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Objective:To improve quality of life (QOL) in patients at risk for post-intensive care syndrome (PICS).
Patients and Methods: We conducted a mixed-method, prospective, observational, pre-post interventional study in an adult medical and mixed medical/surgical/transplant intensive care unit (ICU) at a tertiary academic hospital. Pre-intervention included patients admitted from October 1 through October31, 2016, and post-intervention included patients admitted from January 15 through February 14, 2017.First, a multidisciplinary team of stakeholders identified barriers associated with decreased QOL in patients at risk for PICS. Next, interventions were designed and implemented. The effect of interventions was assessed using a mixed-method analysis. The qualitative analysis used a modified grounded theory approach. The quantitative analysis included assessment of preexisting symptoms and risk factors associated with PICS. The 36-Item Short-Form Health Status Survey (SF-36), which surveys physical and mental composite scores, was used to assess QOL.
Results:Barriers identified were lack of awareness and understanding of PICS. Interventions included educational videos, paper and online education and treatment materials, and online and in-person support groups for education and treatment. After interventions, the qualitative analysis found that patients who participated in the interventions after hospital discharge showed improved QOL, whereas education during hospitalization alone was not effective. The quantitative analysis did not find improvement in QOL,as defined by SF-36 physical or mental composite scores.
Conclusion:Interventions targeted to patients after hospitalization may offer subjective improvement in QOL for those at risk for PICS

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Introduction

Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD.
Methods

Intensive care patients with an ICU stay of more than 72 hours were recruited to a randomised controlled trial examining the effect of a diary outlining the details of the patients ICU stay on the development of acute PTSD. The intervention patients received their ICU diary at 1 month following critical care discharge and the final assessment of the development of acute PTSD was made at 3 months.
Results

352 patients were randomised to the study at 1 month. The incidence of new cases of PTSD was reduced in the intervention group compared to the control patients (5% versus 13%, P = 0.02).
Conclusions

The provision of an ICU diary is effective in aiding psychological recovery and reducing the incidence of new PTSD.

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At least one-third of ICU patients and their families experience PICS or PICS-F. Incidence is at least 50% among patients who’ve had sepsis or acute respiratory distress syndrome or were on a mechanical ventilator for more than 5 days. At least half of PICS patients still need some form of care 1 year after hospital discharge. The past decade has seen a tremendous increase in our understanding of the long-term effects of critical illness on patients and their families. As our PICS knowledge base continues to expand, the challenge is to inform healthcare providers who care for critically ill patients during and after their hospital stay of the potential consequences of ICU admission.

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Background: Delirium affects nearly 70% of older adults hospitalized in the intensive care unit (ICU), and many of those will be left with persistent cognitive impairment or dementia. There are no effective and scalable recovery models to remediate ICU-acquired cognitive impairment and its attendant elevated risk for dementia or Alzheimer disease (AD). The Improving Recovery and Outcomes Every Day after the ICU (IMPROVE) trial is an ongoing clinical trial which evaluates the efficacy of a combined physical exercise and cognitive training on cognitive function among ICU survivors 50 years and older who experienced delirium during an ICU stay. This article describes the study protocol for IMPROVE.

Methods: IMPROVE is a four-arm, randomized controlled trial. Subjects will be randomized to one of four arms: cognitive training and physical exercise; cognitive control and physical exercise; cognitive training and physical exercise control; and cognitive control and physical exercise control. Facilitators administer the physical exercise and exercise control interventions in individual and small group formats by using Internet-enabled videoconference. Cognitive training and control interventions are also facilitator led using Posit Science, Inc. online modules delivered in individual and small group format directly into the participants’ homes. Subjects complete cognitive assessment, mood questionnaires, physical performance batteries, and quality of life scales at baseline, 3, and 6 months. Blood samples will also be taken at baseline and 3 months to measure pro-inflammatory cytokines and acute-phase reactants; neurotrophic factors; and markers of glial dysfunction and astrocyte activation.

Discussion: This study is the first clinical trial to examine the efficacy of combined physical and cognitive exercise on cognitive function in older ICU survivors with delirium. The results will provide information about potential synergistic effects of a combined intervention on a range of outcomes and mechanisms of action.

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Paul Nappi arrived at Penn Presbyterian Medical Center's intensive care unit suffering from a severe lung problem on March 8.
The 53-year-old Chester County man, already depleted by cancer treatments and a December bout with pneumonia, was unconscious and hooked to a breathing machine. His family was told he might not make it through the night.
They also were given a small spiral notebook labeled ICU Healing Journal. The family could fill it with words that could help hospital staff understand who Nappi is. Doctors, nurses, and therapists would add entries offering support and explaining what Nappi was going through. The journal could help him adjust to life after the ICU — if he survived.

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The 2 purposes of this systematic review were to identify the scope and magnitude of physical problems associated with PICS during the first year after critical illness and to use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to elucidate impairments of body functions and structures, activity limitations, and participation restrictions associated with PICS.

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1. Identify symptoms and risk factors for post-intensive care syndrome-families (PICS-F).
2. Describe techniques for pre venting PICS-F.
3. Discuss management of PICS-F

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Post–intensive care syndrome (PICS) is a myriad of chronically
debilitating symptoms, often including chronic pain, associated with prolonged
ICU care. Though the exact mechanism of chronic post-ICU pain is unknown, it is
postulated that the severity of inflammation associated with many forms of
critical illness leads to chronic pain in patients long after resolution of their acute
critical illness. Increasing emphasis on long-term outcomes of ICU survivors
makes prevention of chronic pain and PICS a priority for multidisciplinary ICU
teams. This article discusses the prevalence and mechanisms of chronic post-ICU
pain and suggests strategies to reduce the impact of chronic pain on quality of life
in ICU survivors.

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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.

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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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In the United States, nearly 27% of hospital admissions involve the use of intensive care unit (ICU) services. Due to advancements in acute care, survival rates have increased among patients admitted to the ICU. However, these individuals are at high risk for mortality and readmission following discharge, along with numerous long-term challenges that are collectively referred to as post-intensive care syndrome (PICS).

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Over the past decade, survival from critical illness has dramatically increased due to a better understanding of the pathophysiological mechanisms of disease, improved treatment strategies and advancements in medical technology. Several studies have shown improved survival and long-term outcomes in survivors of critically illness. However, surviving the intensive care unit (ICU) stay is just the start of a long road to recovery for a majority of these patients. The discharge from the ICU opens the path to a long journey of challenging physical rehabilitation, mood disorders, cognitive impairment, psychological distress, financial hardship, and caregiver burden and burnout.
In recent years there has been a growing recognition of impairments that affect the physical, psychological, social, and emotional aspects of the individual after ICU discharge that may adversely impact daily functioning and quality of life (QOL). Recently, the term “post-intensive care syndrome” (PICS) is used to describe any new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond the acute care hospitalization.1 PICS may persist for months to years after hospital discharge. Most impairments will diminish with time but some may linger on until the patient’s actual demise. This chapter will explore in detail the different domains affected in PICS, its impact on the individual and society, and offer insights into future developments.