic A/H1N1/2009 among socially disadvantaged populations.Methods/Principal Findings:Studies were identified through searching MEDLINE, EMBASE, scanning reference lists, and contacting experts. Studies reporting hospitalization, severe illness, and mortality attributable to laboratory-confirmed 2009H1N1 pandemic among socially disadvantaged populations (e.g., ethnic minorities, low-income or lower-middle-income economy countries [LIC/LMIC]) were included. Two independent reviewers conducted screening, data abstraction, and quality appraisal (Newcastle Ottawa Scale). Random effects meta-analysis was conducted using SAS and Review Manager.Conclusions/Significance:Sixty-two studies including 44,777 patients were included after screening 787 citations and 164full-text articles. The prevalence of hospitalization for H1N1 ranged from 17–87% in high-income economy countries (HIC)and 11–45% in LIC/LMIC. Of those hospitalized, the prevalence of intensive care unit (ICU) admission and mortality was 6–76% and 1–25% in HIC; and 30% and 8–15%, in LIC/LMIC, respectively. There were significantly more hospitalizations among ethnic minorities versus non-ethnic minorities in two studies conducted in North America (1,313 patients, OR 2.26 [95% CI:1.53–3.32]). There were no differences in ICU admissions (n = 8 studies, 15,352 patients, OR 0.84 [0.69–1.02]) or deaths (n = 6studies, 14,757 patients, OR 0.85 [95% CI: 0.73–1.01]) among hospitalized patients in HIC. Sub-group analysis indicated that the meta-analysis results were not likely affected by confounding. Overall, the prevalence of hospitalization, severe illness,and mortality due to H1N1 was high for ethnic minorities in HIC and individuals from LIC/LMIC. However, our results suggest that there were little differences in the proportion of hospitalization, severe illness, and mortality between ethnic minorities and non-ethnic minorities living in HI

Brief description of media:

Background: The aim of the study was to investigate whether intravenous (iv) infusion of exenatide, a synthetic
GLP-1 receptor agonist, could provide a protective efect against myocardial ischemia-reperfusion injury after coronary artery bypass graft (CABG) surgery.
Methods: A sub study analysis of patients >18 years admitted for elective CABG and included in the ExSTRESS trial was conducted. Patients were randomized to receive either iv exenatide (1-h bolus of 0.05 µg min−1 followed by a constant infusion of 0.025 µg min−1) (exenatide group) or iv insulin therapy (control group) for blood glucose control (target range 100–139 mg dl−1) during the frst 48 h after surgical incision. All serum levels of troponin I measured during routine care in the Cardiac Surgery ICU were recorded. The primary outcome was the highest value of plasma concentration of troponin I measured between 12 and 24 h after ICU admission. The proportion of patients presenting an echocardiographic left ventricular ejection fraction (LVEF) >50% at the follow-up consultation was compared between the two groups.
Results: Finally, 43 and 49 patients were analyzed in the control and exenatide groups, respectively {age: 69 [61–76] versus 71 [63–75] years; baseline LVEF<50%: 6 (14%) versus 16 (32%) patients; on-pump surgery: 29 (67%) versus 33 (67%) patients}. The primary outcome did not signifcantly difer between the two groups (3.34 [1.06–6.19] µg l−1 versus 2.64 [1.29–3.85] µg l−1 in the control and exenatide groups, respectively; mean diference (MD) [95% confidence interval (95% CI)] 0.16 [−0.25; 0.57], p=0.54). The highest troponin value measured during the frst 72 h in the ICU was 6.34 [1.36–10.90] versus 5.04 [2.39–7.18] µg l−1, in the control and exenatide groups respectively (MD [95% CI] 0.20 [−0.22; 0.61], p=0.39). At the follow-up consultation, 5 (12%) versus 8 (16%) patients presented a LVEF<50% in the control and in the exenatide groups respectively (relative risk [95% CI] 0.68 [0.16; 2.59], p=0.56).
Conclusions: Postoperative iv exenatide did not provide any additional cardioprotective efect compared to iv insulin in low-risk patients undergoing scheduled CABG surgery.

Brief description of media:

Post-ICU clinics may facilitate the care of survivors of critical illness, but there is a paucity of data describing post-ICU clinic implementation. We sought to describe implementation of our ICU recovery clinic, including an assessment of barriers and facilitators to clinic attendance.

Brief description of media:

Background

Psychological morbidity in both patients and family members related to the intensive care unit (ICU) experience is an often overlooked, and potentially persistent, healthcare problem recognized by the Society of Critical Care Medicine as Post-intensive Care Syndrome (PICS). ICU diaries are an intervention increasingly under study with potential to mitigate ICU-related psychological morbidity, including ICU-related post-traumatic stress disorder (PTSD), depression and anxiety. As we encounter a growing number of ICU survivors, in particular in the wake of the coronavirus pandemic, clinicians must be equipped to understand the severity and prevalence of significant psychiatric complications of critical illness.
Methods

We compared the efficacy of the ICU diary, written by family and healthcare workers during the patient's intensive care course, versus education alone in reducing acute PTSD symptoms after discharge. Patients with an ICU stay >72 h, who were intubated and mechanically ventilated over 24 h, were recruited and randomized to either receive a diary at bedside with psycho education or psycho education alone. Intervention patients received their ICU diary within the first week of admission into the intensive care unit. Psychological symptom screening with IES-R, PHQ-8, HADS and GAD-7 was conducted at baseline within 1 week of ICU discharge and at weeks 4, 12, and 24 after ICU discharge. Change from baseline in these scores was assessed using Wilcoxon rank sum tests.
Results

From September 26, 2017 to September 25, 2018, our team screened 265 patients from the surgical and medical ICUs at a single large academic urban hospital. 60 patients were enrolled and randomized, of which 35 patients completed post-discharge follow-up, (n = 18) in the diary intervention group and (n = 17) in the education-only control group. The control group had a significantly greater decrease in PTSD, hyperarousal, and depression symptoms at week 4 compared to the intervention group. There were no significant differences in other measures, or at other follow-up intervals. Both study groups exhibited clinically significant PTSD symptoms at all timepoints after ICU discharge. Follow-up phone interviews with patients revealed that while many were interested in getting follow-up for their symptoms, there were many barriers to accessing appropriate therapy and clinical attention.
Conclusions

Results from psychological screening tools demonstrate no benefit of ICU diaries versus bedside education-alone in reducing PTSD symptoms related to the intensive care stay. However, our study finds an important gap in clinical practice – patients at high risk for PICS are infrequently connected to appropriate follow-up care. Perhaps ICU diaries would prove beneficial if utilized to support the work within a program providing wrap-around services and close psychiatric follow up for PICS patients. This study demonstrates the high prevalence of ICU-related PTSD in our cohort of survivors, the high barrier to accessing care for appropriate treatment of PICS, and the consequence of that barrier—prolonged psychological morbidity.