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Experts say hospital ICU stays, often faced alone, bring mental health woes to older patients in particular

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Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will likely experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.

Brief description of media:

Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will like experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.

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While the long-term impacts of the novel coronavirus are largely unknown,
the effects of extended ICU stays and intubation on severely ill patients are
alarmingly clear. In the midst of a pandemic that has affected over 2.7
million people in the United States alone, some medical professionals are
now concerned that the health-care system will continue to be overwhelmed
by patients who are dealing with the aftermath of the coronavirus.

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We face a truly unprecedented healthcare crisis. The COVID 19 pandemic is testing the resources and capacity of health systems around the world. Anaesthetists and theatre teams are being redeployed, Intensive Care Units are struggling with a surge in demand and our normal working patterns are being radically altered. In addition to this, a number of front-line staff are being affected as colleagues are removed from the workforce either because of “at risk” characteristics or are themselves become exposed to the virus and are going into self-isolation after the development of symptoms. As a result, we are all being forced to reconsider the appropriate course of action for patients dealing with urological issues. This brings into question if the latest guidelines based upon the best evidence and published less than three weeks ago are relevant in this crisis.

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The long-term effects of surviving COVID-19 have become a new focus of attention for clinicians and researchers. This focus has been driven partly by concerns about late ill-effects of a previously unknown virus, but recognised generic patterns of chronic disease after critical illness also exist. These patterns are termed PICS, an acronym both for post-intensive care syndrome and for persistent inflammation, immunosuppression, and catabolism syndrome. We recommend unifying post-COVID-19 research aims with those of PICS research and propose a novel approach to its management by repurposing drugs that are approved, inexpensive, and safe.

Brief description of media:

The long-term effects of surviving COVID-19 have become a new focus of attention for clinicians and researchers. This focus has been driven partly by concerns about late ill-effects of a previously unknown virus, but recognised generic patterns of chronic disease after critical illness also exist. These patterns are termed PICS, an acronym both for post-intensive care syndrome and for persistent inflammation, immunosuppression, and catabolism syndrome. We recommend unifying post-COVID-19 research aims with those of PICS research and propose a novel approach to its management by repurposing drugs that are approved, inexpensive, and safe.

Brief description of media:

The long-term effects of surviving COVID-19 have
become a new focus of attention for clinicians and
researchers. This focus has been driven partly by concerns
about late ill-effects of a previously unknown virus, but
recognised generic patterns of chronic disease after
critical illness also exist. These patterns are termed PICS,
an acronym both for post-intensive care syndrome and
for persistent inflammation, immunosuppression, and
catabolism syndrome. We recommend unifying post-
COVID-19 research aims with those of PICS research
and propose a novel approach to its management by
repurposing drugs that are approved, inexpensive, and
safe.

Brief description of media:

The emergence of coronavirus diseases (COVID-19) has presented a global health threat. The number of COVID-19 cases continues to increase in Africa; this poses a challenge to the African healthcare system, particularly the intensive care unit(ICU). More so, individuals with severe COVID-19 would often have a prolonged intensive care stay, requiring mechanical ventilation and sedation and this may increase their risk of developing physical, cognitive and psychosocial impairments. These post-ICU sequelae of morbidities have been termed Post Intensive Care Syndrome. The African healthcare system needs to be prepared to manage the adverse effects of Post Intensive Care Syndrome (PICS) largely characterized by a decline in functional capacity and health-related quality of life. It is thus expedient that multi-targeted measures such as early rehabilitation, adequate screening, patient/caregiver education and post-discharge rehabilitation be adopted to combat imminent poor health out comes in COVID-19 survivors. In this editorial, we provided a brief review of PICS and highlighted strategies for preventing and managing PICS in the critically ill within the African context Key words: Pandemic, COVID-19 Survivors, African healthcare,Intensive Care Unit, Rehabilitation

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This guide contains broad recommendations which can be adapted based on circumstances.  It will remain under review and will be updated continually as new information develops. 

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This practice statement and level of care guidance manuscript addresses important specifications for each PICU level of care, including the team structure and resources, technology and equipment, education and training, quality metrics, admission and discharge criteria, and indications for transfer to a higher level of care. The sparse high-quality evidence led the panel to use a modified Delphi process to seek expert opinion to develop consensus-based recommendations where gaps in the evidence exist. Despite this limitation, the members of the Task Force believe that these recommendations will provide guidance to practitioners in making informed decisions regarding pediatric admission or transfer to the appropriate level of care to achieve best outcomes.

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The power point main points:
PICS is a big deal for patients and families and it does not go away as soon as they leave the ICU
Awareness and advocacy are crucial
PICS is going to be an on-going research point in the next decade, with several large RCT’s and clinical practice guidelines in review process to be published
*Survival by itself is not a patient-centered endpoint*
From a hospital metrics and bench-marking standpoint, surviving an ICU admission is typically where the data collection ends