Brief description of media:

Family caregivers of intensive care unit (ICU) patients are exposed to high levels of stress (1). During ICU admission, family caregivers are in a position to witness the stress-provoking ICU environment more vividly than the patients who lack physical and cognitive capacity to control or understand surroundings.

Because limited decisional capacity is common in patients during the critical phase of their illness, many family caregivers are expected to take the role of a surrogate decision maker to discuss options for life supporting treatments. Demands on family caregivers do not stop after patients’ ICU discharge. Recovering from critical illness leads to a new phase of complex and unpredictable illness experience. Over time, support from formal resources dissipate and more responsibilities are assumed by family caregivers.

Decades of research have highlighted that ICU family caregivers are at risk for adverse psychological responses at various timelines across the trajectory of their loved one’s illness, recovery and/or death (2-4). Despite growing awareness, supportive and effective interventions targeted to family caregivers of ICU patients are lacking (2). One of major challenges in developing interventions may be limited knowledge of ways to identify family caregivers at high risk for severe stress response and other modifiable risk factors.

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Main results: Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Post-traumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe post-traumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life. Conclusion: Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions.

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Objectives: Factors associated with these symptoms need to be identified. Methods: For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role.

Measurements: Ninety days after ICU discharge or death, family members completed the Impact of Event Scale (which evaluates the severity of post-traumatic stress reactions), Hospital Anxiety and Depression Scale, and 36-item Short-Form General Health Survey during a telephone interview. Linear regression was used to identify factors associated with the risk of post-traumatic stress symptoms.

Main results: Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Post-traumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe post-traumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life.

Conclusion: Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.

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The purpose of this analysis is to describe the safety of propofol administration in adult ECMO patients. We performed a prospective cohort analysis of patients utilizing ECMO at Brigham and Women’s Hospital between February 2013 and October 2015. Patients were included if they utilized ECMO for at least 48 hours. The major endpoint of the analysis was the median oxygenator lifespan. Oxygenator exchanges were analyzed by the number of patients requiring an oxygenator exchange and the number of oxygenator exchanges per ECMO day. A priori analysis was performed comparing outcomes between patients who did and did not receive propofol during their ECMO course.

During the study, 43 patients were included in the analysis. Sixteen patients utilized propofol during their ECMO course. There were 12 oxygenator exchanges during therapy. Oxygenator exchange occurred on 1.8% of ECMO days. The median oxygenator lifespan was 7 days. Patients who utilized propofol had a significantly longer oxygenator lifespan (p=0.02). Among patients who received propofol, patients who required oxygenator exchange utilized a significantly lower median daily dose of propofol (p<0.001). The use of propofol appears safe in ECMO with regards to oxygenator viability. Contrary to expected, oxygenator lifespan was significantly longer among patients who received propofol.

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Tens of thousands of Covid-19 survivors should be screened for post-traumatic stress disorder because of their experiences in fighting for their lives, mental health experts have urged. Leading psychiatrists and psychologists want NHS bosses to ensure that all those who were admitted to hospital when they became seriously ill with the disease are assessed and checked regularly. Survivors showing signs of PTSD would undergo treatment to prevent nightmares and flashbacks that could blight the rest of their lives.

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Purpose: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown.

Methods: A multicenter prospective randomized trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomization (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multi drug-resistant (MDR) bacteria and re operation rate, with 45-day follow-up.

Results: Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6–20] vs 12 [6–13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99–6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI − 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or re-operation rate, while subsequent drainage between day 8 and day 45 were observed following short-course ABT (P= 0.041).

Conclusion: Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit.

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This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium, as well as reducing the risk of delirium. The guideline applies to all settings: home, long-term care, hospital, and hospice. It is important to note that, to date, much of the existing evidence and the focus of other guidelines, is in acute care settings. However, this does not preclude application of the recommendations to other settings, adapted according to clinician judgement. Person-centred care should be the focus of the implementation of this guideline. The guideline excludes delirium secondary solely to alcohol and illicit substances use. It also excludes delirium in children.

Brief description of media:

Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families.

Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU. All critical care survivors should be evaluated for PICS and those having signs and symptoms of it should be managed by a multidisciplinary team which includes critical care physician, neuropsychiatrist, physiotherapist, and respiratory therapist, with the use of pharmacological and non-pharmacological interventions. This can be achieved through an organizational change and improvement, knowing the high rate of incidence of PICS and its adverse effects on the survivor’s life and daily activities and its effect on the survivor’s family. Key words: cognition, critical illness, intensive care, syndrome.

Brief description of media:

Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS).Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.

Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.

Results: A total of 62 parents/caregivers received one of three educational interventions: informational brochures (n=22), scripted informational conversation (n=20), or three-minute educational video (n=20). An additional 19 bedside nurses completed surveys to describe how each educational intervention affected daily workflow. Changes in parental/caregiver PICS fund of knowledge was evaluated using Fischer’s exact test. All three educational interventions were associated with a significant improvement in understanding of PICS, with no single intervention being superior. Nursing surveys indicated that workflow was minimally disrupted using PICS education and that all interventions were perceived to be important and useful.

Conclusions: Targeted educational interventions led to improvement in knowledge about PICS among parents/caregivers and were well supported by PICU nursing staff. Thus, providing support for a sustainable implementation of PICS education in the SLCH PICU.

Brief description of media:

Millions of people worldwide have survived an admission to the intensive care unit (ICU), and the number of survivors is growing [1]. While these patients have survived a life-threatening illness, most survivors suffer important long-term complications [2]. Post-intensive care syndrome (PICS) is a term that describes the cognitive, psychological, physical, and other consequences that plague ICU survivors [3, 4]. Our aim is to discuss the prevalence, risk factors, impact, prevention and management of PICS.

Brief description of media:

Millions of people worldwide have survived an admission to the intensive care unit (ICU), and the number of survivors is growing. While these patients have survived a life-threatening illness, most survivors suffer important long-term complications. Post-intensive care syndrome (PICS) is a term that describes the cognitive, psychological, physical and other consequences that plague ICU survivors. Our aim is to discuss the prevalence, risk factors, impact, prevention, and management of PICS.

Brief description of media:

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses.

Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS.

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. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.