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Nic Brown is lucky, and he knows it. The 38-year-old father of three is recovering from the coronavirus after spending 10 days in Cleveland Clinic’s intensive care unit. He was kept mostly sedated while hooked up to a ventilator to help him breathe. “There was a time during this process where the hospital reached out to my wife to have the discussion about end-of-life options,” Brown, of Tuscarawas County, Ohio, said. “It was very emotional for all of us.” While a majority of patients who become infected with the coronavirus appear to have mild symptoms or no symptoms at all, it’s becoming clear that those with the most severe complications must spend a significant amount of time in the ICU. “We have people on ventilators for 20 to 30 days,” New York Gov. Andrew Cuomo said during a news conference this week. It’s a similar situation at the Tulane Medical Center in New Orleans, which has become another hot spot in the coronavirus outbreak.

Doctors there say COVID-19 patients rarely get better within two or three days, instead of remaining on mechanical oxygen for one to two weeks. Critical care doctors know that the longer patients remain in the ICU, the more likely they are to suffer long-term physical, cognitive, and emotional effects of being sedated. In fact, those effects have a name: “post-intensive care syndrome.” Some physicians call it post-ICU delirium.

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Jessica, a nurse, is a survivor of post-intensive care syndrome (PICS). Below, she recounts her experiences in the ICU and after discharge. As you read her story, think about how you and your peers provide care to critically ill patients—and how you might be able to prevent some of the negative effects experienced by ICU patients.

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“Wake Up and Breathe” Protocol
Spontaneous Awakening Trials (SATs) + Spontaneous Breathing Trials (SBTs)

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Critical care services are atypical in the wide heterogeneity of their patients. This is in part a reflection of the way in which these services have evolved. The progress of intensive care in the UK has been described as ‘haphazard’, consisting of ‘largely unplanned and unevaluated’ developments that occurred in reaction to changes in surgical and medical practice. There has been debate about the configuration of critical care services, fueled by a perception that there are not enough beds in some parts of the country and that existing beds are not in the right places. During the late 1990s, the NHS Executive established a National Expert Group to review adult critical care services in the UK and to produce a national Framework for future organization and care delivery. As a result, in May 2000 a critical care modernization plan was announced.

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Complex trauma is still a relatively new field of psychology. Complex post-traumatic stress disorder (C-PTSD) results from enduring complex trauma. Complex trauma is ongoing or repeated interpersonal trauma, where the victim is traumatized in captivity, and where there is no perceived way to escape. Ongoing child abuse is captivity abuse because the child cannot escape. Domestic violence is another example. Forced prostitution/sex trafficking is another. Complex PTSD is a proposed disorder which is different to post-traumatic stress disorder. Many of the issues and symptoms endured by complex trauma survivors are outside of the list of symptoms within the (uncomplicated) PTSD diagnostic criterion. Complex PTSD does acknowledge and validate these added symptoms. The impact of complex trauma is very different to a one time or short-lived trauma. The effect of repeated/ongoing trauma – caused by people – changes the brain, and also changes the survivor at a core level. It changes the way survivors view the world, other people, and themselves in profound ways.

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The impact of complex trauma is very different to a one time or short-lived trauma. The effect of repeated/ongoing trauma – caused by people – changes the brain, and also changes the survivor at a core level. It changes the way survivors view the world, other people and themselves in profound ways. This article provides some of the symptoms and impact most felt by complex trauma survivors.

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International Symposium on Intensive Care and Emergency Medicine

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24th International Symposium on Intensive Care and Emergency Medicine

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This article contains key information on assisting family members survive when a loved one is in the intensive care unit. Communication, decision making, multi-disciplinary meetings, pain/comfort, and sleep are discussed. Hopefully, knowing this information will help you and your loved one have a positive experience and survive your time in the ICU.

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A case study regarding a patient with Fibromyalga and Post-traumatic Stress Disorder.

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Organizational data such as bed occupancy rate and nurse-to-patient ratio are related to clinical outcomes and to the efficient use of intensive care unit (ICU) resources. Standards for these performance indicators are provided in guidelines. We studied the effects of a multifaceted feedback strategy to improve the adherence to these standards.

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Nathan Maryn walks in the post-surgical intensive care unit at The Johns Hopkins Hospital with his wife, Barbara Maryn, and Jennifer Sahm, a physical therapist. A nurse followed with a chair in case he became unsteady. Exercise in the ICU is associated with better long-term outcomes. One woman left Johns Hopkins' intensive-care unit believing her husband and nurse had been plotting to kill her. Another ICU patient had flashbacks of hospital walls covered in blood. A third had visions of big spiders riding bicycles in her room. Suddenly, a favorite hobby, gardening, felt creepy. Doctors used to think patients returned to normal after the delusions and hallucinations of ICU delirium stopped. They're learning instead that some leave the hospital with terrifying false memories, often of being assaulted or imprisoned. The horrible visions help explain why a recent Johns Hopkins study found that one in four patients had post-traumatic stress symptoms two years after going home.