Brief description of media:

Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have been published for delivering trauma-focused cognitive behavioural therapy with this population. In
this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU.

Brief description of media:

Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during theCOVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months.Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have beenpublished for delivering trauma-focused cognitive behavioural therapy with this population. In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU.

Brief description of media:

Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have been published for delivering trauma-focused cognitive behavioural therapy with this population. In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU.

Brief description of media:

Rationale: The US has seven times as many intensive care unit (ICU) beds per capita as the UK; the effect on care of critically ill patients is unknown.
Objective: Compare medical ICU admission in the US and UK.
Methods: Retrospective (2002-2004) cohort study of 172,785 admissions (137 US ICUs, Project IMPACT database; 160 UK ICUs, UK Case Mix Programme), with patients followed until initial hospital discharge.
Results: UK (vs US) admissions were less likely to be admitted directly from the emergency room (ER), (33.4 vs 58.0%), had longer hospital stays before ICU admission (mean days 2.6±8.2 vs 1.0±3.6), and fewer were ≥85 years (3.2% vs 7.8%). UK patients were more frequently mechanically ventilated within 24h after ICU admission (68.0% vs 27.4%), were sicker (mean Acute Physiology Score 16.7±7.6 vs 10.6±6.8), and had higher primary hospital mortality (38.0% vs 15.9%; adjusted Odds Ratio (OR) 1.73, 95%CI 1.50-1.99). There was no mortality difference for mechanically ventilated patients admitted from the ER (adjusted OR 1.09, 0.89-1.33). Comparisons of hospital mortality were confounded by differences in casemix, hospital length of stay (UK median 10 days (IQR 3-24) vs US 6 (3-11)), and discharge practices: more US patients were discharged to skilled care facilities (29.0% of survivors vs 6.0% in the UK).
Conclusions: Lower UK ICU bed availability is associated with fewer direct admissions from the ER, longer hospital stays before ICU admission, and higher severity of illness. Interpretation of between-country hospital outcomes is confounded by differences in casemix, processes of care and discharge practices.

Brief description of media:

An increased proportion of deaths occur in the intensive care unit (ICU).
We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score>25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised
Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms
were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient
died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.

Brief description of media:

To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States.
A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care.
218/307 referred patients (71%) survived to hospital discharge; 62 (28% of survivors) were seen in clinic. Median time from discharge to ICU-RC visit was 29days. At initial evaluation, 64% of patients had clinically meaningful cognitive impairment. Anxiety and depression were present in 37% and 27% of patients, respectively. One in three patients was unable to ambulate independently; median 6min walk distance was 56% predicted. Of 47 previously working patients, 7 (15%) had returned to work. Case management and referral services were provided 142 times. The median number of interventions per patient was 4.
An ICU-RC identified a high prevalence of cognitive impairment, anxiety, depression, physical debility, lifestyle changes, and medication-related problems warranting intervention. Whether an ICU-RC can improve ICU recovery in the US should be investigated in a systematic way.

Brief description of media:

Over 6 million patients become critically ill each year. Of these, an increasing number will survive due to advances in critical care. However, this survival is not without cost. As the long term effects of critical illness become known, the need to design and implement effective interventions to rescue critical illness survivors from incomplete recovery has become a pressing priority for many clinicians. However, evidence based guidelines for intensive care unit (ICU) follow up and recovery remain elusive. In 2012, we started seeing patients in an outpatient team clinic designed to screen for and treat Post Intensive Care Syndrome (PICS), with the goal of promoting recovery for the sickest patients who survive the ICU. This effort was inspired by a patient in the Vanderbilt Medical ICU, and was undertaken as a pragmatic clinical intervention in an attempt to address the multifaceted yet ICU-specific problems emerging in the literature and in practice.

Brief description of media:

Over the past several decades, advances in pediatric critical care have saved many lives. As such, contemporary care has broadened its focus to also include minimizing morbidity. Post Intensive Care Syndrome, also known as “PICS,” is a group of cognitive, physical, and mental health impairments that commonly occur in patients after ICU discharge. Post Intensive Care Syndrome has been well-conceptualized in the adult population but not in children

Brief description of media:

The flow sheet help the medical practitioner to evaluate the confusion level of the patient in the ICU.

Brief description of media:

This is a training manual for physicians, nurses and other healthcare professionals who wish to use the Confusion Assessment Method for the ICU (CAM-ICU). The CAM-ICU is a delirium monitoring instrument for ICU patients. A complete detailed explanation of how to use the CAM-ICU, as well as answers to frequently asked questions and case studies are provided in this manual.

Brief description of media:

Guidelines summarize and evaluate all available evidence on a particular issue at the time of the writing process, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk – benefit ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

Brief description of media:

Since the COVID-19 global pandemic was declared over a year ago, medical research has gradually turned its focus on a condition that has been coined ‘long COVID’ – a term to describe the effects of COVID-19 that can continue for months after the initial acute infection.
Since April 2020, UNSW Sydney medical researchers have been investigating the long-term effects of COVID-19 to develop improved post-COVID-19 clinical care and help guide future health service requirements. This is part of the ADAPT study at the Kirby Institute where researchers have been following patients diagnosed with COVID-19 at regular intervals over a minimum of one year post-diagnosis.
In its most recent report – published on preprint server medRxiv and yet to be peer reviewed – the ADAPT team revealed only 80 per cent of patients reported full recovery at eight months. Additionally, there was no significant improvement in symptoms or measures of health-related quality of life between the four- and eight-month assessments.