Brief description of media:

Since critical care began over 50 years ago, there have been tremendous advances in the science and practice that allow more severely ill and injured patients to survive. Each year, millions of people are discharged back to the community. The recognition of long-term consequences for ICU survivors and their families is a growing concern. Critical care practitioners have always known that the patients have a long road to recovery after discharge from the ICU.

In the 2 past decades, research has revealed how remarkably common and devastating long-term consequences of critical illness can be and how much some patients and their families suffer (1–9). These consequences in patients are referred to as post-intensive care syndrome (PICS) and in families as post-intensive care syndrome-family (PICS-F) (1). The research findings are disturbing and a source of dis-tress to critical care practitioners. In response, they are working hard to identify the risk factors for PICS and are rapidly implementing ways to mitigate their impact. Although the critical care community is becoming increasingly aware of PICS, patients, families, and the post hospital care community need more information. They are the ones who are deal most directly PICS and PICS-F.

There are three key emerging concepts driving these initiatives: a focus on safe transitions and hand offs, an emphasis on family-centered care, and the acceptance that critical care is defined by the whole episode of care, not just the ICU stay. It is clear that those in the field of critical care have a responsibility to increase the awareness and to work with those who care for patient’s post-ICU to identify and treat the consequences of critical illness in patients and families.

Brief description of media:

Since critical care began over 50 years ago, there have been tremendous advances in the science and practice that allow more severely ill and injured patients to survive. Each year, millions of people are discharged back to the community. The recognition of long-term consequences for ICU survivors and their families is a growing concern. Critical care practitioners have always known that the patients have a long road to recovery after discharge from the ICU. In the 2 past decades, research has revealed how remarkably common and devastating long-term consequences of critical illness can be and how much some patients and their families suffer (1–9). These consequences in patients are referred to as post intensive care syndrome (PICS) and in families as post intensive care syndrome-family (PICS-F).

Brief description of media:

Our objective was to summarize and critically review data on the prevalence of posttraumatic stress disorder (PTSD) in general intensive care unit (ICU) survivors, risk factors for post-ICU PTSD, and the impact of post-ICU PTSD on health-related quality of life (HRQOL).

Brief description of media:

The prevalence of diabetes mellitus in patients requiring cardiac surgery is rapidly increasing. These patients have higher perioperative morbidity and mortality, significantly reduced long-term survival, and less freedom from recurrent episodes of angina[1–3]. There is now evidence to suggest that achieving glycemic control in patients with diabetes decreases perioperative morbidity and improves short-term and long-term survival. Despite the emerging recognition of the importance of glycemic control, there are no specific guidelines for cardiac surgeons as to what the optimal level of glucose should be during the perioperative period, and the best method to achieve these target values. What follows is an executive summary of guidelines for the management of hyperglycemia in both patients with and without diabetes undergoing adult cardiac surgical procedures, derived from evidence-based recommendations.

Brief description of media:

Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients.

Brief description of media:

Introduction
Relatives of patients with severe sepsis have high risk of adverse psychological outcomes. Better knowledge about risk factors is needed.
Objectives
To predict psychological outcomes in relatives of patients at 90 days after death or discharge.
Methods
Prospective study on 4 ICUs in one German University hospital (04/2014 - 01/2015). The main relative of consecutive patients with severe sepsis were interviewed by phone at 90 days after patient discharge or death. Post-traumatic stress symptoms (PTSS) were assessed by the Impact of Event Scale (IES), symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale(HADS). Predictors were chosen based on literature, including demographic data, satisfaction with ICU care and information and experience of end-of-life care in the ICU. All patients’ health status before severe sepsis and survivors’ health status at 90 days were assessed by the relative using the EQ-5D questionnaire. A new item was introduced: feeling over strained by the ICU experience with rating on a scale from 1 to 10. Linear regression analyses were used to identify predictors in the full sample and among relatives of deceased and surviving patients.
Results
143 relatives (64% response rate) participated. Fifty (35%)patients died in the ICU, 78 (55%) were alive at the time of the interview. Among relatives, median [IQR] age was54 [47,63], 73% were female, 43% were spouses and 39%were children of the patient, 78% were legal proxies. After90 days, 66 relatives (47%) experienced symptoms of PTSS; 55 (39%) and 41 (29%) suffered from symptoms of anxiety and depression, respectively. IES, HADS anxiety or depression scores did not differ between relatives of deceased and surviving patients. By multivariate analyses, no item on satisfaction with the ICU experience or the experience of end-of-life care reached significance. Female gender and lower education of relatives were risk factors for some psychological symptoms in the full sample and among relatives of deceased patients. Tracheostomy was a predictor of IES in the full sample (p=.004), treatment on a surgical ICU was a predictor of IES among relatives of deceased patients (p=.004). The degree of feeling over-strained by the ICU experience was a predictor of IES, HADS anxiety and depression in the full sample as well as in the subsamples of relatives of deceased and surviving patients (p≤.021).ThedifferenceinEQ-5Dhealthstatuspredicted IES and HADS depression among surviving patients (p≤.049).
Conclusions
Feeling overs trained during the ICU stay might be the strongest predictor of relatives’ psychological symptoms after three months. Tracheostomy in the ICU might be a predictor for PTSS. Both should be investigated in prospective longitudinal or interventional studies to better assess and prevent relatives’ psychological burden after their ICU experience.

Brief description of media:

Purpose: Post-traumatic stress disorder has been reported in survivors of critical illness. The aim of this study was to investigate the predictors of post-traumatic stress disorder in survivors of critical illness.

Materials and methods: Patients attending the intensive care unit (ICU) follow-up clinic completed the UK-Post-Traumatic Stress Syndrome 14-Questions Inventory and data was collected from their medical records. Predictors investigated included age, gender, Apache II score, ICU length of stay, pre-illness psychopathology; delirium and benzodiazepine administration during ICU stay and delusional memories of the ICU stay following discharge.

Results: A total of 198 patients participated, with 54 (27%) patients suffering with post-traumatic stress disorder. On multivariable logistic regression, the significant predictors of post-traumatic stress disorder were younger age, lower Apache II score, pre-illness psychopathology and delirium during the ICU stay.

Conclusions: The predictors of post-traumatic stress disorder in this study concur with previous research however a lower Apache II score has not been previously reported.

Brief description of media:

As more patients are surviving intensive care, mental health concerns in survivors have become a research priority. Among these, post-traumatic stress disorder (PTSD) can have an important impact on the quality of life of critical care survivors. However, data on its burden are conflicting. Therefore, this systematic review and meta-analysis aimed to evaluate the prevalence of PTSD symptoms in adult critical care patients after intensive care unit (ICU) discharge.

Brief description of media:

As more patients are surviving intensive care, mental health concerns in survivors have become a research priority. Among these, post-traumatic stress disorder (PTSD) can have an important impact on the quality of life of critical care survivors. However, data on its burden are conflicting. Therefore, this systematic review and meta-analysis aimed to evaluate the prevalence of PTSD symptoms in adult critical care patients after intensive care unit (ICU) discharge.

Brief description of media:

Surgical intensive care unit (ICU) stay of longer than 10 days is often described by the experienced intensivist as a ‘‘complicated clinical course’’ and is frequently attributed to persistent immune dysfunction. ‘‘Systemic inflammatory response syndrome’’ (SIRS) followed by ‘‘compensatory anti-inflammatory response syndrome’’ (CARS) is a conceptual framework to explain the immunologic trajectory that ICU patients with severe sepsis, trauma, or emergency surgery for abdominal infection often traverse, but the causes, mechanisms, and reasons for persistent immune dysfunction remain unexplained.

Often involving multiple-organ failure (MOF) and death, improvements in surgical intensive care have altered its incidence, phenotype, and frequency and have increased the number of patients who survive initial sepsis or surgical events and progress to a persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Often observed, but rarely reversible, these patients may survive to transfer to a long-term care facility only to return to the ICU, but rarely to self-sufficiency. We propose that PICS is the dominant pathophysiology and phenotype that has replaced late MOF and prolongs surgical ICU stay, usually with poor outcome.

This review details the evolving epidemiology of MOF, the clinical presentation of PICS, and our understanding of how persistent inflammation and immunosuppression define the pathobiology of prolonged intensive care. Therapy for PICS will involve innovative interventions for immune system rebalance and nutritional support to regain physical function and well-being. (J Trauma Acute Care Surg. 2012;72: 1491Y1501. Copyright*2012 by Lippincott Williams & Wilkins)

Brief description of media:

After long-term hospitalization or ICU treatment, COVID- 19 patients are severe functionally impaired. They experience not only physical weakness but may also suffer from problems on the pulmonary, physical, psychosocial, and cognitive domain. These domains interact, and the impact on participation varies between patients. Therefore, aftercare should be customized to the patient individual needs. In this article, we present a patient-centred model to tailor treatment in the view of the Dutch healthcare system. This model can be helpful to determine the appropriate treatment for each patient at the right time in the right setting.

Brief description of media:

The 2 purposes of this systematic review were to identify the scope and magnitude of physical problems associated with PICS during the first year after critical illness and to use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to elucidate impairments of body functions and structures, activity limitations, and participation restrictions associated with PICS.