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A FORMER sales representative has spoken out about living with long covid to show the lasting impact the virus has for certain sufferers.

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LONG Covid is the term used to explain the long-term effects of Covid-19 that are being discovered as people recover from the initial impact of the virus. According to a review by the National Institute of Health Research (NIHR), it may actually be a number of different syndromes and researchers are now examining what exactly happens after someone has contracted coronavirus. In the NIHR review, it was suggested that people suffering from long-term effects of Covid-19 may have different syndromes such as post-intensive care syndrome, post-viral fatigue syndrome, and long term Covid syndrome.

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In this power point, the author explained the long-term cognitive impairment, delirium and how to prevent them using the ABCDE bundle.

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For people rendered critically ill by coronavirus, the road to recovery will be long and difficult. Doctors are already weighing up the aftermath of COVID-19, and how the NHS and social care can help survivors fully rehabilitate. Even though the UK is more than three months into the health crisis, experts can’t confidently say what the long-lasting impact of Covid will be for some survivors. Like other people who have been critically ill in intensive care, recovery from the physical and psychological trauma of the virus will be another battle for some patients.

Dougal Atkinson is a consultant in Anesthesia and Intensive Care Medicine at the Manchester Royal Infirmary (MRI), part of Manchester University NHS Foundation Trust. For the last three months Dr Atkinson has been working on the frontline of the pandemic caring for Covid patients in the MRI's intensive care unit (ICU). Dr Atkinson says it can take months for anyone who has been critically ill to recover from the physical and mental strains put on the body while in intensive care.

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Drew Patten, who was in the same intensive care unit as Derek Draper tells of the twilight world between life and death where he was convinced doctors were trying to kill him.

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At the time of discharge home, parents of preterm infants in the neonatal intensive care unit often feel apprehensive and may question their ability to care for their baby. The well-planned, comprehensive discharge of a medically stable infant helps to ensure a positive transition to home and safe, effective care after discharge.

This statement provides guidance in planning discharge of infants born before 34 weeks’ gestational age from tertiary and community settings. Discharge readiness is usually determined by demonstration of functional maturation, including the physiological competencies of thermoregulation, control of breathing, respiratory stability, and feeding skills and weight gain. Supporting family involvement and providing education from the time of admission improve parental confidence and decrease anxiety. Assessing the physical and psychosocial discharge environment is an important part of the discharge process. The clinical team is responsible for ensuring that appropriate investigations and screening tests have been completed, that medical concerns have been resolved and that a follow-up plan is in place at the time of discharge home.

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When we talk about critical illness recovery, we often speak about physical debility, fatigue, anxiety, depression and even anger. But less often do we name another very common experience and emotion - grief. After all, you just survived a critical illness, why would you be grieving? Shouldn't you be thankful, happy even? That may how the outside world interprets your experience, but for your thankfulness and happiness during this time may be very elusive emotions.

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There is increasing evidence of the significant impact that critical illness has on family members of the critically ill. Stressful decision making often falls to family members because most patients in the ICU are too ill to participate in decision making (1). Furthermore, family members bear a significant burden of caregiving to the more than 50% of critical illness survivors who have post discharge disability (2, 3). Approximately one quarter to one half of family members of critically ill children or adults experience psychological symptoms, including acute stress, post-traumatic stress, generalized anxiety, and depression both during and after the critical illness of a loved one (4–6). The sum total of family exposure to critical illness may result in what has been termed “Post-Intensive Care Syndrome-Family” (3, 5). There is increasing awareness of the importance of improving outcomes for family caregivers and that support for family caregivers can also improve patient outcomes (6, 7).

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Objective:
To provide clinicians with evidence-based strategies to optimize the support of the family of critically ill patients in the ICU.
Methods:
We used the Council of Medical Specialty Societies principles for the development of clinical guidelines as the framework for guideline development. We assembled an international multidisciplinary team of 29 members with expertise in guideline development, evidence analysis, and family-centered care to revise the 2007 Clinical Practice Guidelines for support of the family in the patient-centered ICU. We conducted a scoping review of qualitative research that explored family-centered care in the ICU. Thematic analyses were conducted to support Population, Intervention, Comparison, Outcome question development. Patients and families validated the importance of interventions and outcomes. We then conducted a systematic review using the Grading of Recommendations, Assessment, Development and Evaluations methodology to make recommendations for practice. Recommendations were subjected to electronic voting with pre-established voting thresholds. No industry funding was associated with the guideline development.
Results:
The scoping review yielded 683 qualitative studies; 228 were used for thematic analysis and Population, Intervention, Comparison, Outcome question development. The systematic review search yielded 4,158 reports after deduplication and 76 additional studies were added from alerts and hand searches; 238 studies met inclusion criteria. We made 23 recommendations from moderate, low, and very low level of evidence on the topics of: communication with family members, family presence, family support, consultations and ICU team members, and operational and environmental issues. We provide recommendations for future research and work-tools to support translation of the recommendations into practice.
Conclusions:
These guidelines identify the evidence base for best practices for family-centered care in the ICU. All recommendations were weak, highlighting the relative nascency of this field of research and the importance of future research to identify the most effective interventions to improve this important aspect of ICU care.

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One of the challenges with producing a document such as GPICS can be the lack of a hard evidence base for some of the standards and recommendations that may be, by necessity, based on professional opinion and established practice. It is therefore essential that standards and recommendations are subject to regular review and revision, as new evidence becomes available and practice changes. In undertaking this significant review and revision to GPICS, the FICM and ICS consulted widely, both with the key stakeholder organizations and through an open public survey. One of the criticisms of the first edition was the underrepresentation of authors from smaller units and the devolved nations; we have addressed this in the second edition, recognizing that the majority of critical care is not delivered in large tertiary centers.

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Advances in critical care medicine have improved patients’ survival rate. However, physical and cognitive sequels after Intensive Care Unit (ICU) discharge remain substantial. Our objectives were to evaluate the Health-related Quality of Life (HRQL) at 6-month after ICU discharge and identify the risk factors of this outcomes.

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Our study objective was to assess health-related quality of life in survivors of acute lung injury (ALI) and to supplement generic and disease-specific questionnaires with findings from a focus group of ALI survivors. Six patients participated in the focus group, which revealed patient concerns with amnesia, depressed mood, avoidance behaviors, and a prolonged recovery period. Using a cross-sectional study design, 24 patients completed a questionnaire 6 to 41 months after their lung injury. A total of 43% of the patients with ALI met criteria for depression; 43% had self-reported significant functional limitations, although 39% had minimal or no limitations.

Significant respiratory and psychologic symptoms were reported in a quarter to a third of patients. There were large decrements in all domains of the SF-36 (a generic health-related quality-of-life instrument) in our sample compared with norms previously established for the general population. In addition, our patients had similar physical difficulties compared with previously studied patients with chronic medical illnesses but had more deficits in the social functioning and mental health domains. We conclude that long after lung injury, survivors have significantly lower health-related quality of life than the general population and are likely to have pulmonary and psychologic symptoms.