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A Typical Patient's Experience, Life In and After the ICU - Delirium, Hallucinations, Pain and Finding Comfort and Resolution.

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Survivors of critical illness and their caregivers frequently face long-term impairments of cognition, mental health, mobility and beyond, which demand for a patient-centered transition management and well-coordinated, outpatient post-ICU care.

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Advancements in critical care medicine result in a growing population of survivors of critical illness. Many intensive care unit (ICU) patients have physical, mental, and cognitive sequelae after discharge from the ICU, known as post-intensive care syndrome (PICS). These problems are associated with long-lasting restrictions in daily functioning and reduced health-related quality of life (QoL) and can also negatively affect family members (PICS-F). The nature of these restrictions requires interdisciplinary rehabilitation care, but to date there is no structured pathway for the prevention and treatment of the symptoms of PICS.

The aim of this thesis was to explore the course and prognosis of functioning in ICU survivors, and to investigate means for early identification of PICS. In the studies assembled in this thesis, we found that patients with prolonged ICU-stay, longer duration of mechanical ventilation (> 48 hours), and/or ICU-AW, have a higher risk of short- and long-term functional impairments, limitations in activities and restrictions in participation. A majority of ICU survivors do not receive adequate rehabilitation care after discharge from the hospital. This implies, that patients and their close relatives should be closely monitored after discharge from the ICU to initiate interdisciplinary rehabilitation treatment. In order to improve the quality of survivorship, we propose a structured, stepped care rehabilitation pathway, consisting of clinical assessments with validated screening instruments, interdisciplinary rehabilitation interventions, tailored to the patients’ abilities and needs, and adequate handover in the transition of care.

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Each year, about 28.000 individuals are discharged from intensive care units (ICUs) encountering physical, mental and/or cognitive disorders as part of the post-intensive care syndrome (PICS). The general aim of this thesis was to explore the course and prognosis of functioning in ICU survivors during the first year after ICU discharge, and to investigate means for early identification of PICS. The studies included in this thesis focused on adult ICU-patients, who were mechanically ventilated more than 48 hours in a closed format mixed medical-surgical ICU. In this chapter the main findings and methodological issues of the presented studies are reviewed, implications for clinical practice are discussed, and recommendations for rehabilitation care as well as for future research are provided.

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Improvements in devices and techniques used to provide life support for patients at intensive care units have reduced patient mortality. Increases in the number of survivors from a critical illness have brought long-term complications experienced during the post-intensive care period into question. The term post-intensive care syndrome (PICS) is defined as a new and deteriorating disorder in the cognitive, mental, and physical health status experienced by the survivor after intensive care unit discharge that might continue for months or even years. Opioid and sedation exposure, the severity of illnesses and injuries, dense life support interventions, length of stay in the intensive care unit, and social isolation constitute risk factors for PICS in children. These factors cause the child to experience deterioration in physical, cognitive, and psychological health domains. Such deteriorations occur on various levels and have negative effects on quality of life.

The purpose of this article is to raise awareness and help pediatric nurses to develop an understanding of the condition. Increasing awareness by pediatric nurses about the magnitude and effects of complications after discharge from the intensive care unit will be the first step to protect survivors from new problems, to provide assistance for ongoing problems, and to develop follow-up strategies. PICS-related morbidities affect the majority of children discharged from PICUs. We need to understand the scope of those morbidities and develop efficient nursing interventions accordingly. It is time to expand our goal for critical and noncritical care from lifesaving into improvement of functional health status and quality of life.

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Aggressive reimbursement reform has been an imposing directive for care providers of ICU medicine. Timely knowledge of actual care routines obtained from a large sample of actively practicing physicians should be mandatory when developing any guidelines or practice standards. A questionnaire was therefore designed by the steering committee of the ACCP Council on Critical Care and sent to its members. The 1,294 responses were analyzed for demographics of the individual practitioner, local aspects of ICU staffing and policies, reimbursement, and a specific practice issue, nutrition.

The typical respondent was aged 41 to 50 (41 percent), was a pulmonary subspecialist (68 percent), was not critical care certified (55 percent), worked 25 to 50 percent of his or her total time in the ICU (40 percent), and would continue ICU practice despite poor reimbursement (82 percent). Physicians practiced within a group (53 percent), in a 100- to 500-bed hospital (69 percent), with house staff available (60 percent), and predominantly cared for Medicare patients (55 percent). The following data may allow better judgments to be made pertaining to the implementation of care policies in the current ICU environment.

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With multiple advances in critical care, more patients are given the chance to survive life-threatening illnesses such as sepsis. This growing cohort of patients, however, grapples with a new challenge – post-intensive care syndrome (PICS). As the condition is increasingly recognized, the number of clinics devoted to helping patients with PICS recover is also on the rise.

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A 33-item Trauma Symptom Checklist (TSC-33) is presented, and the psychometric properties of this scale are summarized from four separate studies. Developed to assess the impact of childhood abuse on later (adult) functioning, the TSC-33 consists of five subscales (Dissociation, Anxiety, Depression, Post-Sexual Abuse Trauma-hypothesized [PSAT-h], and Sleep Disturbance) and a total scale score. Data suggest that the TSC-33 and its associated subscales are reasonably reliable measures that display some predictive and discriminative validity with regard to childhood sexual abuse. Other variables appear to elevate checklist scores as well, however, such as physical abuse history and mental health client status, although apparently not gender.

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Three common cognitive impairments among older adults: delirium, dementia, and depression.

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This is a referral form that includes information about PICS and PICS-F.

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The article is a guide for medical practitioner to monitor ICU patients and prevent them to develop Delirium

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This evidence note, together with evidence note 52 (TAVI for severe symptomatic aortic stenosis in adults at high surgical risk), updates evidence note 38 published in August 20111. It summarizes the clinical and cost-effectiveness evidence from published secondary sources, randomized controlled trials (RCTs) and economic evaluations comparing TAVI with medical management in adults with severe symptomatic AS who are not eligible for surgery. Additional data from the UK and other European TAVI registries are also included.