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Almost 6 million patients land in an intensive care unit every year, and for many, it marks a turning point in their lives. A substantial number of patients leave the ICU with newly acquired problems, from dementia to nerve disease. Medical leaders have developed new standards to reduce the use of drugs and get patients moving, but adoption has been slow. Special correspondent Jackie Judd reports.

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Paul Nappi arrived at Penn Presbyterian Medical Center's intensive care unit suffering from a severe lung problem on March 8. The 53-year-old Chester County man, already depleted by cancer treatments and a December bout with pneumonia, was unconscious and hooked to a breathing machine. His family was told he might not make it through the night. They also were given a small spiral notebook labeled ICU Healing Journal. The family could fill it with words that could help hospital staff understand who Nappi is. Doctors, nurses, and therapists would add entries offering support and explaining what Nappi was going through. The journal could help him adjust to life after the ICU — if he survived.

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“Long Covid” is a condition currently affecting approximately 60,000 people in the UK – and which will inevitably continue to rise as we move through the pandemic – that is characterized by a variety of physiological and psychological issues. These can include fatigue, breathlessness, cognitive blunting (“brain fog”) and pain, and can require practical, medical and emotional support similar to that already offered by employers for conditions such as cancer, ME and diabetes.

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Critically ill patients are known to suffer from severely fragmented sleep with a predominance of stage I sleep and a paucity of slow wave and REM sleep. The causes of this sleep disruption include the intensive care unit (ICU) environment, medical illness, psychological stress, and many of the medications and other treatments used to help those who are critically ill. The clinical importance of this type of sleep disruption in critically ill patients, however, is not known. This article reviews the literature of commonly used ICU medications on sleep, the relationship between sleep and sedation, and the literature on the biological and psychological consequences of sleep deprivation specifically as it relates to the critically ill. Finally, an integrative approach to improving sleep in the ICU is described.

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The Society of Critical Care Medicine (SCCM) is the largest non-profit medical organization dedicated to promoting excellence and consistency in the practice of critical care. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. The Society offers a variety of activities that ensures excellence in patient care, education, research and advocacy.

Brief description of media:

The commotion over COVID-19's direct impacts has largely drowned out alarm over its longer-term effects. But as more survivors emerge from intensive care units, a chorus of voices, many tweeting under #LongCovid, are clamoring to be heard.

Brief description of media:

For most people—about 80%, according to the World Health Organization—COVID-19 won't result in serious illness. But that still means 1 in 5 people who contract the infection will end up with a more severe form of the disease, and will need hospitalization. In the most severe cases—typically in those with underlying conditions like high blood pressure, heart and lung problems, or diabetes—COVID-19 patients may be admitted to a hospital's intensive care unit (ICU), where they can benefit from respiratory support through a ventilator.

According to multiple studies, the majority of patients admitted to the ICU and require ventilation do not survive. Data from the Intensive Care National Audit and Research Center in London shows that, of outcome data available for 690 ICU patients, 346 (or 50.1%) patients died, while 344 (49.9%) were discharged alive. Similar findings were shown in an Italian study published in JAMA: Of 1,581 patients with available ICU disposition data at the end of the study, 920 patients were still in the ICU—but of the remaining 661 patients, 405 (61.3%) died while 256 (38.7%) were discharged.

Of course, being discharged from the ICU is the best-case scenario—but sometimes, even after coming off of respiratory support, hospitalized patients can experience another issue: ICU delirium.

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Spouse admitted into the intensive care unit (ICU) may make a person more prone to have a heart attack or cardiac-related hospitalization in few weeks of the ICU admission, according to the research published in the journal Circulation. "Spouses of ICU patients should pay attention to their own physical health, especially in terms of cardiovascular disease," said the study's senior author Hiroyuki Ohbe, M.D., M.P.H., a Ph.D. student in the department of clinical epidemiology and health economics in the School of Public Health at The University of Tokyo in Japan.

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DALLAS, Oct. 5, 2020 -- Having a spouse in a hospital's intensive care unit (ICU) may make a person more likely to have a heart attack or cardiac-related hospitalization themselves within a few weeks of the ICU admission, according to new research published today in the American Heart Association's flagship journal Circulation.

Brief description of media:

Having a spouse in a hospital’s intensive care unit (ICU) may make a person more likely to have a heart attack or cardiac-related hospitalization themselves within a few weeks of the ICU admission, according to new research published today in the American Heart Association’s flagship journal Circulation. “Spouses of ICU patients should pay attention to their own physical health, especially in terms of cardiovascular disease,” said the study’s senior author Hiroyuki Ohbe, M.D., M.P.H., a Ph.D. student in the department of clinical epidemiology and health economics in the School of Public Health at The University of Tokyo in Japan. “The ICU can be a stressful environment with significant caregiving burdens, and spouses may face tough decisions about continuing or ending life-sustaining treatment.”

Brief description of media:

Post-traumatic stress disorder, a form of anxiety disorder common among war veterans, was also frequently seen among intensive care patients put on a ventilator, a new study shows. Some patients showed significant effects of the condition, also known as PTSD, up to two years later.

Brief description of media:

Background: Post–intensive care syndrome–family (PICS-F) refers to acute and chronic psychological effects of critical care on family members of patients in intensive care units (ICUs). Evidence suggests that increased distress during the ICU stay increases risk of PICS-F. Sensation Awareness Focused Training (SAF-T) is a new, promising stress management intervention, but the feasibility of such training during the ICU stay for family caregivers who are acting as the surrogate decision-maker for patients who are undergoing mechanical ventilation is unknown.

Objectives: To assess feasibility and acceptability of SAF-T to inform a future larger randomized controlled trial.

Methods: This randomized controlled trial of SAF-T (n = 5) versus a control (n = 5) group was conducted at a level 1 trauma center. Participants assigned to SAF-T completed 1 session daily for 3 days. Measures included enrollment rate, data completion rate, acceptability of SAF-T, and symptoms of PICS-F. Scales used included Perceived Stress, Hospital Anxiety and Depression, Impact of Event, and National Institutes of Health Toolbox Emotion Battery.

Results: Mean age was 58 (SD, 12) years; 70% of participants were female. Predetermined feasibility criteria were met in enrollment rate (67%), outcome measures completion rate (> 90%), and SAF-T acceptability (100% of doses completed during the ICU stay) without adverse events. Stress scores after SAF-T were significantly lower than scores before SAF-T ( ˉ z = −3.5, P = .01).

Conclusions: SAF-T intervention during the ICU stay is feasible, acceptable, and may improve family caregivers’ post-ICU outcomes. Larger clinical trial to assess the effectiveness of SAF-T in preventing PICS-F seem war-ranted.