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Young, healthy people can suffer for far longer than even a bad flu, a Centers for Disease Control and Prevention study found. One in five adults between the ages of 18 and 34 said they didn't feel back to normal two or three weeks after their diagnosis. "A lot of people don't realize, even if the virus is gone, that doesn't mean you're done with it," said Sullivan. "It's done its damage."

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Early on, patients with both mild and severe Covid-19 say they can’t breathe. Now, after recovering from the infection, some of them say they can’t think.

Even people who were never sick enough to go to a hospital, much less lie in an ICU bed with a ventilator, report feeling something as ill-defined as “Covid fog” or as frightening as numbed limbs. They’re unable to carry on with their lives, exhausted by crossing the street, fumbling for words, or laid low by depression, anxiety, or PTSD.

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Background

Psychological morbidity in both patients and family members related to the intensive care unit (ICU) experience is an often overlooked, and potentially persistent, healthcare problem recognized by the Society of Critical Care Medicine as Post-intensive Care Syndrome (PICS). ICU diaries are an intervention increasingly under study with potential to mitigate ICU-related psychological morbidity, including ICU-related post-traumatic stress disorder (PTSD), depression and anxiety. As we encounter a growing number of ICU survivors, in particular in the wake of the coronavirus pandemic, clinicians must be equipped to understand the severity and prevalence of significant psychiatric complications of critical illness.
Methods

We compared the efficacy of the ICU diary, written by family and healthcare workers during the patient's intensive care course, versus education alone in reducing acute PTSD symptoms after discharge. Patients with an ICU stay >72 h, who were intubated and mechanically ventilated over 24 h, were recruited and randomized to either receive a diary at bedside with psycho education or psycho education alone. Intervention patients received their ICU diary within the first week of admission into the intensive care unit. Psychological symptom screening with IES-R, PHQ-8, HADS and GAD-7 was conducted at baseline within 1 week of ICU discharge and at weeks 4, 12, and 24 after ICU discharge. Change from baseline in these scores was assessed using Wilcoxon rank sum tests.
Results

From September 26, 2017 to September 25, 2018, our team screened 265 patients from the surgical and medical ICUs at a single large academic urban hospital. 60 patients were enrolled and randomized, of which 35 patients completed post-discharge follow-up, (n = 18) in the diary intervention group and (n = 17) in the education-only control group. The control group had a significantly greater decrease in PTSD, hyperarousal, and depression symptoms at week 4 compared to the intervention group. There were no significant differences in other measures, or at other follow-up intervals. Both study groups exhibited clinically significant PTSD symptoms at all timepoints after ICU discharge. Follow-up phone interviews with patients revealed that while many were interested in getting follow-up for their symptoms, there were many barriers to accessing appropriate therapy and clinical attention.
Conclusions

Results from psychological screening tools demonstrate no benefit of ICU diaries versus bedside education-alone in reducing PTSD symptoms related to the intensive care stay. However, our study finds an important gap in clinical practice – patients at high risk for PICS are infrequently connected to appropriate follow-up care. Perhaps ICU diaries would prove beneficial if utilized to support the work within a program providing wrap-around services and close psychiatric follow up for PICS patients. This study demonstrates the high prevalence of ICU-related PTSD in our cohort of survivors, the high barrier to accessing care for appropriate treatment of PICS, and the consequence of that barrier—prolonged psychological morbidity.

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One thing that did not make to the spotlight in this COVID-19 pandemic is a question that what happens to the COVID-19 patients after they are discharged from the critical care? A common assumption around the world is that once a patient is discharged from the hospital and is tested negative the problem is resolved. This may be based on a relative lack of information and knowledge, even among the health care professionals, regarding a condition described as Post-Intensive Care Syndrome (PICS). PICS may be a next public health crisis that we may face when this acute form of COVID-19 crisis settles down a bit.

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Summary: PICS is common and under-recognized• COVID-19 survivors seem to be at particularly high risk for PICS• Improving outcomes for our ICU survivors is both a challenge and imperative for the critical care community

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COVID-19 may lead to severe acute respiratory dis-tress syndrome requiring intensive care unit (ICU) sup-port. Patients surviving respiratory distress could develop post-intensive care syndrome (PICS) that includes ICU-acquired weakness (ICUAW). Nearly 66% ofCOVID-19 patients have clinically important muscle weakness following discharge [1]. Therefore, communication between the critical care and rehabilitation physician is important to evaluate the physical function ofCOVID-19 survivors to start rehabilitation timely.

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While the long-term impacts of the novel coronavirus are largely unknown,
the effects of extended ICU stays and intubation on severely ill patients are
alarmingly clear. In the midst of a pandemic that has affected over 2.7
million people in the United States alone, some medical professionals are
now concerned that the health-care system will continue to be overwhelmed
by patients who are dealing with the aftermath of the coronavirus.

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Coronavirus patients who require treatment in an intensive care unit could suffer from post-intensive care syndrome (PICS), experts say.

In general, patients who require intensive care are at risk for mental health issues such as post-traumatic stress disorder, anxiety and depression when their treatment is over, according to Weill Cornell Medicine at Cornell University. They also can suffer cognitive impairment and physical limitations.

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The emergence of coronavirus diseases (COVID-19) has presented a global health threat. The number of COVID-19 cases continues to increase in Africa; this poses a challenge to the African healthcare system, particularly the intensive care unit(ICU). More so, individuals with severe COVID-19 would often have a prolonged intensive care stay, requiring mechanical ventilation and sedation and this may increase their risk of developing physical, cognitive and psychosocial impairments. These post-ICU sequelae of morbidities have been termed Post Intensive Care Syndrome. The African healthcare system needs to be prepared to manage the adverse effects of Post Intensive Care Syndrome (PICS) largely characterized by a decline in functional capacity and health-related quality of life. It is thus expedient that multi-targeted measures such as early rehabilitation, adequate screening, patient/caregiver education and post-discharge rehabilitation be adopted to combat imminent poor health out comes in COVID-19 survivors. In this editorial, we provided a brief review of PICS and highlighted strategies for preventing and managing PICS in the critically ill within the African context Key words: Pandemic, COVID-19 Survivors, African healthcare,Intensive Care Unit, Rehabilitation

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The Intensive Care Unit (ICU) of a hospital is where very sick patients are treated, and are are sometimes put on a ventilator, or breathing machine, to survive. The illness or injury, and even the treatments you received in the hospital while in the ICU, can often cause health problems that exist long after you have returned home. Recognize the signs and seek help as soon as you can so you can make a more complete recovery. Ask your medical provider if you need guidance finding specialized professionals who can help

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Preventing, assessing, and treating trauma suffered by families of a hospitalized loved one.

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To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States.
A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care.
218/307 referred patients (71%) survived to hospital discharge; 62 (28% of survivors) were seen in clinic. Median time from discharge to ICU-RC visit was 29days. At initial evaluation, 64% of patients had clinically meaningful cognitive impairment. Anxiety and depression were present in 37% and 27% of patients, respectively. One in three patients was unable to ambulate independently; median 6min walk distance was 56% predicted. Of 47 previously working patients, 7 (15%) had returned to work. Case management and referral services were provided 142 times. The median number of interventions per patient was 4.
An ICU-RC identified a high prevalence of cognitive impairment, anxiety, depression, physical debility, lifestyle changes, and medication-related problems warranting intervention. Whether an ICU-RC can improve ICU recovery in the US should be investigated in a systematic way.