Brief description of media:

Attendance and attrition in ICU recovery clinic are related to patient factors (living in rural area) and ICU factors. Data suggest different recovery trajectories exist based on gender, severity of illness, and self-reported outcomes.

Brief description of media:

The ICU can be an intimidating and stressful environment. This manual is intended to help support medical students, interns, and residents working in the ICU. Please be mindful that this manual is a guide for care in the ICU. Clinical treatment decisions are variable and nuanced depending on patient, nursing, and attending factors.

Brief description of media:

The ICU can be an intimidating and stressful environment. This manual is intended to help support medical students, interns, and residents working in the ICU. This manual is a guide for care in the ICU. Clinical treatment decisions are variable and nuanced depending on patient, nursing, and attending factors.

Brief description of media:

A new study finds that treatment in the intensive care unit has a unique set of terrors -- painful enough to be a precipitating factor in the onset of posttraumatic stress disorder (PTSD). The conclusion comes from a German study of patients who spent at least one month in the intensive care unit (ICU) at the University of Munich and were evaluated for PTSD up to three years later.

Brief description of media:

Helping a Love One Who Has Delirium

Brief description of media:

The mortality for this cohort of patients with temperature at least 38.0°C and known or suspected infection was 8/51(16%). This was more than double the mortality rate for non-eligible patients over the same period 36/514 (7%) (P= 0.05).The 28-day ICU-free survival and organ-support-free survival of patients with fever and known or suspected infection are shown in Table.

Brief description of media:

ABCDEF-Bundle-Implementation guide

Brief description of media:

The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD.

Brief description of media:

Background: Patients may suffer extreme psychological reactions in intensive care units (ICU), and post-traumatic stress disorder (PTSD) after leaving hospital. Previous systematic reviews of studies up to 2007 found that the true prevalence of and consistent risk factors for PTSD after ICU were not established, due to methodological shortcomings of studies. Therefore, we aimed to conduct a systematic review of observational studies of post-ICU PTSD from 2008-2012, and to compare them to 1997-2007 studies, with regard to quality, prevalence estimates and risk factors.

Methods: We used a pre-specified protocol, and systematic, explicit methods to identify, select and critically appraise studies. Studies in general ICU settings with mixed-diagnosis patients (N.>30) were included. Risk of bias was assessed, with lower-risk studies given greater weight. No quantitative synthesis was possible due to heterogeneity, therefore ranges of estimates and frequencies of risk factors were examined.

Results: The review included 26 papers, 13 from 1997-2007 and 13 from 2008-2012. There were more high-quality studies in the latter period. The range of prevalence estimates from high-quality studies was similar; 8% to 27% (1997-2007) and 9% to 27% (2008-2012). Clinical risk factors consistently identified over the two periods were use of benzodiazepines, duration of sedation and mechanical ventilation. Psychological risk factors include stress and fear experienced acutely in ICU, and frightening memories of the admission.

Conclusion: The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD. (Minerva Anestesiol 2013;79:944-63)

Brief description of media:

Patients may suffer extreme psychological reactions in intensive care units (ICU), and post-traumatic stress disorder (PTSD) after leaving hospital. Previous systematic reviews of studies up to 2007 found that the true prevalence of and consistent risk factors for PTSD after ICU were not established, due to methodological shortcomings of studies. Therefore, we aimed to conduct a systematic review of observational studies of post-ICU PTSD from 2008-2012, and to compare them to 1997-2007 studies, with regard to quality, prevalence estimates and risk factors.

Brief description of media:

Post-ICU clinics may facilitate the care of survivors of critical illness, but there is a paucity of data describing post-ICU clinic implementation. We sought to describe implementation of our ICU recovery clinic, including an assessment of barriers and facilitators to clinic attendance.

Brief description of media:

Immobility in the intensive care unit (ICU) is associated with neuromuscular weakness, post–intensive care syndrome, functional limitations, and high costs. Early mobility–based rehabilitation in the ICU is feasible and safe. Mobility-based rehabilitation varied widely across 5 ICUs in 1 health care system, suggesting a need for continuous training and evaluation to maintain a strong mobility-based rehabilitation program. Early mobility–based rehabilitation shortens ICU and hospital stays, reduces delirium, and increases muscle strength and the ability to ambulate.

Long-term effects include increased ability for self-care, faster return to independent functioning, improved physical function, and reduced hospital readmission and death. Factors that influence early mobility–based rehabilitation include having an interdisciplinary team; strong unit leadership; access to physical, occupational, and respiratory therapists; a culture focused on patient safety and quality improvement; a champion of early mobility; and a focus on measuring performance and outcomes.