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This article depicted the experience and life of the ICU patient after discharged.

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Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge.

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Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

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This document is part of a suite of documents setting out adult and paediatric standards and service specifications for congenital heart disease services in England.

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Even after surviving COVID-19, many patients who were critically ill face long and arduous recoveries, often requiring extensive physical rehabilitation. The problems they encounter are wide-ranging. Some patients suffer muscle atrophy, kidney damage or reduced lung capacity, making it difficult for them to leave their homes or get out of bed. Many struggles with cognitive and psychological issues like memory loss, depression and anxiety. Among the most common problems they face are shortness of breath, fatigue, confusion and body aches.

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Ronan’s lingering symptoms aren’t unique to COVID-19 patients. In as many as 80% of them leaving the ICU, researchers have documented what they call post-intensive care syndrome (PICS) -- a group of physical, mental, and psychiatric symptoms that result from an ICU stay. Although their illness plays a role in these symptoms, the amount of time spent in critical care is
a major factor.

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Researchers are still trying to understand everything that Ronan and other COVID-19 patients need to let them move on with their lives after being in the ICU. Mysteries abound, but the groundwork laid by Sevin, Needham, Weinhouse, and others has provided a solid foundation on which to build.

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This After the ICU booklet is intended to be used by former ICU patients and their family/caregiver to help find the health care services and community resources
that may be helpful during recovery from critical illness. Specifically, this booklet was created to provide information and resources related to Post-Intensive
Care Syndrome (PICS). While PICS and PICS-F can be common after a critical illness, you may not experience all or any of these symptoms. PICS is defined as new or worsening physical, cognitive and emotional health problems that remain after a critical illness. Family members and caregivers of former ICU patients can
also experience emotional and psychological health problems such as anxiety, depression and posttraumatic stress disorder. This is referred to as PICS-F. Our hope is to raise awareness about PICS and PICS-F and provide resources for those who are experiencing these symptoms. If you or your family/caregiver are having difficulty, we want you to know that you are not alone and that help is available.

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Our project addresses one of the pressing issues of ICU medicine—the post-ICU patient. Research has documented deficits faced by survivors of intensive care, specifically neuro-cognitive dysfunction, depression, anxiety, and post-traumatic stress. These long-lasting disabilities present an important and prevalent public health concern. Although clinicians are increasingly aware of the challenges that face ICU survivors, they do not frequently discuss this with patients or families. As a result, patients often face a bewildering number of care transitions—from hospitals to long-term care to nursing facilities—without a roadmap or community. Furthermore, there is little research that investigates which outcomes are important to ICU survivors and their families, or how to change care with these outcomes in mind.

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Early this year, when the world was first coming to grips with the spread of COVID-19 and the challenges it would present, Dr. Brad Butcher, a critical care medicine specialist at UPMC Mercy, was focused on what was coming next.
“We heard that patients who required time in the intensive care unit, and particularly time on a mechanical ventilator, were staying on the ventilator for a very long time,” he said. “This is concerning because the longer people stay in bed, the more physical weakness can develop, and the longer they’re on ventilation, the more drugs they need to sedate them.”
Additional medication increases the risk of patients developing delirium, which raises the likelihood of long-term cognitive complications from the critical illness. These conditions would only be intensified by the limited interactions with care providers and loved ones permitted by COVID-19 safety protocols.
“We were very concerned that these patients would be at increased risk for anxiety, depression and post-traumatic stress disorder,” Butcher said.
In other words, COVID-19 had the potential to create a perfect storm in the realm where Butcher and his colleague Tammy Eaton, C.R.N.P., specialize: Post-Intensive Care Syndrome (PICS). PICS is a set of conditions that have been around as long as critical care medicine, but it received a name only a decade ago. Addressing PICS is the mission of the UPMC Critical Illness Recovery Center (CIRC), which Butcher and Eaton founded at UPMC Mercy.

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Post-intensive care syndrome–family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons. First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment, compared to older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared to other geriatric populations.Second,as caregivers themselves age, caring for this unique burden can be more challenging compared to other geriatric populations. Third, evidence for models of care centered on patients with multi morbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multi morbidity and their caregivers. Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.

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MONDAY, Jan. 25, 2021 (American Heart Association News) -- Rosemary "Rosie" Veltz was "medically maxed out." That was the term the doctors used six months after a third surgery to correct a heart defect that left her struggling to breathe while her lungs continued to fill with fluid.