Brief description of media:

The terms intensive care unit(ICU) syndrome and ICU psychosis have been used interchangeably to describe a cluster of psychiatric symptoms that are unique to the ICU environment. It is often postulated that aspects of the ICU, such as sleep deprivation and sensory overload or monotony, are causes of the syndrome. This article reviews the empirical support for these propositions. We conclude that ICU syndrome does not differ from delirium and that ICU syndrome is caused exclusively by organic stressors on the central nervous system. We argue further that the term ICU syndrome is dangerous because it impedes standardized communication and research and may reduce the vigilance necessary to promptly investigate and reverse the medical cause of the delirium. Directions for future research are suggested.

Brief description of media:

The terms intensive care unit (ICU) syndrome and ICU psychosis have been used interchangeably to describe a cluster of psychiatric symptoms that are unique to the ICU environment. It is often postulated that aspects of the ICU, such as sleep deprivation and sensory overload or monotony, are causes of the syndrome. This article reviews the empirical support for these propositions. We conclude that ICU syndrome does not differ from delirium and that ICU syndrome is caused exclusively by organic stressors on the central nervous system. We argue further that the term ICU syndrome is dangerous because it impedes standardized communication and research and may reduce the vigilance necessary to promptly investigate and reverse the medical cause of the delirium. Directions for future research are suggested.

Numerous authors have noted a cluster of psychiatric signs and symptoms that may occur in patients who are treated in an intensive care unit (ICU) or high-dependency ward and have termed this syndrome ICU psychosis, postoperative delirium, and ICU syndrome; when patients have undergone heart surgery, it has been called post cardiotomy delirium or cardiac psychosis. Frequently, this syndrome is assumed to be peculiar to ICUs.

The aims of this article are to review the etiology and nature of this syndrome and then to discuss the implications of this review for nosology and management. Is there actually a psychiatric syndrome that is attributable to some feature of the ICU experience, or is this "syndrome" most accurately and most helpfully classified as a delirium? We argue that the latter is true and that it is possible and preferable to describe the disorder using established medical nomenclature. Appropriate classification will help to demystify the concept, ensure that crucial organic causes are sought and found, indicate optimal management, and facilitate standardized research.

Brief description of media:

This booklet contains advice and information about intensive care. It tells you how critical illness may be treated and what recovery may be like. Not every patient will experience all of these things, but they are more likely to if they have been in intensive care for more than a few days. Most of this booklet is written for patients but there is a section specifically for relatives and visitors. By reading this booklet, relatives will learn what a patient’s recovery may involve and it will give them the answers to some of the questions they may have.

Brief description of media:

This booklet contains advice and information about intensive care. It tells you how critical illness may be treated and what recovery may be like. Not every patient will experience all of these things, but they are more likely to if they have been in intensive care for more than a few days. Most of this booklet is written for patients but there is a section specifically for relatives and visitors. By reading this booklet, relatives will learn what a patient’s recovery may involve and it will give them the answers to some of the questions they may have.

Brief description of media:

Many people felt there was a lack of support for ICU patients when they were discharged from hospital and recovering at home. Some said they were shocked and disappointed when the ill person had come back home but hadn't received any physiotherapy or other treatment, even though they'd still been extremely weak and immobile. One man said he had to pay for his wife to have physiotherapy privately and felt that they'd only started receiving the emotional support they needed when they joined a local support group. Some people said they'd worried about a lack of support for ICU patients during recovery, which meant they failed to discover whether the ill person was being adequately cared for when they got home.

Brief description of media:

Here people talk about the support they received when someone close to them was discharged from hospital after being critically ill in an intensive care unit (ICU).

Brief description of media:

Many people who have been critically ill in the intensive care unit are invited to attend follow-up clinics, as out-patients, when they are recovering at home. They will be seen either by the ICU follow-up team or by the doctors specializing in their particular condition. The aims of ICU follow-up include providing support and guidance for those people who have had an extended stay in intensive care, often over a week. Medical, nursing and psychology support may be offered for up to a year after hospital discharge where appropriate.

Brief description of media:

Background: Early physical rehabilitation in the intensive care unit (ICU) has been shown to improve short-term clinical outcomes but long-term benefit has not been proven and the optimum intensity of rehabilitation is not known.

Methods: We conducted a randomized, parallel-group, allocation-concealed, assessor-blinded, controlled trial in patients who had received at least 48 hours of invasive or non-invasive ventilation. Participants were randomized in a 1:1 ratio, stratified by admitting ICU, admission type and level of independence. The intervention group had a target of 90 min physical rehabilitation per day, the control group a target of 30 min per day (both Monday to Friday). The primary outcome was the Physical Component Summary (PCS) measure of SF-36 at 6 months.

Results: We recruited 308 participants over 34 months: 150 assigned to the intervention and 158 to the control group. The intervention group received a median (IQR) of 161 (67–273) min of physical rehabilitation on ICU compared with 86 (31–139) min in the control group. At 6 months, 62 participants in the intervention group and 54 participants in the control group contributed primary outcome data. In the intervention group, 43 had died, 11 had withdrawn and 34 were lost to follow-up, while in the control group, 56 had died, 5 had withdrawn and 43 were lost to follow-up. There was no difference in the primary outcome at 6 months, mean (SD) PCS 37 (12.2) in the intervention group and 37 (11.3) in the control group.

Conclusions: In this study, ICU-based physical rehabilitation did not appear to improve physical outcomes at 6 months compared with standard physical rehabilitation.

Brief description of media:

The brochure describes the symptoms of people with Delirium, and what the family can do to help.

Brief description of media:

It has long been known that patients with inflammatory bowel disease (IBD) are at higher risk of systemic thromboembolism than is the general population. In fact, patients with both ulcerative colitis (UC) and Crohn’s disease (CD) have a 3- to 4-fold higher number of thromboembolic events including pulmonary embolism and a 6-fold higher incidence found at autopsy. It has been hypothesized that prothrombotic genetic variants may be more prevalent in IBD patients than in the general population.

Bernstein et al identified 492 IBD patients from the Manitoba IBD Research Registry and 412 controls from Manitoba Health’s administrative database. Subjects filled out questionnaires and their records were reviewed to determine their demographics, diagnosis, environmental factors, family history, smoking history, IBD phenotype, and extent and location of disease. All participants donated blood for genetic analysis, and most were contacted 2 years after venipuncture to update their history of thromboembolic events. Subjects’ blood was analyzed for the 4 most common genetic mutations associated with the risk of thrombosis.

Brief description of media:

Survivors of critical illness frequently experience a post–intensive care syndrome comprising physical, psychological, and cognitive disabilities. In this randomized clinical trial, Walsh and colleagues developed a rehabilitation strategy that used a dedicated therapist to increase the frequency and intensity of mobilization and exercise therapy, dietetic review and advice, and referral for other therapies using predefined triggers, together with providing greater illness-specific information.

Brief description of media:

A Kent State assistant professor’s research study on post-intensive care syndrome has linked family caregivers of intensive care unit patients as the unidentified population who suffer from unanticipated psychological symptoms.