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When Nina Dalsania Makadia felt the first symptoms of COVID-19 in March, she
braced herself for a couple of miserable weeks.
The Kennesaw mother of three young children expected the virus to be like a bad
cold or the flu. Her headache, chills and fever would require rest and recuperation in
bed, she thought. After that, she’d be better, and life would return to normal. But things haven’t returned to normal for the 38-year-old.
Three months since falling ill, Makadia still can’t shake extreme exhaustion. Even
going up and down the stairs in her home leaves her winded. Then there’s the leg
soreness, dizziness and gastrointestinal bleeding.

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Over 80% of survivors of critical illness experience post-intensive care syndrome (PICS). PICS is a constellation of physical, cognitive and mental health problems after intensive care including prolonged muscle weakness, reduced performance of activities of daily living, diminished ambulation and strength, post-traumatic stress disorder, and anxiety that persists for months and years. PICS is a relatively recently described syndrome and many physical therapists in acute and sub-acute care, outpatient, and home care settings may not be familiar with the patient presentation, evaluation strategy, and interventions for these individuals. Using evidence from our recent systematic review, this session will characterize the physical impairments, activity limitations, and participation restrictions experienced by individuals with PICS during their first year following survival of an episode of critical illness. Strategies for outpatient clinic and home-based physical therapy examination and evaluation of this unique patient population will be discussed. Recent clinical trials of interventions for individuals with PICS aimed at reducing physical impairments and restoring functional activity and community participation will be presented. This course will conclude with a discussion of current challenges associated with the evaluation and physical therapy management of individuals with PICS and offer some potential solutions.

Brief description of media:

Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have been published for delivering trauma-focused cognitive behavioural therapy with this population. In
this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU.

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The brochure describes the symptoms of people with Delirium, and what the family can do to help.

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Dynamics is the annual national convention and product exhibition of the Canadian Association of Critical Care Nurses (CACCN). Diverse programming allows participants to choose from a broad selection of evidence-based topics that are geared to enhancing clinical practice, leadership, education, and research. With paediatric and adult critical care opportunities provided, participants design educational agendas to meet their own unique needs. Dynamics brings colleagues together from coast to coast, to share ideas and experiences.

Brief description of media:

An increased proportion of deaths occur in the intensive care unit (ICU).
We performed this prospective study in 41 ICUs to determine the prevalence and determinants of complicated grief after death of a loved one in the ICU. Relatives of 475 adult patients were followed up. Complicated grief was assessed at 6 and 12 months using the Inventory of Complicated Grief (cut-off score>25). Relatives also completed the Hospital Anxiety and Depression Scale at 3 months, and the Revised
Impact of Event Scale for post-traumatic stress disorder symptoms at 3, 6 and 12 months. We used a mixed multivariate logistic regression model to identify determinants of complicated grief after 6 months. Among the 475 patients, 282 (59.4%) had a relative evaluated at 6 months. Complicated grief symptoms
were identified in 147 (52%) relatives. Independent determinants of complicated grief symptoms were either not amenable to changes (relative of female sex, relative living alone and intensivist board certification before 2009) or potential targets for improvements (refusal of treatment by the patient, patient
died while intubated, relatives present at the time of death, relatives did not say goodbye to the patient, and poor communication between physicians and relatives). End-of-life practices, communication and loneliness in bereaved relatives may be amenable to improvements.

Brief description of media:

Patient and family* engagement in the ICU is an active partnership between health professionals and patients and families working at every level of the healthcare system to improve health and the quality, safety, and delivery of healthcare. Arenas for such engagement include but are not limited to participation in direct care, communication of patient values and goals, and transformation of care processes to promote and protect individual respect and dignity. PFE comprises five core concepts: Collaboration, Respect and Dignity, Activation and Participation, Information Sharing, and Decision Making

Brief description of media:

The article contains the definition of Post Intensive Care Syndrome (PICS) and it's syndrome, definition of PICS-Family, and what friend and family's member can do to help.

Brief description of media:

The critical care literature in the US has recently brought attention to the impact an ICU experience can have long after the patient survives critical illness, particularly if delirium was present. Current recommendations to mitigate post-intensive care syndrome (PICS) are embedded in patient and family-centered care and aim to promote family presence in the ICU, provide support for decision-making, and enhance communication with the health-care team. Evidence-based interventions are few in number but include use of an ICU diary to minimize the psychological and emotional sequelae affecting patients and family members in the months following the ICU stay. In this paper we describe our efforts to implement an ICU diary and solicit feedback on its role in fostering teamwork and communication between patients, family members, and ICU staff. Next steps will involve a PICS follow-up clinic where trained staff will coordinate specialty referrals and perform long-term monitoring of mental health and other quality of life outcomes.

Brief description of media:

Health systems, granting agencies, and professional societies are increasingly involving patients and their family members in the delivery of health care and the improvement of health sciences. This is a laudable advance toward fully patient-centered medicine. However, patient engagement is not a simple matter, either practically or ethically. The complexities include (1) the physical limitations that
patients and their family members may have, from traveling to meetings to special dietary needs; (2) the emotional sensitivities patients and their families might experience—from distress at discussions of disease prognosis, outcomes, and therapies to being inexperienced at public speaking; and (3) the fact that advocacy efforts by patients and family members, which may be encouraged at the national level, may threaten individual professionals providing care to individual patients and may result in risk to patients. In this article, a patient-physician and patient-bioethicist set out the obstacles, including ones that they have encountered in their own advocacy efforts. The aim is to survey the practical and ethical landscape so that solutions to various problems may be identified and solved as we move forward in our efforts to involve patients and their families in research, policy, and quality improvement in critical care medicine.

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Hundreds of thousands of seriously ill coronavirus patients who survive and leave the hospital are facing a new and difficult challenge: recovery. Many are struggling to overcome a range of troubling residual symptoms, and some problems may persist for months, years or even the rest of their lives. Patients who are returning home after being hospitalized for severe respiratory failure from the virus are confronting physical, neurological, cognitive and emotional issues. And they must navigate their recovery process as the pandemic continues, with all of the stresses and stretched resources that it has brought. “It’s not just, ʻOh, I had a terrible time in hospital, but thank goodness I’m home and everything’s back to normal,’” said Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. “It’s, ʻI just had a terrible time in hospital and guess what? The world is still burning. I need to address that while also trying to sort of catch up to what my old life used to be.’” It is still too early to say how recovery will play out for these patients. But here is a look at what they are experiencing so far, what we can
learn from former patients with similar medical experiences, and the challenges that most likely lie ahead.

Brief description of media:

Although we are currently overwhelmed by the astonishing speed of infection of the Covid-19 pandemic, and the daily onslaught of new, and ever-worsening predictions, it is vital that we begin to prepare for the aftershocks of the pandemic. Prominent among this will be the cohort of post-intensive case survivors who have been mechanically ventilated and will likely experience short- and medium-term consequences. The notion that patients surviving intensive care and mechanical ventilation for several weeks can be discharged home without further medical attention is a dangerous illusion. Post Intensive Care Syndrome and other severe conditions will require not only adequate screening but early rehabilitation and other interventions. Action must be taken now to prepare for this inevitable aftershock to the healthcare system.