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Alcoholism is such a common condition that virtually every clinician is confronted with its complications. There are an estimated 8 million alcohol dependent people in the United States. Approximately 500,000 episodes of withdrawal severe enough to require pharmacologic treatment occur each year
The in-patient management of syndromes associated with moderate and severe alcohol withdrawal is reviewed here. The ambulatory management of mild alcohol withdrawal, the initial diagnosis and treatment of alcohol dependence, and specific conditions due to alcohol-related organ damage (eg, cirrhosis, pancreatitis) are discussed elsewhere.

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Objective: Patients and caregivers can experience a range of physical, psychological, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism.
Design: We sought to identify technical, safety and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation.
Subjects: 17 Thrive sites from the USA, UK, and Australia were represented by a range of healthcare professionals.
Interventions: Via an iterative process of in-person and email/conference calls, members of the Collaborative, defined the key areas on which peer support models could be defined and compared; collected detailed self-reports from all sites; reviewed the information and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented.
Results: Within the Thrive Collaborative, six general models of peer support were identified:
Community based, Psychologist-led outpatient, Models based within ICU follow-up clinics, Online, Groups based within ICU and Peer mentor models. The most common barriers to implementation were: recruitment to groups, personnel input and training: sustainability and funding, risk management and measuring success.
Conclusion: A number of different models of peer support are currently being developed to help patients and families recover and grow in the post-critical care setting.

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Objective: Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of post-intensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them.
Design: Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data.
Setting: Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 23 sites, across three continents.
Subjects: Clinicians from 23 sites.
Measurement and Main Results: Ten enablers and nine barriers to implementation of ICU follow-up clinics were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding.
Nine enablers and five barriers to the implementation of peer support groups were identified.
Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising.
Conclusions: Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.

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Post-intensive care syndrome among families of intensive care unit (ICU) survivors

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Today we welcome Giora Netzer M.D., M.S.C.E., Associate Professor of Medicine here at the University of Maryland Medical Center. Dr. Netzer was trained at the great bastion of intensive care medicine, the University of Pennsylvania, where he also earned a master’s degree in clinical epidemiology. Since joining the University of Maryland Pulmonary and Critical Care Medicine department he has proven to be one the greatest minds the ICU has to offer, earning him the title: Wiki-Netzer. His passion for knowledge led to his appointment as the Director of Clinical Research and has yielded a tremendous breadth of publications. Today he focuses on his true passion: how to assist family members care for their loved ones both in the ICU and in the post-ICU setting. Trust me, this is a topic that is often overlooked and one that can truly mean life or death for your patients! You cannot miss it!!

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The commotion over COVID-19's direct impacts has largely drowned out alarm over its longer-term effects. But as more survivors emerge from intensive care units, a chorus of voices, many tweeting under #LongCovid, are clamoring to be heard.

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Critically ill patients are known to suffer from severely fragmented sleep with a predominance of stage I sleep and a paucity of slow wave and REM sleep. The causes of this sleep disruption include the intensive care unit (ICU) environment, medical illness, psychological stress, and many of the medications and other treatments used to help those who are critically ill. The clinical importance of this type of sleep disruption in critically ill patients, however, is not known. This article reviews the literature of commonly used ICU medications on sleep, the relationship between sleep and sedation, and the literature on the biological and psychological consequences of sleep deprivation specifically as it relates to the critically ill. Finally, an integrative approach to improving sleep in the ICU is described.

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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

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Increasing numbers of survivors of critical illness are at risk for physical, cognitive, and/or mental health impairments that may persist for months or years after hospital discharge. The post-intensive care syndrome framework encompassing these multidimensional morbidities was developed at the 2010 Society of Critical Care Medicine conference on improving long-term outcomes after critical illness for survivors and their families.

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Background: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge.. Conclusions: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

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ABCDEF's of Prevention and Safety

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