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Delirium has been previously described as a syndrome of organ dysfunction involving the central nervous system. The prevalence of delirium in the ICU varies from 20-80%. Delirium has been associated with increased hospital length of stay, duration of mechanical ventilation, and mortality. Sedative and narcotic use has been shown to increase the risk and severity of delirium. Haloperidol is the mainstay of delirium management as recommended by the Society of Critical Care Medicine (SCCM) due to extensive clinical experience with this medication. However, its usage is often limited by safety concerns. Atypical antipsychotics such as quetiapine have been shown to have equivalent success in the treatment of delirium while being associated with fewer side effects.

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The delirium protocol helps the medical practitioner to perform Delirium assessment via CAM-ICU

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Delirium is a medical condition that increases length of stay, risk of death, functional decline, healthcare cost, caregiver burden, and impaired quality of life.
The Delirium Toolbox is low-cost, efficient option of non pharmacological tools to use in delirium prevention and management.

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THURSDAY, May 7, 2020 (HealthDay News) -- The ordeal faced by critically ill COVID-19 patients likely won't end even if they pull through and survive their life-threatening infection, experts fear.

Some of these survivors will be emotionally scarred by their time spent in an intensive care unit (ICU), and they are at increased risk of psychological problems, such as anxiety, depression and post-traumatic stress disorder (PTSD).

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Background: Admission of a patient in the Intensive Care Unit (ICU) and the recovery process may be stressful for family members.
Objectives: This study aimed to explore the families' psychological symptoms and their evolution over the 1st week of patients' ICU stay. Additional objectives were the estimation of the families' need for support and the estimation of satisfaction regarding the information provided by ICU physicians.
Methods: A total of 108 individuals were participated in the study. Participants were interviewed with the Hamilton Anxiety Rating Scale and filled the Beck Depression Scale II on days 1 and 7 of patients' ICU admission. They also filled a self-reported questionnaire which was created by the investigators, involving decision-making procedures; the satisfaction of the families of the patients' care; and the support of the families by medical and nursing staff.
Results: Anxiety levels were not significantly different among 2-time points, whereas rates of depressive symptoms raised significantly from 38% (day 1) to 58.3% (day 7). In cases of anxiety changes, age, education, closeness of relationship, and APACHE II score were the factors been associated. Changes in depressive symptoms were not associated with any of those factors. Over a week, there were significant differences in relatives' views on participating in the decision-making procedure, and on expressing their opinion and concerns regarding the treatment process. Their attitudes about receiving support by the ICU personnel and even by mental health specialists, such as psychologists also changed.
Conclusions: Over the 1st week of ICU admission, depressive symptoms in patients' relatives were gradually evolving, while anxiety symptoms fluctuated and they were affected by the severity of the patients' condition. Attitudes toward treatment procedures and the perceived need for support also changed. These findings should be taken into account by the ICU personnel.

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Objective: To synthesize data on prevalence, natural history, risk factors and post-intensive care unit (ICU) interventions for depressive symptoms in ICU survivors
Data Sources: PubMed, EMBASE, CINAHL, PsycINFO, CENTRAL (1970 – 2015)
Study Selection: Studies measuring depression after hospital discharge using a validated instrument in >20 adults from non-specialty ICUs
Data Extraction: Duplicate independent review and data abstraction
Data Synthesis: The search identified 27,334 titles, with 42 eligible articles on 38 unique studies (n=4,113). The Hospital Anxiety and Depression Scale-Depression subscale (HADS-D), was used most commonly (58%). The pooled HADS-D prevalence (95% confidence interval (CI)) of depressive symptoms at a threshold score ≥8 was 29% (22–36%) at 2–3 months (12 studies, n=1,078), 34% (24–43%) at 6 months, (7 studies, n=760), and 29% (23–34%) at 12–14 months, (6 studies, n=1,041). The prevalence of supra-threshold depressive symptoms (compatible with HADS-D≥8) across all studies, using all instruments, was between 29–30% at all 3 time points. The pooled change in prevalence (95% CI) from 2–3 to 6 months (4 studies, n=387) was 5% (−1% to +12%), and from 6 to 12 months (3 studies, n=412) was 1% (−6% to +7%). Risk factors included pre-ICU psychological morbidity and presence of in-ICU psychological distresssymptoms. We did not identify any post-ICU intervention with strong evidence of improvement in depressive symptoms.
Conclusions: Clinically important depressive symptoms occurred in approximately one-third of ICU survivors, and were persistent through 12-month follow-up. Greater research into treatment is needed for this common and persistent post-ICU morbidity.
Keywords Depression; critical illness; critical care; meta-analysis; review

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NICE has assessed 3 viscoelastometric point-of-care testing devices (the ROTEM, TEG and Sonoclot systems), to help the NHS decide whether to use these products.

Viscoelastometric point-of-care testing may be useful to help determine if bleeding is because of a problem with the blood’s ability to clot, or because of a surgical bleed. This helps the doctor choose the right treatment to stop the bleeding. Using these systems may mean that patients are less likely to need a blood transfusion during surgery or need more operations to investigate further bleeding.

NICE has said that the ROTEM and TEG systems are recommended to help monitor blood clotting during and after heart surgery by healthcare professionals who have had appropriate training.

Because it’s not certain how much benefit they provide, NICE has said that:

the Sonoclot system should only be used in research to help monitor blood clotting during heart surgery
the ROTEM, TEG and Sonoclot systems should only be used in research to help monitor blood clotting in the emergency control of bleeding after an accident or after having a baby.

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Aim:The purpose of this article was to highlight the need to provide support for patients and relatives following critical illness and discharge from hospital and how this can be improved through the establishment of user support groups.
Background:Critical illness predisposes patients to extended physical and psychological ill health with the potential for a reduced quality of life. The authors’ personal experience, patient feedback and current literature suggested that there was a need for further support during their recovery.
Methods:Building on an existing formal follow-up service, Intensive Care Unit (ICU) Support Team for Ex-Patients established a patient-centred forum, where patients and relatives could share experiences with others who had also been through critical illness by holding drop-in sessions. Feedback from those attending these flexible and informal sessions indicates that support was needed and that patients and families have found benefit in sharing experiences with others who can empathise, having been through critical illness themselves.
Conclusions:Our experience has shown there is a need that can be met simply with minimal investment of time and funding but that addresses a gap in patient support that otherwise goes unmet. Although this was a service development in one local area, it could be adapted to ICU patients and relatives more widely

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Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post–intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions—tied to the specific conditions of interest—will be required to address these important problems.

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Health professionals have been aware of the incidence of post-intensive care syndrome (PICS) for some time. However, there has not been a clear or definitive way of administering treatment or nursing care to help patients suffering from PICS in their recovery. This paper suggests some ideas for the care of patients from the nursing point of view.

Brief description of media:

Health professionals have been aware of the incidence of post-intensive care syndrome (PICS) for some time. However, there has not been a clear or definitive way of administering treatment or nursing care to help patients suffering from PICS in their recovery. This paper suggests some ideas for the care of patients from the nursing point of view.

Brief description of media:

Health professionals have been aware of the incidence of post-intensive care syndrome (PICS) for some time. However, there has not been a clear or definitive way of administering treatment or nursing care to help patients suffering from PICS in their recovery. This paper suggests some ideas for the care of patients from the nursing point of view.