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Understanding how nurses cope following the death of a patient after CPR may help identify nurses most at risk for postcode stress and posttraumatic stress disorder (PTSD) according to new research published in the American Journal of Critical Care (AJCC). “Stress and Coping of Critical Care Nurses After Unsuccessful Cardiopulmonary Resuscitation” explores the relationship between postcode stress, PTSD symptom severity and coping behaviors after an unsuccessful attempt to resuscitate a patient.

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Hundreds of thousands of seriously ill coronavirus patients who survive and leave the hospital are facing a new and difficult challenge: recovery. Many are struggling to overcome a range of troubling residual symptoms, and some problems may persist for months, years or even the rest of their lives. Patients who are returning home after being hospitalized for severe respiratory failure from the virus are confronting physical, neurological, cognitive, and emotional issues. And they must navigate their recovery process as the pandemic continues, with all of the stresses and stretched resources that it has brought.

“It’s not just, OH, I had a terrible time in hospital, but thank goodness I’m home and everything’s back to normal,’” said Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. “It’s, I just had a terrible time in hospital and guess what? The world is still burning. I need to address that while also trying to sort of catch up to what my old life used to be.’” It is still too early to say how recovery will play out for these patients. But here is a look at what they are experiencing so far, what we can learn from former patients with similar medical experiences, and the challenges that most likely lie ahead.

Brief description of media:

Hundreds of thousands of seriously ill coronavirus patients who survive and leave the hospital are facing a new and difficult challenge: recovery. Many are struggling to overcome a range of troubling residual symptoms, and some problems may persist for months, years or even the rest of their lives. Patients who are returning home after being hospitalized for severe respiratory failure from the virus are confronting physical, neurological, cognitive, and emotional issues. And they must navigate their recovery process as the pandemic continues, with all of the stresses and stretched resources that it has brought.

“It’s not just, ʻOh, I had a terrible time in hospital, but thank goodness I’m home and everything’s back to normal,’” said Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. “It’s, I just had a terrible time in hospital and guess what? The world is still burning. I need to address that while also trying to sort of catch up to what my old life used to be.’” It is still too early to say how recovery will play out for these patients. But here is a look at what they are experiencing so far, what we can learn from former patients with similar medical experiences, and the challenges that most likely lie ahead.

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Common symptoms experienced after sepsis include fatigue, insomnia, difficulties with concentration or memory, muscle weakness, and depression or anxiety.

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More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings.

This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and post-acute inpatient settings.

This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.

Brief description of media:

More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings.

This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and post-acute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.

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As many as 80% of ICU survivors have some form of cognitive or brain dysfunction, according to the Society of Critical Care Medicine. While receiving intensive care, patients often are heavily sedated and connected to a ventilator. During this time, a temporary brain injury can develop that is linked to later issues with memory and thinking. At the same time, many ICU survivors experience post-traumatic stress symptoms, including depression, prolonged muscle weakness, and fatigue. Patients who survive sepsis are particularly vulnerable to post-ICU syndrome and about 1.4 million of them suffer from long-term disabilities, according to the Sepsis Alliance. The not-for-profit advocacy group is developing pamphlets on post-sepsis issues for patients, as well as spreading the word on social media websites.

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PICS can manifest as problems with physical function, cognition and mental health, according to a fact sheet from the American Thoracic Society. PICS is a relatively under-recognized issue, despite the fact that it affects a large number of people treated in an ICU, according to Patricia Ohtake, PT, Ph.D., an associate professor in the physical therapy program in the University at Buffalo's School of Public Health and Health Professions. Ohtake has tailored her recent research on the rehabilitation of ICU survivors to reflect working with COVID-19 patients, particularly how physical therapy can aid in their recovery at home.

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Did you know, you don’t have to be “living” dangerously, to get PTSD ? A stint in an ICU, can bring on the condition, impeding your recovery long term.

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Most people recover from COVID-19 within two weeks; however, early figures show that around 10% of people are still unwell after three weeks, and a smaller proportion are sick for months. As infections begin to rise steeply once again, ‘long COVID’ is beginning to be taken seriously.

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The emotional trauma of a near-death experience causes ongoing emotional and physical symptoms in one-third of ICU patients.

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BACKGROUND: Skeletal muscle dysfunction occurring as a result of ICU admission associates with higher mortality. Although preadmission higher BMI correlates with better outcomes, the impact of baseline muscle and fat mass has not been defined. We therefore investigated the association of skeletal muscle and fat mass at ICU admission with survival and disability at hospital discharge.

METHODS: This single-center, prospective, observational cohort study included medical ICU (MICU) patients from an academic institution in the Unites States. A total of 401 patients were evaluated with pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) determinations conducted by CT scanning at the time of ICU admission, which were later correlated with clinical outcomes accounting for potential confounders.

RESULTS: Larger admission PMA was associated with better outcomes, including higher 6month survival (OR, 1.03; 95% CI, 1.01-1.04; P < .001), lower hospital mortality (OR, 0.96; 95% CI, 0.93-0.98; P < .001), and more ICU-free days (slope, 0.044 0.019; P 1⁄4 .021). SAT was not significantly associated with any of the measured outcomes. In multivariable analyses, PMA association persisted with 6 months and hospital survival and ICU-free days, whereas SAT remained unassociated with survival or other outcomes. PMA was not associated with regaining of independence at the time of hospital discharge (OR, 0.99; 95% CI, 0.98-1.01; P 1⁄4 .56).

CONCLUSIONS: In this study cohort, ICU admission PMA was associated with survival during and following critical illness; it was unable to predict regaining an independent lifestyle following discharge. ICU admission SAT mass was not associated with survival or other measured outcomes.