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I started the Intensive care follow-up clinic to try to make sense of my work with critical patients and get feedback from their physical recovery. Over time, I verified that the patients presented not only physical effects, but that they maintained psychological and cognitive changes. They also suffered from post-traumatic stress disorder (PTSD), as survivors of war or other catastrophes would, which may last for years because of their near death experience.

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After spending two months in the hospital with COVID-19, Michael Mariano wants more than anything for his life to return to normal. But like many
patients who develop a severe respiratory illness, his road to recovery is far from over.

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One thing that did not make to the spotlight in this COVID-19 pandemic is a question that what happens to the COVID-19 patients after they are discharged from the critical care? A common assumption around the world is that once a patient is discharged from the hospital and is tested negative the problem is resolved. This may be based on a relative lack of information and knowledge, even among the health care professionals, regarding a condition described as Post Intensive Care Syndrome (PICS).

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A comprehensive functional assessment requires thorough and careful inquiry, which is difficult to accomplish in most busy clinical practices. This paper examines the reliability and validity of the Functional Status Questionnaire (FSQ), a brief, standardized, self-administered questionnaire designed to provide a comprehensive and feasible assessment of physical, psychological, social and role function in ambulatory patients. The FSQ can be completed and computer-scored in minutes to produce a one-page report which includes six summated-rating scale scores and six single-item scores. The clinician can use this report both to screen for and to monitor patients" functional status. In this study, the FSQ was administered to 49? regular users of Boston's Beth Israel Hospital's Healthcare Associates and 656 regular users of 76 internal medicine practices in Los Angeles. The data demonstrate that the FSQ produces reliable sub-scales with construct validity. The authors believe the FSQ addresses many of the problems behind the slow diffusion into primary care of systematic functional assessment.

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During recovery period patients could develop: Physical, Cognitive, and Psychiatric disabilities

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There is increasing evidence of the significant impact that critical illness has on family members of the critically ill. Stressful decision making often falls to family members because most patients in the ICU are too ill to participate in deci sion making (1). Furthermore, family members bear a significant burden of caregiving to the more than 50% of critical illness survivors who have post discharge disability (2, 3). Approximately one quarter to one half of family members of critically ill children or adults experience psychological symptoms, including acute stress, post-traumatic stress, generalized anxiety, and depression both during and after the critical illness of a loved one (4–6). The sum total of family exposure to critical illness may result in what has been termed “Post-Intensive Care Syndrome-Family” (3, 5). There is increasing awareness of the importance of improving outcomes for family caregivers and that support for family caregivers can also improve patient outcomes (6, 7).

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Factors that heighten the risk of developing PICS-F include patient and family characteristics, as well as the critical care unit’s environmental characteristics. (See Knowing the risk factors.) The characteristics most amenable to nurses’ preventive actions are those in the critical care environment and those related to family’s needs.

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The mortality for this cohort of patients with temperature at least 38.0°C and known or suspected infection was 8/51(16%). This was more than double the mortality rate for non-eligible patients over the same period 36/514 (7%) (P= 0.05).The 28-day ICU-free survival and organ-support-free survival of patients with fever and known or suspected infection are shown in Table

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As Belgium enters a new wave of Covid-19 infections, the federal knowledge centre for health care (KCE) has just issued an extensive new report warning of a danger on the horizon: a wave of cases of post intensive care syndrome (PICS).

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Whether intensivists should be present in ICUs around the clock is currently a matter of considerable controversy. This controversy is intertwined with a debate about the comparative performance of open versus closed ICUs. A complicating factor is the existence of considerable differences in ICU organization across countries (1). In the open format, nonintensivists continue to care for the patients they admit to the ICU, with advice from consulting intensivists. This is the most common format in the United States (1). In the closed format, all care is given by intensivists, which occurs for up to 75% of ICU patients in Western Europe (2, 3). Patients managed in closed ICUs are the sickest ICU patients (1).

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Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families. Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU.All critical care survivors should be evaluated for PICS and those having signs and symptoms of it should be managed by a multidisciplinary team which includes critical care physician, neuro-psychiatrist, physiotherapist and respiratory therapist,with the use of pharmacological and non-apharmacological interventions. This can be achieved through an organizational change and improvement, knowing the high rate of
incidence of PICS and its adverse effects on the survivor’s life and daily activities and its effect on the survivor’s family.

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Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in "Post-ICU Syndrome" (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption, of the sleep-wake cycle. Innovative solutions aim to transform standard concepts of ICU room design to limit potential stressors, and utilizing the patient care space as a treatment tool, exerting positive, therapeutic effects. The main areas affected by most architectural and interior design modifications are sound environment, light control, floor planning, and room arrangement. Implementation of corresponding solutions is challenging considering the significant medical and technical demands of ICUs. This article discusses innovative concepts and promising approaches in ICU design that may be used to prevent stress and to support the healing process of patients, potentially limiting the impact of delirium and PICS.