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The Coronavirus (COVID-19) Pandemic has put a strain on NHS critical care services. Whilst recovering from the acute phase of the pandemic, we need to think of the aftermath and seek solutions to provide effective recovery and rehabilitation services for affected patients and their families. This is a unique opportunity to elevate public understanding of the impact of critical illness on outcomes
and recovery.

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For adults (mean age 61 years; 64% men) admitted to the ICU when specified due to traumatic brain injury, septic shock, chronic obstructive pulmonary disease, surgery, cardiac arrest, or stroke, evidence suggests that increasing oxygenation levels by at least 1 kPa in partial pressure of oxygen (PaO2), 10% in fraction of inspired oxygen (FiO2), or 2% in arterial oxygen saturation (SaO2)/pulse oximetry (SpO2) may increase mortality (347 vs 295 per 1000 people; all results on average) and the incidence of serious adverse events (SAEs) (333 vs 295 per 1000 people when the most common SAE reported in each trial was used) at six months follow‐up, and the incidence of sepsis within six days (94 vs 50 per 1000 people). However, adjustment for multiple outcomes, sparse data and repetitive testing (for mortality and SAEs), and the type of SAE data used in the analysis (event with highest proportion or cumulated event rate), impact results sufficiently to reduce confidence, downgrade the evidence to very low certainty, and preclude the possibility of drawing conclusions. When reported, the lower oxygenation levels used in trials were as follows: FiO2 0.40 to 0.50, PaO2 6.6 to 15 kPa, 50 to 112.5 mmHg, and/or SaO2/SpO2 88% to 98%.

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For adults with ARDS who are mechanically ventilated, very low‐certainty evidence suggests that immunonutrition may reduce intensive care unit days (by 3.09 days; all results on average) and ventilator days (by 2.24 days), and may lead to higher oxygenation (partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2] ratio difference of 38.88 mmHg) compared with standard formula feeding. Low‐ to very low‐certainty evidence suggests little to no difference in nosocomial infection between the two types of nutrition; effects on mortality and on the overall number of adverse events are uncertain due to imprecision of the results.

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The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can’t sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family.

Studies show that about one-fourth of family members, and sometimes more, experience at least one symptom of PICS-Family, including anxiety, depression, post-traumatic stress disorder or “complicated grief” — grief that is persistent and disabling — when their loved one has been hospitalized, according to a 2012 review article published in the journal Critical Care Medicine. Dr. Daniela Lamas, a critical care physician at Boston’s Brigham and Women’s Hospital, believes relatives and friends of coronavirus patients may be particularly vulnerable.

Hospital rules designed to prevent the spread of the virus have robbed them of the opportunity to sit with their loved ones, watching clinicians provide medical care and gradually processing what’s happening between physician updates, Lamas said. In pre-pandemic times, a nurse “would explain what they had heard [from the doctor] and help them come to terms with unacceptable realities,” she said.

Brief description of media:

The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can’t sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family.

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The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalized with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives. Many will likely deal with lingering effects of the virus—and of the emergency treatments that allowed them to survive it.

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This guide is for:People who have survived a frightening medical experience, such as being admitted to critical care (intensive care).People who have been hospitalized with severe medical problems related to COVID-19.Their family and friends.Mental health and medical professionals who want to understand more about how to help.

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British MPs have called for long Covid to be classed as an "occupational disease", with a compensation scheme set up for sufferers who were infected during their work on the frontline.

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American Society of Anesthesiologists' resources to address COVID-19 clinically related questions. 

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Abstract
Introduction Intravenous fluid therapy during gastrointestinal surgery is a life-saving part of the perioperative care. Too little fluid may lead to hypovolaemia, decreased organ perfusion and circulatory shock. Excessive fluid administration increases postoperative complications, worsens pulmonary and cardiac function as well as the healing of surgical wounds. Intraoperative individualised goal-directed fluid therapy (GDT) and zero-balance therapy (weight adjusted) has shown to reduce postoperative complications in elective surgery, but studies in urgent gastrointestinal surgery are sparse. The aim of the trial is to test whether zero-balance GDT reduces postoperative mortality and major complications following urgent surgery for obstructive bowel disease or perforation of the gastrointestinal tract compared with a protocolled standard of care.

Methods/analysis This study is a multicentre, randomised controlled trial with planned inclusion of 310 patients. The randomisation procedure is stratified by hospital and by obstructive bowel disease and perforation of the gastrointestinal tract. Patients are allocated into either ‘the standard group’ or ‘the zero-balance GDT group’. The latter receive intraoperative GDT (guided by a stroke volume algorithm) and postoperative zero-balance fluid therapy based on body weight and fluid charts. The protocolled treatment continues until free oral intake or the seventh postoperative day.

The primary composite outcome is death, unplanned reoperations, life-threatening thromboembolic and bleeding complications, a need for mechanical ventilation or dialysis. Secondary outcomes are additional complications, length of hospital stay, length of stay in the intensive care unit, length of mechanical ventilation, readmissions and time to death. Follow-up is 90 days.

We plan intention-to-treat analysis of the primary outcome.

Ethics and dissemination The Danish Scientific Ethics Committee approved the GAS-ART trial before patient enrolment (J: SJ-436). Enrolment of patients began in August 2015 and is proceeding. We expect to publish the GAS-ART results in Summer 2019.

Trial registration number EudraCT 2015-000563-14.

Brief description of media:

When we talk about critical illness recovery, we often speak about physical debility, fatigue, anxiety, depression and even anger. But less often do we name another very common experience and emotion - grief. After all, you just survived a critical illness, why would you be grieving? Shouldn't you be thankful, happy even? That may how the outside world interprets your experience, but for your thankfulness and happiness during this time may be very elusive emotions.

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This guidance addresses the responsibiities of anaesthetists in relation to patient care.