Brief description of media:

The number of patients discharged alive from the ICU is increasing due to the remarkable progress of medical care. Nevertheless, a growing concern is that many ICU survivors subsequently develop mental health impairments. Recently, it has become clear that the memories formed during a patient’s ICU stay are a risk factor for subsequent mental health impairment.

Patient memories can be classified into memories of factual events, memories of feelings, and delusional memories. Delusional memories are reported by 26-73% of ICU survivors and can be difficult to forget. Delusional memories are also thought to be correlated with mental health impairment, such as anxiety, depression, posttraumatic stress disorder (PTSD), a lower QOL, and failure to return to work. To support the formation of beneficial memories in patients, clinicians should help patients to construct appropriate memories during their ICU stay, to restructure memories after their discharge from the ICU, and to avoid preserving delusional memories. However, further research is required in this field.

Understanding how unpleasant memories can lead to long-term disturbances in patients, even if the memories are not factual, and providing follow-up opportunities for patients to talk about their experiences after they have left the ICU may be necessary.

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Critical illness is associated with high rates of significant, negative psychologic and psychiatric sequelae that are associated commonly with post-intensive care syndrome (PICS). PICS refers to the cognitive, physical, and psychologic impairments that many patients experience after an ICU admission. The primary mental health impairments that critical illness survivors experience are long-term cognitive impairments, depression (approximately 30% of survivors), anxiety (up to approximately 70%), and post-traumatic stress disorder (PTSD) (10%-50%). Delirium during critical illness, sometimes referred to as “ICU psychosis,” is also common and has been associated with PTSD.

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Patients recovering from COVID-19 may face a second battle -- coping with the disease's mental health ramifications. This is particularly true for the sickest of the sick who required time in the ICU and intubation. These patients may experience "post-intensive care syndrome" (PICS) that could manifest as a combination of physical, cognitive, and mental health impairments following an ICU stay for a critical illness.

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Objective: Patients and caregivers can experience a range of physical, psychological, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism.

Design: We sought to identify technical, safety and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation.

Subjects: 17 Thrive sites from the USA, UK, and Australia were represented by a range of healthcare professionals.

Interventions: Via an iterative process of in-person and email/conference calls, members of the Collaborative, defined the key areas on which peer support models could be defined and compared; collected detailed self-reports from all sites; reviewed the information and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented.

Results: Within the Thrive Collaborative, six general models of peer support were identified: Community based, Psychologist-led outpatient, Models based within ICU follow-up clinics, Online, Groups based within ICU and Peer mentor models. The most common barriers to implementation were: recruitment to groups, personnel input and training, sustainability and funding, risk management and measuring success.

Conclusion: A number of different models of peer support are currently being developed to help patients and families recover and grow in the post-critical care setting.

Brief description of media:

Due to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarized as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors’ HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs.

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ABCDEF's of Prevention and Safety

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Open abdominal management with negative pressure wound therapy (NPWT) is increasingly used for critically ill trauma and surgery patients. We sought to determine the comparative efficacy and safety of NPWT versus alternate temporary abdominal closure (TAC) techniques in critically ill adults with open abdominal wounds.

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Today we welcome Giora Netzer M.D., M.S.C.E., Associate Professor of Medicine here at the University of Maryland Medical Center. Dr. Netzer was trained at the great bastion of intensive care medicine, the University of Pennsylvania, where he also earned a master’s degree in clinical epidemiology. Since joining the University of Maryland Pulmonary and Critical Care Medicine department he has proven to be one the greatest minds the ICU has to offer, earning him the title: Wiki-Netzer. His passion for knowledge led to his appointment as the Director of Clinical Research and has yielded a tremendous breadth of publications. Today he focuses on his true passion: how to assist family members care for their loved ones both in the ICU and in the post-ICU setting. Trust me, this is a topic that is often overlooked and one that can truly mean life or death for your patients! You cannot miss it!!

Brief description of media:

Significant improvements have been made with regard to mortality in patients with sepsis and critical illness over the last decade. However, this success is mitigated by the fact that 60-80 % of critically ill patients will become delirious during their hospital stay, 50-70% will suffer cognitive impairment after discharge, and 60-80% will have physical disability due to ICU acquired weakness. Furthermore, survivors of critical illness are five times more likely to develop depression after discharge and up to 25% will experience symptoms of post-traumatic stress disorder (PTSD).

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The m-CCRP aims to improve the recovery of acute respiratory failure survivors utilizing a mobile care coordinator. The NIH-funded randomized controlled trial will evaluate the success of m-CCRP in improving the health-related quality of life as well as the cognitive, physical and psychological functioning of ARF survivors. Dr. Khan and colleagues will also determine if m-CCRP reduces future health care utilization by ICU survivors.

Brief description of media:

The m-CCRP aims to improve the recovery of acute respiratory failure survivors utilizing a mobile care coordinator. The NIH-funded randomized controlled trial will evaluate the success of m-CCRP in improving the health-related quality of life as well as the cognitive, physical and psychological functioning of ARF survivors. Dr. Khan and colleagues will also determine if m-CCRP reduces future health care utilization by ICU survivors.

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Oxford mental health researchers have published new guidelines and provide free resources for treating patients experiencing Post-Traumatic Stress Disorder (PTSD) following admission to an Intensive Care Unit (ICU) during the COVID-19 pandemic.