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July 20, 2007, ST. LOUIS – When Wilson Guthrie entered Barnes-Jewish Hospital, the birds had begun flying south for the winter.
The next time he stepped outside, the Cardinals were trying to stay in the pennant race.
With a stay lasting from October 31, 2006 to July 21, 2007, Guthrie is thought to be the patient with the longest stay in Barnes-Jewish''s cardio thoracic ICU to be discharged.

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Each year, about 28.000 individuals are discharged from intensive care units (ICUs)
encountering physical, mental and/or cognitive disorders as part of the post-intensive care syndrome (PICS). The general aim of this thesis was to explore the course and prognosis of functioning in ICU survivors during the first year after ICU discharge, and to investigate means for early identification of PICS. The studies included in this thesis focused on adult ICU-patients, who were mechanically ventilated more than 48 hours in a closed format mixed medical-surgical ICU. In this chapter the main findings and methodological issues of the presented studies are reviewed, implications for clinical practice are discussed, and recommendations for rehabilitation care as well as for future research are provided.

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LONG Covid is the term used to explain the long-term effects of Covid-19 that are being discovered as people recover from the initial impact of the virus.
According to a review by the National Institute of Health Research (NIHR), it may actually be a number of different syndromes and researchers are now examining what exactly happens after someone has contracted coronavirus.
In the NIHR review, it was suggested that people suffering from long-term effects of Covid-19 may have different syndromes such as post-intensive care syndrome, post-viral fatigue syndrome, and long term covid syndrome.

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Frequently asked questions regard the "Confusion Assessment Method for the ICU" (CAM-ICU)

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Introduction
Engaging patients and family members as partners in research increases the relevance of study results and enhances patient-centered care; how to best engage patients and families in research is unknown.
Methods
We tested a novel research approach that engages and trains patients and family members as researchers to see if we could understand and describe the experiences of patients admitted to the intensive care unit (ICU) and their families. Former patients and family members conducted focus groups and interviews with patients (n = 11) and families of surviving (n = 14) and deceased (n = 7) patients from 13 ICUs in Alberta Canada, and analyzed data using conventional content analysis. Separate blinded qualitative researchers conducted an independent analysis.
Results
Participants described three phases in the patient/family “ICU journey”; admission to ICU, daily care in ICU, and post-ICU experience. Admission to ICU was characterized by family shock and disorientation with families needing the presence and support of a provider. Participants described five important elements of daily care: honoring the patient’s voice, the need to know, decision-making, medical care, and culture in ICU. The post-ICU experience was characterized by the challenges of the transition from ICU to a hospital ward and long term effects of critical illness. These “ICU journey” experiences were described as integral to appropriate interactions with the care team and comfort and trust in the ICU, which were perceived as essential for a community of caring. Participants provided suggestions for improvement: 1) provide a dedicated family navigator, 2) increase provider awareness of the fragility of family trust, 3) improve provider communication skills, 4) improve the transition from ICU to hospital ward, and 5) inform patients about the long-term effects of critical illness. Analyses by independent qualitative researchers identified similar themes.
Conclusions
Patient and family member-led research is feasible and can identify opportunities for improving care.

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Cost considerations may influence therapeutic reasoning and decisions in the intensive care unit (ICU). To date only very few data illuminating the association of costs and consequences (i.e. outcomes) of critical care services are available. In this study, the long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed.

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Objective: An intensive care unit (ICU) diary is a relatively new concept in low middle-income countries (LMICs). Illiteracy and socio-cultural inhibitions may affect the use and utility of this intervention, which has proven beneficial to patients and their families in high income countries (HICs). We aimed to explore how families of ICU patients experienced ICU diaries in our set up by using the Grounded Theory (GT) approach. A relatively new research tool, this enables exploration of a phenomenon to build theories in areas hitherto uncharted.
Method: A clinical psychologist did 29 in-depth interviews of relatives of 13 patients admitted in the ICU for > 24 h for whom an ICU diary was being maintained. We used a three-step coding process- open, axial, and selective coding, followed by the formulation of a theory embedded in the data.
Results: We found that the younger relatives of ICU patients accepted the idea better (age 30, SD 6) Half (48%) had education between 5th to 10th standards. Emergent themes suggested that for the family members, reading and writing the diary brought novelty, acted as a communication enabler, spiritual truss, and improved knowledge leading to change in perspective about the health care system. It also became a bridge to community bonding after patient discharge. Starting with appreciating the novelty of ‘diary entries,’ which was a new and exciting concept, family members used the diaries to communicate with health care workers (to gain information and understanding about the disease and treatment) and the patient to express their love and to maintain a connection. The diary acted as a confessional for hopes, fears, guilt, and faith for many members. As a tool, it enabled them to understand medical personnel as human beings and to appreciate their efforts, effectively improving confidence in the system. Finally, upon returning home, the diary was a crowd puller for extended family and neighbors encouraging discussions and enhancing bonding and information sharing.
Conclusions: Our findings indicate a good acceptance of ICU diaries by family members in our ICU. With less literate, admitted ‘shy ‘members, in a society where ‘diary writing’ is not culturally rampant, the appreciation for the novel concept was universal. We see a place for these interventions not only at the patient/ family level but also as a means to ‘correct’ the image of health care workers in our society by humanizing ourselves to the end-user- the patient and his family.

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24th International Symposium on Intensive Care and Emergency Medicine

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Most people recover from COVID-19 within two weeks; however, early figures show that around 10% of people are still unwell after three weeks, and a smaller proportion are sick for months. As infections begin to rise steeply once again, ‘long COVID’ is beginning to be taken seriously.

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The long-term effects of surviving COVID-19 have become a new focus of attention for clinicians and researchers. This focus has been driven partly by concerns about late ill-effects of a previously unknown virus, but recognised generic patterns of chronic disease after critical illness also exist. These patterns are termed PICS, an acronym both for post-intensive care syndrome and for persistent inflammation, immunosuppression, and catabolism syndrome. We recommend unifying post COVID-19 research aims with those of PICS research and propose a novel approach to its management by repurposing drugs that are approved, inexpensive, and safe.

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Risk Assessment: Distance from hospital, female gender, adequate support, preference for inclusion in decision-making, decision-making style, needs, comprehension, pre-existing: anxiety, depression, or PTSD

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The number of patients discharged alive from the ICU is increasing due to the remarkable progress of medical care. Nevertheless, a growing concern is that many ICU survivors subsequently develop mental health impairments. Recently, it has become clear that the memories formed during a patient’s ICU stay are a risk factor for subsequent mental health impairment. Patient memories can be classified into memories of factual events, memories of feelings, and delusional memories. Delusional memories are reported by 26-73% of ICU survivors and can be difficult to forget. Delusional memories are also thought to be correlated with mental health impairment, such as anxiety, depression, posttraumatic stress disorder (PTSD), a lower QOL, and failure to return to work. To support the formation of beneficial memories in patients, clinicians should help patients to construct appropriate memories during their ICU stay, to restructure memories after their discharge from the ICU, and to avoid preserving delusional memories. However, further research is required in this field. Understanding how unpleasant memories can lead to long-term disturbances in patients, even if the memories are not factual, and providing follow-up opportunities for patients to talk about their experiences after they have left the ICU may be necessary.