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A crisis is silently brewing in hospitals around the world, and it may not be exactly what you think. While the numbers of COVID-19 cases and deaths continue to swell, the very treatments used to battle this deadly disease are triggering life-altering mental health effects.

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Post-hospital medical resource use among ICU survivors is substantial, although similar to that after non-ICU hospitalization. Although the fraction of survivors unable to live independently was small, a larger fraction required home care services. Identifying post-hospital supports needed by ICU survivors can be useful for policy makers and others responsible for healthcare planning.

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Rationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few intensive care units (ICUs).

Objectives: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs.

Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a 9-year period, we assessed ICU, hospital, 30-day, and 180-day mortality rates; ICU and hospital lengths-of-stay; post-hospital use of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For post-hospital use variables, we compared ICU patients with those admitted to hospitals without the need for ICU care.

Measurements and Main Results: After ICU admission there was a high initial death rate, which declined between 30 and 180 days and thereafter remained at the lower value. Hospital mortality was 19.0%, with 21.7% dying within 6 months of ICU admission. Women had higher hospital mortality than men.

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As Belgium enters a new wave of Covid-19 infections, the federal knowledge center for health care (KCE) has just issued an extensive new report warning of a danger on the horizon: a wave of cases of post intensive care syndrome (PICS).

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Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge.

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Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

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This publication discusses the utility of chest radiographs and chest ultrasound (US) in the intensive care unit (ICU)setting. The intentions for routine daily portable chest radiographs—patient monitoring; documenting the course of disease for which radiographs are obtained after specific procedures or following insertion of tubes and lines, such as endotracheal, nasogastric (orogastric), and chest tubes; placement of pulmonary artery and central venous catheters (CVCs); and chest tube removal—are addressed.

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Acute kidney injury (AKI) has now replaced the term acute renal failure and a universal definition and staging system has been proposed to allow earlier detection and management of AKI. The new terminology enables health care professionals to consider the disease as a spectrum of injury. This spectrum extends from less severe forms of injury to more advanced injury when acute kidney failure may require renal replacement therapy (RRT). Clinically AKI is characterized by a rapid reduction in kidney function resulting in a failure to maintain fluid, electrolyte and acid-base homoeostasis. There have previously been many different definitions of AKI used in the literature which has made it difficult to determine the epidemiology and outcomes of AKI. Over recent years there has been increasing recognition that relatively small rises in serum creatinine in a variety of clinical settings are associated with worse outcomes.

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Doctors have known for some time that survivors of critical illness can develop long-term physical, cognitive, and mental health problems, which can persist for years after they leave intensive care units. The phenomenon is known as post-intensive care syndrome or PICS, and the risk factors for it are especially common among patients hospitalized with COVID-19: prolonged periods of time on a ventilator, heavy sedation, organ failure and acute respiratory distress syndrome, in which fluid builds up in the lungs, causing low blood oxygen levels.

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Even after surviving COVID-19, many patients who were critically ill face long and arduous recoveries, often requiring extensive physical rehabilitation. The problems they encounter are wide-ranging. Some patients suffer muscle atrophy, kidney damage or reduced lung capacity, making it difficult for them to leave their homes or get out of bed. Many struggles with cognitive and psychological issues like memory loss, depression, and anxiety. Among the most common problems they face are shortness of breath, fatigue, confusion and body aches.

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Ronan’s lingering symptoms aren’t unique to COVID-19 patients. In as many as 80% of them leaving the ICU, researchers have documented what they call post-intensive care syndrome (PICS) -- a group of physical, mental, and psychiatric symptoms that result from an ICU stay. Although their illness plays a role in these symptoms, the amount of time spent in critical care is a major factor.

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Researchers are still trying to understand everything that Ronan and other COVID-19 patients need to let them move on with their lives after being in the ICU. Mysteries abound, but the groundwork laid by Sevin, Needham, Weinhouse, and others has provided a solid foundation on which to build.