Brief description of media:

Specialists in intensive care medicine have long focused on the prevention of short-term mortality. As intensive care unit (ICU) mortality continues to improve, interest in outcome measures has expanded to include the morbidity and mortality of survivors. Over the last 10 years it has been increasingly recognised that critical illness is a medical condition itself, irrespective of the underlying cause for ICU admission, and patients experience physical, psychological, and cognitive dysfunction after hospital discharge (Figure 1). However, because relatively few patients ultimately require critical care, many GPs may have little contact with these patients. It may therefore be difficult to provide the additional support required by ICU survivors. This short paper highlights some of the physical and psychological difficulties that patients face after discharge from ICUs, and will hopefully help GPs to plan long-term management of their patients in the community.

Brief description of media:

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.

Brief description of media:

Bedside rounds have evolved concurrently with hospitalist medicine and patient-centered care. Family-centered rounds are the foundation of effective communication in the in-patient pediatric setting. Participant perspectives (family members, patients, nurses, faculty, and trainees) on family-centered rounds differ and goals may not always align. Further, the practical components of how rounds are conducted varies and have continued opportunities for improvement. This article summarizes the most recent experience with rounds in an attempt to identify unified and effective strategies moving forward.

Brief description of media:

We will break our conversation about preventing Post Intensive Care Syndrome into two parts. This month in Part I, we will focus on steps that the health care team will take to prevent PICS. Next month in Part II, we will focus on preventative steps that loved ones can take.

Brief description of media:

Purpose:Post-traumatic stress disorder has been reported in survivors of critical illness. The aim of this study was to investigate the predictors of post-traumatic stress disorder in survivors of critical illness.Materials and methods:Patients attending the intensive care unit (ICU) follow-up clinic completed the UK-Post-Traumatic Stress Syndrome 14-Questions Inventory and data was collected from their medical records. Predictors investigated included age, gender, Apache II score, ICU length of stay, pre-illness psychopathology; delirium and benzodiazepine administration during ICU stay and delusional memories of the ICU stay following discharge.Results:A total of 198 patients participated, with 54 (27%) patients suffering with post-traumatic stress disorder.On multivariable logistic regression, the significant predictors of post-traumatic stress disorder were younger age,lower Apache II score, pre-illness psychopathology and delirium during the ICU stay.Conclusions:The predictors of post-traumatic stress disorder in this study concur with previous research however a lower Apache II score has not been previously reported.

Brief description of media:

Post-intensive care syndrome (PICS) is a collection of symptoms, limitations, and impairments that are present in people who have recently been treated in a hospital’s intensive care unit (ICU). These impairments may be chronic and may limit your full participation in your normal activities upon discharge from the ICU.

If you have been recently discharged from the intensive care unit, you may benefit from the care of a physical therapist to help you recover fully and return to your previous level of work and recreational activity.

Brief description of media:

This article stresses four main questions about PICS: What is post intensive care syndrome (PICS), Who gets post-intensive care syndrome (PICS), What are the symptoms of post-intensive care syndrome (PICS), and What causes post-intensive care syndrome (PICS).

Brief description of media:

While the short-term outcomes of ICU patients have dramatically improved over the last half-century, it is increasingly recognized that many ICU survivors experience declines in physical and cognitive functioning that persist well beyond their acute hospitalization. Psychiatric sequelae, including anxiety, depression, and post-traumatic stress disorder (PTSD) are also prevalent among both ICU survivors and their family members. Attendees of a 2010 meeting of the Society of Critical Care Medicine coined the term Post Intensive Care Syndrome (PICS) to describe new and persistent declines in physical, cognitive, and mental health functioning that follow an ICU stay and for which other causes, such as traumatic brain injury (TBI) or cerebrovascular accident (CVA), have been excluded. The term PICS-F is applied to the close family members of ICU patients who experience subsequent adverse mental health outcomes, the most common of which are sleep deprivation, anxiety, depression, and complicated grief.

Brief description of media:

The quality and number of post-ICU PTSD studies has increased over time, and we can be more confident in the accumulated findings. Evidence from both periods suggests that up to 27% of ICU survivors suffer from PTSD. There is also increasing evidence that use of benzodiazepines and duration of sedation, along with fear, stress and delirium in the ICU are likely risk factors for subsequent PTSD.

Brief description of media:

According to a medical report by The Centers for Disease Control and Prevention (CDC), millions of patients are usually admitted to ICU annually in which a third of this population require a ventilator for breathing purposes. They are critically ill and after leaving the ICU, most of them develop health complications related to their injury, illness, ventilator and other treatments. In most cases, such issues are hardly treated and continue after a patient leaves the health sector. Notably, sepsis, delirium, and respiratory distress syndrome may increase the chances of a person experiencing these health issues. There has been an advancement of healthcare with a motive of improving outcomes for these patients as well as their recovery.

Brief description of media:

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long‐term prognoses. Post‐intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long‐term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS‐p) and the mental status of their family (PICS‐F). Intensive care unit‐acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. 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. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

Brief description of media:

The Confusion Assessment Method (CAM) was created in 1990, and it was intended to be a bedside assessment tool usable by non-psychiatrists by Dr. Sharon Inouye to assess for delirium.6 The CAM-ICU is an adaptation of this tool for use in ICU patients (e.g., critically ill patients on or off the ventilator). Delirium is defined in terms of four diagnostic features, and is deemed positive when Feature 1 and Feature 2 and either Feature 3 or 4 are present (see CAM-ICU schematic on
next page). The CAM-ICU is one of the recommended ICU delirium screening tools.