Brief description of media:

This After the ICU booklet is intended to be used by former ICU patients and their family/caregiver to help find the health care services and community resources that may be helpful during recovery from critical illness. Specifically, this booklet was created to provide information and resources related to Post-Intensive Care Syndrome (PICS). While PICS and PICS-F can be common after a critical illness, you may not experience all or any of these symptoms.

PICS is defined as new or worsening physical, cognitive, and emotional health problems that remain after a critical illness. Family members and caregivers of former ICU patients can also experience emotional and psychological health problems such as anxiety, depression, and posttraumatic stress disorder. This is referred to as PICS-F. Our hope is to raise awareness about PICS and PICS-F and provide resources for those who are experiencing these symptoms. If you or your family/caregiver are having difficulty, we want you to know that you are not alone, and that help is available.

Brief description of media:

Our project addresses one of the pressing issues of ICU medicine – properly informing post-ICU patients and their families about the increasing body of research documenting the deficits faced by a significant percentage of survivors of intensive care, specifically neuro-cognitive dysfunction, depression, anxiety and post-traumatic stress disorder, ICU-acquired muscle weakness, and chronic pain. These documented deficits are classified as one of two syndromes, post intensive care syndrome [“PICS”] and family post intensive care syndrome [PICS-F”].

Brief description of media:

Our project addresses one of the pressing issues of ICU medicine—the post-ICU patient. Research has documented deficits faced by survivors of intensive care, specifically neuro-cognitive dysfunction, depression, anxiety, and post-traumatic stress. These long-lasting disabilities present an important and prevalent public health concern. Although clinicians are increasingly aware of the challenges that face ICU survivors, they do not frequently discuss this with patients or families. As a result, patients often face a bewildering number of care transitions—from hospitals to long-term care to nursing facilities—without a roadmap or community. Furthermore, there is little research that investigates which outcomes are important to ICU survivors and their families, or how to change care with these outcomes in mind.

Brief description of media:

Patients who survive long stays in the intensive care unit (ICU), such as those who receive prolonged mechanical ventilation, will most often require continued assistance from a caregiver more than a year after ICU discharge. The effects of this responsibility on the family caregivers are not well known but may include such negative consequences as poor health-related quality of life, emotional distress, a subjective sense of burden, and symptoms of post-traumatic stress disorder.

Brief description of media:

Patients who survive long stays in the intensive care unit (ICU), such as those who receive prolonged mechanical ventilation, will most often require continued assistance from a caregiver more than a year after ICU discharge. The effects of this responsibility on the family caregivers are not well known but may include such negative consequences as poor health-related quality of life, emotional distress, a subjective sense of burden, and symptoms of posttraumatic stress disorder.

Brief description of media:

Early this year, when the world was first coming to grips with the spread of COVID-19 and the challenges it would present, Dr. Brad Butcher, a critical care medicine specialist at UPMC Mercy, was focused on what was coming next.

“We heard that patients who required time in the intensive care unit, and particularly time on a mechanical ventilator, were staying on the ventilator for a very long time,” he said. “This is concerning because the longer people stay in bed, the more physical weakness can develop, and the longer they’re on ventilation, the more drugs they need to sedate them.”

Additional medication increases the risk of patients developing delirium, which raises the likelihood of long-term cognitive complications from the critical illness. These conditions would only be intensified by the limited interactions with care providers and loved ones permitted by COVID-19 safety protocols.

“We were very concerned that these patients would be at increased risk for anxiety, depression and post-traumatic stress disorder,” Butcher said.

In other words, COVID-19 had the potential to create a perfect storm in the realm where Butcher and his colleague Tammy Eaton, C.R.N.P., specialize: Post-Intensive Care Syndrome (PICS). PICS is a set of conditions that have been around as long as critical care medicine, but it received a name only a decade ago. Addressing PICS is the mission of the UPMC Critical Illness Recovery Center (CIRC), which Butcher and Eaton founded at UPMC Mercy.

Brief description of media:

Due to the aging of the intensive care unit (ICU) population and an improvement in survival rates after ICU hospitalization, an increasing number of older adults are suffering from long-term impairments due to critical illness, known as post-intensive care syndrome (PICS). This paper focuses on PICS-related cognitive, psychological, and physical impairments, and the impact of ICU hospitalization on families and caregivers. The authors also describe innovative models of care for PICS, and what roles geriatric psychiatrists could play in the future of this rapidly growing population.

Brief description of media:

Post-intensive care syndrome–family (PICS-F) describes the psychological symptoms that affect the family members of patients hospitalized in the intensive care unit (ICU) or recently discharged from the ICU. Geriatric psychiatrists should be concerned about PICS-F for several reasons.

First, ICU hospitalization in older adults is associated with higher rates of cognitive and physical impairment, compared to older adults hospitalized in non-ICU settings or dwelling in the community. This confers a special burden on the caregivers of these older ICU survivors compared to other geriatric populations. Second, as caregivers themselves age, caring for this unique burden can be more challenging compared to other geriatric populations. Third, evidence for models of care centered on patients with multi morbidity and their caregivers is limited. A deeper understanding of how to care for PICS and PICS-F may inform clinical practice for other geriatric populations with multi morbidity and their caregivers.

Geriatric psychiatrists may play a key role in delivering coordinated care for PICS-F by facilitating timely diagnosis and interdisciplinary collaboration, advocating for the healthcare needs of family members suffering from PICS-F, and leading efforts within healthcare systems to increase awareness and treatment of PICS-F. This clinical review will appraise the current literature about the impact of critical illness on the family members of ICU survivors and identify crucial gaps in our knowledge about PICS-F among aging patients and caregivers.

Brief description of media:

Hypothesis: Restrictive albumin use guidelines in the surgical intensive care unit (SICU) will not increase mortality and will result in cost savings.

Design: Prospective cohort study.

Setting: Tertiary teaching hospital.

Patients: All patients admitted to the SICU from July 1, 2004, through July 1, 2005, were included in this study.

Interventions: Patients in the first 3 quarters of the study were treated with no restriction on albumin use. An organized educational program was initiated by the new intensivist-led critical care team and directed toward the residents, nursing staff, and primary surgical teams. Appropriate albumin use guidelines were instituted in the last quarter.

Main Outcome Measures: Prospective clinical and outcome data were collected. Albumin use data and costs were obtained from the pharmacy prospective database.

Results :A total of 1361 patients were included in the study. A statistically significant reduction in albumin use (54%) was found in the fourth quarter (P=.004), and a substantial cost saving was realized (56% reduction in cost) with the albumin use guidelines. Restrictive use of albumin had no negative impact on ICU mortality. Mean Acute Physiology and Chronic Health Evaluation III scores on ICU day 1 were not different. No significant difference in mean ICU length of stay was noted. Maintained reduction in the use of albumin was documented during the next 6 quarters. Conclusions: The implementation of albumin use guidelines during critical care resuscitation using an educational approach in a SICU is associated with reduced albumin use, significant cost savings, and no negative impact on ICU outcome. Continued educational efforts promoting evidence-based practices in the ICU are warranted.
Arch Surg. 2008;143(10):935-939

Brief description of media:

Researchers in Denmark have developed a new algorithm that predicts an individual patient’s risk of mortality in the ICU. Their work, recently published in the journal Digital Health, demonstrates that the algorithm outperforms current non-computational methods of estimating mortality. Algorithms of this nature can help direct resources where they are needed most to best improve patient outcomes and help catch problems early.

Brief description of media:

Providing insight into key clinical practices that can ameliorate Post-Intensive Care Syndrome (PICS), we will describe the role of interprofessional collaboration in implementation of a multicomponent intervention to reduce the burden of PICS following critical illness.

Brief description of media:

Purpose: Closed endotracheal suctioning (CES) may impact ventilator-associated pneumonia (VAP) risk by reducing environmental contamination. In developing countries where resource limitations constrain the provision of optimal bed space for critically ill patients, CES assumes greater importance.

Materials and methods: In this prospective, open-labeled, randomized controlled trial spanning 10 months, we compared CES with open endotracheal suctioning (OES) in mechanically ventilated patients admitted to the medical intensive care unit (ICU) of a university-affiliated teaching hospital. Patients were followed up from ICU admission to death or discharge from hospital. Primary outcome was incidence of VAP. Secondary outcomes included mortality, cost, and length of stay.

Results: Two hundred patients were recruited, 100 in each arm. The incidence of VAP was 23.5%. Closed endotracheal suctioning was associated with a trend to a reduced incidence of VAP (odds ratio, 1.86; 95% confidence interval, 0.91-3.83; P = .067). A significant benefit was, however, observed with CES for late-onset VAP (P = .03). Mortality and duration of ICU and hospital stay were similar in the 2 groups. The cost of suction catheters and gloves was significantly higher with CES (Rs 272 [US $5.81] vs Rs 138 [US $2.94], P < .0001). Nine patients need to be treated with CES to prevent 1 VAP (95% confidence interval, -0.7 to 22).

Conclusions: In the ICU setting in a developing country, CES may be advantageous in reducing the incidence of VAP, particularly late-onset VAP. These results mandate further studies in this setting before specific guidelines regarding the routine use of CES are proposed.