Brief description of media:

New or worsening cognitive, physical and/or
mental health impairments after acute care for critical illness
are referred to as “post-intensive care syndrome” (PICS). Little is known about the incidence of its components, since it is challenging to recruit patients after intensive care unit (ICU) treatment for observational studies. Claims data are particularly suited to achieve incidence estimates in difficult-to-recruit
groups. However, some limitations remain when using claims
data for empirical research on the outcome of ICU treatment.
The objective of this article is to describe three challenges and
possible solutions for the estimation of the incidence of PICS
based on claims data.

Brief description of media:

Doctors have known for some time that survivors of critical illness can develop long-term physical, cognitive and mental health problems, which can persist for years after they leave intensive care units. The phenomenon is known as post-intensive care syndrome or PICS, and the risk factors for it are especially common among patients hospitalized with COVID-19: prolonged periods of time on a ventilator, heavy sedation, organ failure and acute respiratory distress syndrome, in which fluid builds up in the lungs, causing low blood oxygen levels.

Brief description of media:

Most people know that resuscitation efforts aren’t always success-
ful. Armed with this knowledge, family presence during resuscitation (FPDR) can be a comfort to patients who are fearful of dying alone without the support and advocacy of their loved ones.

Brief description of media:

Health professionals have been aware of the incidence of post-intensive care syndrome (PICS) for some time. However, there has not been a clear or definitive way of administering treatment or nursing care to help patients suffering from PICS in their recovery. This paper suggests some ideas for the care of patients from the nursing point of view.

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.

Brief description of media:

The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness?

Brief description of media:

Definition of post-intensive care unit syndrome (PICS) and post-intensive care unit syndrome-family (PICS-F)

Brief description of media:

Brain Road Map for Rounds (Script for Interdisciplinary Communication)

Brief description of media:

More than 5.7 million Americans are admitted to an ICU each year, and at least half who survive treatment will suffer long-term disorders that were acquired or exacerbated by a combination of their initial illness and the treatment they received in an ICU. The symptoms can include debilitating muscle weakness, mobility problems, cognitive decline, and psychological problems. Both critical illness myopathy and lack of mental acuity can prolong the recovery process.

Brief description of media:

The PTSD scoring system

Brief description of media:

“Mrs. Croft, I truly regret that I’m calling you about a covid-19 research program only an hour after your husband, John, died of his coronavirus infection. None of us know what you are feeling, and we want you to know how immensely sorry we are for all that you and your family are going through. It’s just that the whole world is trying to grapple with this pandemic, and we are trying to understand what the virus is doing to the brain, since so many people are presenting with an inability to smell, confusion and strokes. I am calling to see if you might consider a priceless gift to the world so we can learn and hopefully help others: We are studying the brain in those who die of covid, and I’d like to talk with you about the possibility of donating John’s brain to our NIH-funded scientific research program.”

As a physician-scientist, I have spent 30 years at the bedside of my patients and their families. There is no place I’d rather be, but I wouldn’t have stayed here for so long without the research part. Alongside 90 others in Vanderbilt’s Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, I now study covid-19, the disease caused by the novel coronavirus. The pandemic is different: tough, inspiring and exasperating all at once. Answering questions to help reduce human suffering is what we do. Attempts to flatten the curve have shuttered our existing projects and catapulted us into new work and international collaborations in what seemed like one day. And then almost as quickly this month, we were immersed in disparities. The pandemic has amplified elements of the everyday disadvantages that millions face, and it’s obvious to all of us that it’s not fair or just.

Brief description of media:

The long run physical, cognitive and emotional consequences of admission to an intensive care unit (ICU) are well-known. However, the ongoing debate on the best practices supporting the former ICU patients and their relatives for these consequences, is still inconclusive. A new method, ‘Balance-training’, has been developed to stimulate the regaining of emotional and physical capability.