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Despite caring for the sickest patients in the hospital, critical care teams have seen significant improvements in rates for mortality, sepsis and a host of other measures. For example, mortality among patients with acute respiratory distress syndrome has decreased from about 40 percent to 28 percent, and septic shock mortality has decreased from 33 percent to 18 percent. However, despite these impressive reductions in mortality, ICU care frequently leaves patients feeling weak, confused, possibly depressed and with PTSD, and with a long road to recovery. During the past decade, more attention has been directed to recognizing and preventing symptoms that have come to be recognized as “post-intensive care unit syndrome.”

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Background: Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs.

Methods: Pilot randomized clinical trial with 3-month follow-up conducted at two academic medical centres. adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomized after discharge home to 1 of 3month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme.

Results: among 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean client Satisfaction Questionnaire 27.6 (SD 3.8)) and usability (mean Systems Usability Score 89.1 (SD 11.5)). For secondary outcomes, mean values (and 95% cis) reflected clinically significant group-based changes on the Patient Health Questionnaire depression scale (mobile (−4.8 (−6.6, −2.9)), telephone (−3.9 (−5.6, −2.2)), education (−3.0 (−5.3, 0.8)); the generalized anxiety Disorder scale (mobile −2.1 (−3.7, −0.5), telephone −1.6 (−3.0, −0.1), education −0.6 (−2.5, 1.3)); the Post-traumatic Stress Scale (mobile −2.6 (−6.3, 1.2), telephone −2.2 (−5.6, 1.2), education −3.5 (−8.0, 1.0)); and the Patient Health Questionnaire physical symptom scale (mobile −5.3 (−7.0, −3.7), telephone −3.7 (−5.2, 2.2), education −4.8 (−6.8, 2.7)).

Conclusions: Among ICU patients, a mobile mindfulness app initiated after hospital discharge demonstrated evidence of feasibility, acceptability and usability and had a similar impact on psychological distress and physical symptoms as a therapist-led programme. a larger trial is warranted to formally test the efficacy of this approach.

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The present systematic review and meta-analysis aimed to synthesize data on subject outcomes associated with post-ICU follow-up.

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Imagine being told you have been diagnosed with a life-altering illness and as a result, will need to deliver your baby prematurely, or that your son or daughter was involved in a car crash and has suffered severe head trauma, or your significant other needs open heart surgery after a positive stress test. There is no doubt you and your family will experience feelings of great anxiety, fear, and sadness. Each of these experiences may lead to an intensive care unit (ICU) admission for your loved one. An ICU stay will further exacerbate these overwhelming emotions and leave you emotionally and mentally changed. According to Davidson, Jones, and Bienvenu (2012), one-third of parents with a child in the ICU have clinically significant symptoms of acute stress disorder. Additionally, 40% of relatives with loved ones who are critically ill suffer from anxiety. Depression, anxiety, and post-traumatic stress disorder (PTSD) are found to be at the highest levels in families of patients in the ICU (Jones, Backman, & Griffiths, 2012).

Brief description of media:

Objective: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of post-intensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs and identify barriers that challenged them.

Design: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.

Setting: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 23 sites, across three continents.

Subjects: Clinicians from 23 sites.

Measurement and Main Results: Ten enablers and nine barriers to implementation of ICU follow-up clinics were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding.

Nine enablers and five barriers to the implementation of peer support groups were identified.
Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.

Conclusions: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.

Brief description of media:

Health systems, granting agencies, and professional societies are increasingly involving patients and their family members in the delivery of health care and the improvement of health sciences. This is a laudable advance toward fully patient-centered medicine. However, patient engagement is not a simple matter, either practically or ethically.

The complexities include (1) the physical limitations that patients and their family members may have, from traveling to meetings to special dietary needs; (2) the emotional sensitivities patients and their families might experience—from distress at discussions of disease prognosis, outcomes, and therapies to being inexperienced at public speaking; and (3) the fact that advocacy efforts by patients and family members, which may be encouraged at the national level, may threaten individual professionals providing care to individual patients and may result in risk to patients.

In this article, a patient-physician and patient-bioethicist set out the obstacles, including ones that they have encountered in their own advocacy efforts. The aim is to survey the practical and ethical landscape so that solutions to various problems may be identified and solved as we move forward in our efforts to involve patients and their families in research, policy, and quality improvement in critical care medicine

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Background: Long-term survival outcome of critically ill patients is important in assessing effectiveness of new treatments and making treatment decisions. We developed a prognostic model for estimation of long-term survival of critically ill patients.

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Demand for intensive care unit (ICU) services is increasing [1], and at a rate that is higher than the average for all health care services [2]. Increase in treatment and monitoring technology, patients' expectations, and ageing population all contribute to this increased demand for intensive care services [1]. Indeed, intensive care is increasingly being provided to older and sicker patients, whom in the past were not treated in intensive care [3]. Intensive care services accounted for 10% of the US$2.1 trillion total health expenditures on health care in the United States in 2006 [4] and has been estimated to cost more than £700 million in the United Kingdom in 1999 [5]. The cost of intensive care services coupled with increasing demand provides the rationale for improved modelling of outcomes of critically ill patients.

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The objective of this study was to evaluate the use of sedative, analgesic, and neuromuscular blocking agents (NMBAs) in patients undergoing extracorporeal membrane oxygenation (ECMO) support.

Brief description of media:

As mortality rates associated with admission to the intensive care unit (ICU) have decreased in recent decades, there has been increasing interest in the long-term negative consequences of critical care. These effects, collectively termed “post-intensive care syndrome,” include emerging or worsening impairments in physical, cognitive, and psychological functioning following ICU admission.

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Clinical practice guidelines are published and promoted, often by professional societies, because they provide a current and transparently analyzed review of relevant research and are written with the aim to guide clinical practice. The 2018 Pain, Agitation/sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep (disruption) (PADIS) guidelines first: 1) builds on this mission by updating the 2013 PAD guidelines ; 2) by adding two inextricably related clinical care topics (immobility and sleep); 3) by including patients as collaborators and coauthors; and 4) by inviting panelists from high-income countries as an early step toward incorporating more diverse practices and expertise from the global critical care community.

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Long-term follow-up of randomized prospective trials of treatments in the intensive care unit may allow us to attain some understanding of the causes of post-intensive care syndrome. This in turn may allow us to produce better long-term outcomes among survivors of critical illness.