Brief description of media:

For many years, we believed that a good outcome for critically ill patients was for them to leave the intensive care unit (ICU) alive. Sadly, we now know from substantial research, including in-depth follow-up of individual patients, that this is not the case.

Many cohort studies of critically ill patients that prospectively followed people after hospital discharge raised concerns regarding long-term outcomes (1–4). Despite the importance of this work, such prospective cohort studies are limited in the type and amount of information they can provide because of small sample size or number of outcome events, uncertain generalizability, and a lack of information on prehospital trajectories. Perhaps most important, many of these exploratory studies lacked comparison with appropriate controls. Therefore, the burden of morbidity and mortality after critical illness was quantified, but with uncertainty regarding the level of attribution to the critical illness and its associated treatments and the contribution of either underlying comorbidity or hospitalization of any kind. In effect, these studies identified that “we have a problem,” but their limitations did not allow us to understand the severity, duration, causation, and trajectory of these problems more fully from the perspectives of our patients and our health systems.

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Economic evaluations of interventions in the hospital setting often rely on the estimated long term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country.

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July 20, 2007, ST. LOUIS – When Wilson Guthrie entered Barnes-Jewish Hospital, the birds had begun flying south for the winter. The next time he stepped outside, the Cardinals were trying to stay in the pennant race. With a stay lasting from October 31, 2006 to July 21, 2007, Guthrie is thought to be the patient with the longest stay in Barnes-Jewish's cardio thoracic ICU to be discharged.

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Alcoholism is such a common condition that virtually every clinician is confronted with its complications. There are an estimated 8 million alcohol dependent people in the United States. Approximately 500,000 episodes of withdrawal severe enough to require pharmacologic treatment occur each year. The in-patient management of syndromes associated with moderate and severe alcohol withdrawal is reviewed here. The ambulatory management of mild alcohol withdrawal, the initial diagnosis and treatment of alcohol dependence, and specific conditions due to alcohol-related organ damage (eg, cirrhosis, pancreatitis) are discussed elsewhere.

Brief description of media:

Each year, hundreds of thousands of patients in the U.S. and millions worldwide become critically ill. Patients who require care in the intensive care unit (ICU) have the most serious illnesses, often requiring multiple forms of life support. While the science of medicine has significantly advanced in the past 30 years, these advances sometimes create many questions, such as:
• Will my loved one be able to live independently after this?
• What kind of rehabilitation will my loved one need?
• What will my loved one’s quality of life be after this illness?
More than ever, medical teams rely on families to help them make important decisions about their loved ones’ care, and their futures. The purpose of this series is built on the ideas that knowledge is power and that every patient needs an advocate. Here, we share some of the most important advances in ICU medicine so patients and their families can ask educated questions.

Brief description of media:

Each year, hundreds of thousands of patients in the U.S. and millions worldwide become critically ill. Patients who require care in the intensive care unit (ICU) have the most serious illnesses, often requiring multiple forms of life support. While the science of medicine has significantly advanced in the past 30 years, these advances sometimes create many questions, such as:
• Will my loved one be able to live independently after this?
• What kind of rehabilitation will my loved one need?
• What will my loved one’s quality of life be after this illness?
More than ever, medical teams rely on families to help them make important decisions about their loved ones’ care, and their futures. The purpose of this series is built on the ideas that knowledge is power and that every patient needs an advocate. Here, we share some of the most important advances in ICU medicine so patients and their families can ask educated questions.

Brief description of media:

Many patients admitted to intensive care units (ICU) for health complications related to the new coronavirus have experienced hospital delirium, a condition that causes hallucinations, confusion and other cognition issues.

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The National Maternity and Perinatal Audit (NMPA) is a national audit of the NHS maternity services across England, Scotland, and Wales, commissioned in July 2016 by the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England, the Welsh Government, and the Health Department of the Scottish Government. The NMPA is led by the Royal College of Obstetricians and Gynecologists (RCOG) in partnership with the Royal College of Midwives (RCM), the Royal College of Pediatrics and Child Health (RCPCH) and the London School of Hygiene & Tropical Medicine (LSHTM).

The overarching objective of the NMPA is to produce high-quality information about NHS maternity and neonatal services that can be used by providers, commissioners, and users of the services to benchmark against national standards and recommendations where these exist, and to identify good practice and areas for improvement in the care of women and babies.

This report focuses on maternal admissions to intensive care in England, Wales, and Scotland. The NMPA, and the data it holds, offers a unique opportunity to link maternity data, which contain information about the mother, her pregnancy, and her baby, to data from national data sets for intensive care admissions.

The purpose of this report is to describe the feasibility of linking the NMPA’s maternity data to intensive care data and to evaluate the suitability of rates of maternal admission to intensive care as an indicator of care quality. It also describes the demographics of women admitted to intensive care and the reasons for admission.

Brief description of media:

MRC-sumscore is a valid, reliable, objective, and easy method to evaluate the global muscle strength including PICS related to COVID-19. It provides beneficial information about the clinical course. Its bedside applicability without necessitating any device makes MRC-sumscore a valuable tool in the follow-up of patients with PICS.

Brief description of media:

COVID-19 may lead to severe acute respiratory distress syndrome requiring intensive care unit (ICU) support. Patients surviving respiratory distress could develop post-intensive care syndrome (PICS) that includes ICU-acquired weakness (ICUAW). Nearly 66% ofCOVID-19 patients have clinically important muscle weakness following discharge [1]. Therefore, communication between the critical care and rehabilitation physician is important to evaluate the physical function ofCOVID-19 survivors to start rehabilitation timely.

Brief description of media:

Mortality rates of critically ill patients have decreased markedly in recent years thanks to advancements in care. Given the improved survival rates of critically ill patients, investigators have broadened their focus from short-term mortality to long-term mortality and morbidities that are often under recognized by intensive care unit (ICU) practitioners.

The Society of Critical Care Medicine (SCCM) has defined post–intensive care syndrome (PICS) as a new or worsening decrement in mental, cognitive, or physical health following critical illness that persists beyond the acute hospitalization. Many medication-related risk factors are associated with development of cognitive impairment in critically ill patients, including glucose dysregulation, delirium, and medications. Medications have also been associated with acute neuromuscular weakness following an ICU admission. In the past decade, the increased risk of adverse drug events (ADEs) during transitions of care has become widely known. This column focuses on how medication management strategies in the ICU, after the ICU, and after hospitalization may prevent or help manage PICS.

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Centra had the opportunity of sending 14 staff to the course, ICU Liberation and Animation: Operationalizing the Pain, Agitation, and Delirium Guidelines through the ABCDEF Bundle at Vanderbilt University. The ICU team included our Medical Director of ICU, Dr. Jeremy Hardison, ICU nurse managers, bedside ICU nurses, Clinical Nurse Specialist, and Directors of Physical Therapy and Respiratory Therapy. What a great opportunity this was to come together as a team and learn from each other to improve outcomes and prevent ICU Delirium and PICS.