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Proposed framework for post‐intensive care syndrome in pediatrics (PICS‐p). Compared to the concept of PICS for adult intensive care unit survivors, the unique features of PICS‐p include the importance of baseline status, system maturation and psychosocial development, stronger interdependence within the family, and recovery trajectories that can potentially impact a child's life for decades.

Brief description of media:

The diagnosis and treatment of psychiatric disorders in intensive care patients have been for a long time neglected. They are nowadays better recognized and managed. These disorders are mainly: delirium; anxiety disorders, from simple anxiety to panic disorder with agitation; adaptation disorders with depressive mood; brief psychotic disorders with persecution ideas. The manifestations of psychiatric disorders occur not only during the stay in intensive care unit (ICU) but also after transfer from ICU and several months after discharge from hospital. Part of psychiatric disorders is caused by organic or toxic causes (metabolic disturbances, electrolyte imbalance, withdrawal syndromes, infection, vascular disorders, and head trauma). Nevertheless, some authors estimate that they are due to the particular environment of ICU. The particularities of these units are a high sound level (noise level average between 50 and 60 dBA), the absence of normal day-night cycle, a sleep deprivation, a sensory deprivation, the inability for intubated patients to talk, the pain provoked by some medical procedures, the possibility to witness other patients' death.

Although most patients feel secure in ICU, some of them perceive ICU's environment as threatening. Simple environmental modifications could prevent the apparition of some psychiatric manifestations: efforts should be made to decrease noise generated by equipment and staff conversations, to provide external windows, visible clocks, and calendar, to ensure adequate sleep with normal day-night cycle and to encourage more human contact. Psychotropic drugs are useful, but a warm and empathetic attitude can be very helpful. Some authors described specific psychotherapeutic interventions in ICU (hypnosis, coping strategies.). To face anxiety, many patients have defense attitudes as psychological regression and denial.

Patient's family is suffering too. Relative's hospitalization causes a crisis in family. Unpredicted illnesses often force family members to reorganize in order to regain their equilibrium. Every family should be proposed a psychological support. Caregivers can be distressed as well. This stress is due to their high responsibility and the fact that they face disease and death. Simple measures can lessen stress' effect and prevent the burn-out syndrome . In conclusion, the importance of a liaison psychiatrist-intensive care physician collaboration must be emphasized in order that patients and their family have a better psychological support. Psychological management should be proposed during the hospitalization and after discharge from hospital.

Brief description of media:

In less than 10 years intensive care units have become an essential part of most general hospitals. They have demonstrated their value in the treatment of the critically ill. Obviously, in the initial development of such instrumentation our attention was focused on mastering the technology. A reasonable level of mastery now appears to exist. I therefore believe this is an appropriate time to examine the impact of this environment on the people who live in it-patients and staff.

Brief description of media:

Patients who have had an admission to ICU for more than 3 days are followed up on the ward by the CCRAFT. This team comprises of an outreach nursing sister, Consultant Intensivist, rehabilitation assistant and physiotherapists.

Brief description of media:

Experiencing treatment on a modern intensive care unit (ICU) is a potentially traumatic event. People who experience traumatic events have an increased risk of depression, anxiety disorders and post-traumatic stress disorder (PTSD). Extended follow-up has confirmed that many patients suffer physical and psychological consequences of the ICU treatment up to 12 months after hospital discharge. PTSD in particular has become increasingly relevant in both the immediate and longer-term follow-up care of these patients. The extent to which the consequences of critical illness and the treatments received in the ICU contribute to the development of PTSD is poorly understood and more rigorous studies are needed. Understanding the factors associated with a poor psychological recovery after critical illness is essential to generate models of causality and prognosis, and to guide the delivery of effective, timely interventions.

Brief description of media:

Experiencing treatment on a modern intensive care unit (ICU) is a potentially traumatic event. People who experience traumatic events have an increased risk of depression, anxiety disorders and post-traumatic stress disorder (PTSD). Extended follow-up has confirmed that many patients suffer physical and psychological consequences of the ICU treatment up to 12 months after hospital discharge. PTSD in particular has become increasingly relevant in both the immediate and longer-term follow-up care of these patients. The extent to which the consequences of critical illness and the treatments received in the ICU contribute to the development of PTSD is poorly understood and more rigorous studies are needed. Understanding the factors associated with a poor psychological recovery after critical illness is essential to generate models of causality and prognosis, and to guide the delivery of effective, timely interventions.

Brief description of media:

During the PICTURE trial a short narrative therapy (narrative exposure therapy adapted for primary care) for patients with posttraumatic stress disorder (PTSD) after intensive care treatment is to be carried out by their general practitioner (GP). During regular practice hours, this is often difficult. For this reason, we are investigating whether the regular treatment can be improved by a specially trained GP. The aim of the study is to investigate the effects and applicability of a short version of an established narrative therapy for patients with posttraumatic stress disorders after intensive medical treatment.

Three months after discharge from the intensive care unit, the diagnosis of a PTSD symptoms is verified, and the patients are randomized into two groups. In the treatment group, the physician will perform three 45-minute therapy sessions with the patient within 6 weeks. During the first session a list of the most intense events - both positive and negative - in the life of the patient is drawn on the basis of a lifeline, with the stay at the intensive care unit being one of these events. The second session deals with the experience during intensive care in detail, led by the GP. During the third session, another event from the patient's life will be discussed in the same manner. This way, the different components (cognitions, emotions, body reactions, context information) can be reconnected and classified into the patient's own biography.

Between the therapy sessions, a conversation between the GP and the psychologist will take place to support the GP during the therapy. In order to monitor the patient's safety and compliance, standardized telephone calls between the patient and the GP practice are regularly carried out every 2-3 weeks in between therapy sessions up to the first data collection after 6 months (T1). In the control group there are three doctor-patient contacts, too, which content is based on the patient's symptoms. This group thus receives the standard therapy which is customary in practice.

Brief description of media:

The COVID-19 pandemic has led to vastly increased admissions into intensive care. Around one in four ICU survivors develop Post-Traumatic Stress Disorder (PTSD) in the months after admission, and others will develop depression or one of several anxiety disorders. This guide aims to provide information for healthcare professionals working with ICU survivors. It will help you recognize PTSD and know how to help.

Brief description of media:

The COVID-19 pandemic has led to vastly increased admissions into intensive care units (ICU). Around one in four ICU patients develop PTSD symptoms after the admission. Other disorders, including depression and various anxiety disorders are also common. This guide aims to provide information for therapists working with patients who have developed PTSD after an ICU admission, or a similar medical environment.

Brief description of media:

Nearly one-quarter of intensive care unit survivors have post-traumatic stress disorder; diaries could be successful prevention tool. Through a systematic literature review, the research team looked at 40 studies of 36 unique patient cohorts with a total of more than 3,000 patients who survived a critical illness and ICU stay. The researchers excluded patients who had suffered a trauma, such as a car crash, or brain injury, because those patients’ cognitive and psychological outcomes can be affected by the injury itself, rather than the critical illness/ICU stay. They found that the prevalence of PTSD in the studies ranged from 10 to 60 percent.

Brief description of media:

Post-traumatic stress disorder is often thought of as a symptom of warfare, major catastrophes, and assault. It’s rarely considered in patients who survive a critical illness and stay in the intensive care unit (ICU). However, in a recent Johns Hopkins study, researchers found that nearly one-quarter of ICU survivors suffer from PTSD. They also identified possible triggers for PTSD and indicated a potential preventive strategy: having patients keep ICU diaries. The findings will be published in the May issue of Critical Care Medicine.

Brief description of media:

Post-traumatic stress disorder is often thought of as a symptom of warfare, major catastrophes, and assault. It's rarely considered in patients who survive a critical illness and stay in the intensive care unit (ICU). However, in a recent Johns Hopkins study, researchers found that nearly one-quarter of ICU survivors suffer from PTSD. They also identified possible triggers for PTSD and indicated a potential preventive strategy: having patients keep ICU diaries. The findings will be published in the May issue of Critical Care Medicine.