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Rationale: Intensive care unit (ICU) nurses work in a demanding environment where they are repetitively exposed to traumatic situations and stressful events. The psychological effects on nurses as a result of working in the ICU are relatively unknown.

Objective: To determine whether there is an increased prevalence of psychological symptoms in ICU nurses when compared with general nurses.

Methods: We surveyed ICU and general nurses from three different hospitals (n = 351) and then surveyed ICU nurses throughout the metropolitan area (n = 140).

Measurements and Main Results: In both cohorts of nurses, we determined the prevalence of symptoms of post-traumatic stress disorder (PTSD), anxiety, and depression using validated survey instruments. Within our hospital system, 24% (54/230) of the ICU nurses tested positive for symptoms of PTSD related to their work environment, compared with 14% (17/121) of the general nurses (p = 0.03). ICU nurses did not report a greater amount of stress in their life outside of the hospital than general nurses. There was no difference in symptoms of depression or anxiety between ICU and general nurses. In the second survey of ICU nurses from our metropolitan area, 29% (41/140) of the respondents reported symptoms of PTSD, similar to our first cohort of ICU nurses.

Conclusions: ICU nurses have an increased prevalence of PTSD symptoms when compared with other general nurses. These results may increase awareness of these symptoms in nurses and lead to future interventions that improve their mental health and job satisfaction and help retain ICU nurses in their profession.

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New or worsened disabilities in functional, cognitive, or mental health following an intensive care unit (ICU) stay are referred to as post intensive care syndrome (PICS). PICS has not been described in older adults receiving home care. Our aim was to examine the relationship between length of ICU stay and PICS among older adults receiving home care. We expected that patients in the ICU for 3 days or longer would demonstrate significantly more disability in all three domains on follow-up than those not in the ICU. A secondary aim was to identify patient characteristics increasing the odds of disability.

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Aim:The purpose of this article was to highlight the need to provide support for patients and relatives following critical illness and discharge from hospital and how this can be improved through the establishment of user support groups.
Background:Critical illness predisposes patients to extended physical and psychological ill health with the potential for a reduced quality of life. The authors’ personal experience, patient feedback and current literature suggested that there was a need for further support during their recovery.
Methods:Building on an existing formal follow-up service, Intensive Care Unit (ICU) Support Team for Ex-Patients established a patient-centred forum, where patients and relatives could share experiences with others who had also been through critical illness by holding drop-in sessions. Feedback from those attending these flexible and informal sessions indicates that support was needed and that patients and families have found benefit in sharing experiences with others who can empathise, having been through critical illness themselves.
Conclusions:Our experience has shown there is a need that can be met simply with minimal investment of time and funding but that addresses a gap in patient support that otherwise goes unmet. Although this was a service development in one local area, it could be adapted to ICU patients and relatives more widely

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Since critical care began over 50 years ago, there have been tremendous advances in the science and practice that allow more severely ill and injured patients to survive. Each year, millions of people are discharged back to the community. The recognition of long-term consequences for ICU survivors and their families is a growing concern. Critical care practitioners have always known that the patients have a long road to recovery after discharge from the ICU. In the 2 past decades, research has revealed how remarkably common and devastating long-term consequences of critical illness can be and how much some patients and their families suffer (1–9). These consequences in patients are referred to as post-intensive care syndrome (PICS) and in families as post-intensive care syndrome-family (PICS-F) (1). The research findings are disturbing and a source of dis-tress to critical care practitioners. In response, they are working hard to identify the risk factors for PICS and are rapidly implementing ways to mitigate their impact. Although the critical care community is becoming increasingly aware of PICS, patients, families, and the post hospital care community need more information. They are the ones who are deal most directly PICS and PICS-F.There are three key emerging concepts driving these initiatives: a focus on safe transitions and hand offs, an emphasis on family-centered care, and the acceptance that critical care is defined by the whole episode of care, not just the ICU stay. It is clear that those in the field of critical care have a responsibility to increase the awareness and to work with those who care for patients post-ICU to identify and treat the consequences of critical illness in patients and families.

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More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.

Brief description of media:

Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post–intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions—tied to the specific conditions of interest—will be required to address these important problems.

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The Riker Sedation-Agitation Scale (SAS) was the first scale tested and developed for the ICU. The SAS identifies seven levels of sedation and agitation, which range from dangerous agitation to deep sedation, with a thorough description of patient behavior. This scale allows the clinician to distinguish easily between each level.

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Sepsis and acute respiratory distress syndrome (ARDS) are life threating diseases with high mortality and morbidity in all the critical care units around the world. After decades of research, and numerous pre-clinical and clinical trials, sepsis and ARDS remain without a specific and effective pharmacotherapy and essentially the management remains supportive. In the last years cell therapies gained potential as a therapeutic treatment for ARDS and sepsis. Based on numerous pre-clinical studies, there is a growing evidence of the potential benefits of cell based therapies for the treatment of sepsis and ARDS. Several cell types are used in the last years for the treatment of both syndromes showing high efficiency. Embryonic stem cells (ESC), multipotent stem (or stromal) cells (MSC) and epithelial progenitors cells (EpPC) have been used for both diseases. Nowadays, the major part of the pre-clinical studies are using MSC, however other relevant groups are also using induced pluripotent stem cells (iPSC) for the treatment of both syndromes and alveolar type II cells for ARDS treatment. Numerous questions need further study including: determining the best source for the progenitor cells isolation, their large scale production and cryopreservation. Also, the heterogeneity of patients with sepsis and ARDS is massive, and establish a target population or the stratification of the patients will help us to determine better the therapeutic effect of these cell therapies. In this review we are going to describe briefly the different cell types, their potential sources and characteristics and mechanism of action. Here, also we elucidate the results of several pre-clicinical and clinical studies in ARDS and in sepsis and the future directions of these studies.

Brief description of media:

More than 4 million adults survive a stay in the intensive care unit each year, with many experiencing new or worsening physical disability, mental health problems, and/or cognitive impairments, known as post-intensive care syndrome (PICS). Given the prevalence and magnitude of physical impairments after critical illness, many survivors, including those recovering from COVID-19, could benefit from physical therapist services after hospital discharge. However, due to the relatively recent recognition and characterization of PICS, there may be limited awareness and understanding of PICS among physical therapists practicing in home health care and community-based settings. This lack of awareness may lead to inappropriate and/or inadequate rehabilitation service provision. While this perspective article provides information relevant to all physical therapists, it is aimed toward those providing rehabilitation services outside of the acute and postacute inpatient settings. This article reports the prevalence and clinical presentation of PICS and provides recommendations for physical examination and outcomes measures, plan of care, and intervention strategies. The importance of providing patient and family education, coordinating community resources including referring to other health care team members, and community-based rehabilitation service options is emphasized. Finally, this perspective article discusses current challenges for optimizing outcomes for people with PICS and suggests future directions for research and practice.

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These slides help the medical student understand the types of PICS, what makes up PICS, the “burden of survivorship” and some novel interventions for the treatment of PICS.

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It is a common sight in the intensive care unit. Family members at the bedside, sometimes 24/7. Holding vigil and attentively monitoring each moment of the day for their critically ill/injured loved one. After all, who knows the needs and subtle hints of change of the patient better then close loved ones?

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For many people their first experience with an Intensive Care Unit may be when they find themselves or a loved one critically ill or injured. It can be an intensely stressful and scary time. It is not uncommon for those who experience critical illness or injury to later develop sleep disturbances such as insomnia, vivid dreams, and even nightmares. Many of the symptoms that former ICU patients experience are consistent with post-traumatic stress disorder and are included within the syndrome we are now calling Post Intensive Care Syndrome or PICS. Many interventions are being explored that address post-ICU recovery, however one intervention has already proven its usefulness in combating PTSD in post-ICU patients - ICU diaries.