Brief description of media:

Objective: To conduct a systematic review and meta-analysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.

Data sources: PubMed, Embase, CINAHL, PsycINFO, and Cochrane Library from inception through March 5, 2014.

Study selection: Eligible studies met the following criteria: 1) adult general/non specialty ICU, 2) validated posttraumatic stress disorder instrument greater than or equal to 1-month post-ICU, and 3) sample size greater than or equal to 10 patients.

Data extraction: Duplicate independent review and data abstraction from all eligible titles/abstracts/full-text articles.

Data synthesis: The search identified 2,817 titles/abstracts, with 40 eligible articles on 36 unique cohorts (n = 4,260 patients). The Impact of Event Scale was the most common post-traumatic stress disorder instrument. Between 1- and 6-months post-ICU (six studies; n = 456), the pooled mean (95% CI) Impact of Event Scale score was 20 (17-24), and the pooled prevalence of clinically important posttraumatic stress disorder symptoms (95% CI) were 25% (18-34%) and 44% (36-52%) using Impact of Event Scale thresholds greater than or equal to 35 and greater than or equal to 20, respectively. Between 7- and 12-months post-ICU (five studies; n = 698), the pooled mean Impact of Event Scale score was 17 (9-24), and pooled prevalence of posttraumatic stress disorder symptoms were 17% (10-26%) and 34% (22-50%), respectively. ICU risk factors for posttraumatic stress disorder symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences. Posttraumatic stress disorder symptoms were associated with worse quality of life. In European-based studies: 1) an ICU diary was associated with a significant reduction in posttraumatic stress disorder symptoms, 2) a self-help rehabilitation manual was associated with significant posttraumatic stress disorder symptom reduction at 2 months, but not 6 months; and 3) a nurse-led ICU follow-up clinic did not reduce posttraumatic stress disorder symptoms.

Conclusions: Clinically important posttraumatic stress disorder symptoms occurred in one fifth of critical illness survivors at 1-year follow-up, with higher prevalence in those who had comorbid psychopathology, received benzodiazepines, and had early memories of frightening ICU experiences. In European studies, ICU diaries reduced posttraumatic stress disorder symptoms.

Brief description of media:

My daughter spent 114 days in the NICU. As she is approaches 2 years old, I’m still suffering the after-effects. I launched my blog during NICU Awareness month, so I’ve focused heavily on my experience during those 114 days. Looking back at all the photos and recounting what I went to has dredged up bucketful of “yuck.” In my past life, I was a data and research driven person. I still read studies, research outcomes and the like when I’m interested in something. Recently, I read studies about acute stress disorder (ASD) and post-traumatic stress disorder (PTSD), specifically for parents in the NICU. Through all the studies I found myself asking: Do I have PTSD? Is this what has been going on all this time?

Brief description of media:

To study the level and predictors of post-traumatic stress, anxiety, and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.
Methods
Of 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for post-traumatic stress symptoms with high probability of a post-traumatic stress disorder (PTSD) was ≥ 35. Case level of HADS-Anxiety or Depression was ≥ 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.
Results
Mean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES ≥ 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P < 0.001. No differences in post-traumatic stress, anxiety, or depression between medical, surgical and trauma patients were found. High educational level (OR 0.4, 95%CI 0.2 to 1.0), personality trait (optimism) OR 0.9, 95%CI 0.8 to 1.0), factual recall (OR 6.6, 95%CI 1.4 to 31.0) and memory of pain (OR 1.5, 95%CI 1.1 to 2.0) were independent predictors of post-traumatic stress symptoms at one year. Optimism was a strong predictor for less anxiety (OR 0.8, 0.8 to 0.9) and depression symptoms (OR 0.8, 0.8 to 0.9) after one year.

Brief description of media:

The COVID-19 patients may be flooding some hospital systems across our nation presently. However, the reality is they will soon need post-acute rehabilitative care, and we as care providers need to be ready to serve them. Our acute-care counterparts are working tirelessly on improved care and survival rates while also initiating the recovery process. As a result, many post-acute care providers are left asking themselves the following questions:
“What is the best practice for treating the COVID-19 patient?”
“What are the long-term impacts of the disease?”
“What is length of stay of the recovery process going to look like?”

Brief description of media:

ICUs have historically focused on survival as the single most important outcome of critical illness. Recent research has shown that most patient who survive their ICU stay develop a combination of cognitive impairment; emotional problems, including depression, anxiety, and posttraumatic stress disorder; physical weakness; and significant social and financial hardships. Together, this constellation of symptoms has been termed post-intensive care syndrome (PICS). The physical, psychological, and financial burden of caring for patients with PICS has common and predictable effects, including anxiety and depression, on family members of ICU survivors. These effects have been termed PICS-F, for the PICS effect on families.

As understanding has improved of the impact that PICS and PICS-F have on quality of life, critical care providers have started to open specialized clinics to provide and coordinate care for ICU survivors and their families. These clinics are composed of an interdisciplinary team of professionals, including critical care and mental health physicians, nurses, physical and occupational therapists, and social workers. Their ultimate goal is to improve patients’ quality of life, ease caregiver burden on families, and work to restore patients to their prior level of functioning.

Brief description of media:

For post-ICU recovery clinics, the opportunities that exist for telehealth and mobile technologies to help extend care delivery, reduce costs, improve the quality of care, and the patient experience in the post discharge period are significant. The demand for intensive care is projected to rise because of an aging population with complex comorbidities and the expanded use of advanced healthcare treatments, and as a result, the number of ICU survivors will rise . Survivors of critical illness require early identification of symptoms and early interventions to decrease symptom burden and enhance their quality of life. Redesign of post-ICU care management and post-acute care delivery systems is needed to engage ICU survivors in self-care, monitor for early signs of deteriorating health, intervene early, and reduce costs. As new value-based payment models for medical services increasingly take hold, financial incentives will also need to align with rehabilitation-oriented services in this population with greater focus on post-ICU care.

Brief description of media:

Aim: To determine the symptoms seen in patients after discharge from an intensive care unit (ICU) and the follow-up programs offered to help patients deal with the problems that arise after an ICU stay.

Brief description of media:

During recovery period patients could develop: Physical, Cognitive, and Psychiatric disabilities.

Brief description of media:

In the United States, nearly 27% of hospital admissions involve the use of intensive care unit (ICU) services. Due to advancements in acute care, survival rates have increased among patients admitted to the ICU. However, these individuals are at high risk for mortality and readmission following discharge, along with numerous long-term challenges that are collectively referred to as post-intensive care syndrome (PICS).

Brief description of media:

High-pitched alarms beep sporadically. A ventilator wheezes. You have an IV line stuck in your arm, a breathing tube down your throat, and a catheter in your urethra. As a patient in a hospital intensive care unit, chances are good that you feel helpless, scared, and confused. Odds are also good, new research shows, that the ordeal could trigger mild to severe depression.

Brief description of media:

The follow-up of patients who are discharged from intensive care units follows distinct flows in different parts of the world. Outpatient clinics or post intensive care clinics represent one of the forms of follow-up, with more than 20 years of experience in some countries. Qualitative studies that followed up patients in these outpatient clinics suggest more encouraging results than quantitative studies, demonstrating improvements in intermediate outcomes, such as patient and family satisfaction.

More important results, such as mortality and improvement in the quality of life of patients and their families, have not yet been demonstrated. In addition, which patients should be indicated for these outpatient clinics? How long should they be followed up? Can we expect an improvement of clinical outcomes in these followed-up patients? Are outpatient clinics cost-effective? These are only some of the questions that arise from this form of follow-up of the survivors of intensive care units. This article aims to review all aspects relating to the organization and performance of post-intensive care outpatient clinics and to provide an overview of studies that evaluated clinical outcomes related to this practice.

Brief description of media:

Define Post‐Intensive Care Syndrome (PICS), associated risk factors, and long-term consequences.
Recognize available resources to address PICS through education, therapy, and support groups.
Integrate knowledge into practice to guide at risk patients/families towards available resources.