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Long-term follow-up of randomized prospective trials of treatments in the intensive care unit may allow us to attain some understanding of the causes of post-
intensive care syndrome. This in turn may allow us to produce better long-term outcomes among survivors of critical illness.

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BACKGROUND: Skeletal muscle dysfunction occurring as a result of ICU admission associates with higher mortality. Although preadmission higher BMI correlates with better outcomes, the impact of baseline muscle and fat mass has not been defined. We therefore investigated the association of skeletal muscle and fat mass at ICU admission with survival and disability at hospital discharge.
METHODS: This single-center, prospective, observational cohort study included medical ICU (MICU) patients from an academic institution in the Unites States. A total of 401 patients were evaluated with pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) determinations conducted by CT scanning at the time of ICU admission, which were later correlated with clinical outcomes accounting for potential confounders.
RESULTS: Larger admission PMA was associated with better outcomes, including higher 6month survival (OR, 1.03; 95% CI, 1.01-1.04; P < .001), lower hospital mortality (OR, 0.96; 95% CI, 0.93-0.98; P < .001), and more ICU-free days (slope, 0.044 0.019; P 1⁄4 .021). SAT was not significantly associated with any of the measured outcomes. In multivariable analyses, PMA association persisted with 6 months and hospital survival and ICU-free days, whereas SAT remained unassociated with survival or other outcomes. PMA was not associated with regaining of independence at the time of hospital discharge (OR, 0.99; 95% CI, 0.98-1.01; P 1⁄4 .56).
CONCLUSIONS: In this study cohort, ICU admission PMA was associated with survival during and following critical illness; it was unable to predict regaining an independent lifestyle following discharge. ICU admission SAT mass was not associated with survival or other measured outcomes.

Brief description of media:

Millions of people worldwide have survived an
admission to the intensive care unit (ICU), and
the number of survivors is growing [1]. While
these patients have survived a life-threatening
illness, most survivors suffer important long-term
complications [2]. Post-intensive care syndrome
(PICS) is a term that describes the cognitive,
psychological, physical and other consequences
that plague ICU survivors [3, 4]. Our aim is to discuss
the prevalence, risk factors, impact, prevention and
management of PICS.

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Now, a new study of 645 ARDS survivors by researchers at Intermountain Medical Center, Johns Hopkins University, and the University of Utah, has identified subgroups of ARDS survivors who suffer what’s been called post-intensive care syndrome, a collection of symptoms that can linger for years.

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A 33-item Trauma Symptom Checklist (TSC-33) is presented, and the psychometric properties of this scale are summarized from four separate studies. Developed to assess the impact of childhood abuse on later (adult) functioning, the TSC-33 consists of five subscales (Dissociation, Anxiety, Depression, Post-Sexual Abuse Trauma-hypothesized [PSAT-h], and Sleep Disturbance) and a total scale score. Data suggest that the TSC-33 and its associated subscales are reasonably reliable measures that display some predictive and discriminative validity with regard to childhood sexual abuse. Other variables appear to elevate checklist scores as well, however, such as physical abuse history and mental health client status, although apparently not gender.

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it is a guideline for the ICU medicine professional to monitor and treat patient who may have ICU delirium.

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Common symptoms experienced after sepsis include fatigue, insomnia, difficulties with concentration or memory, muscle weakness, and depression or anxiety.

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the one-pager helps the ICU medical personnel to screen for ICU delirium among the ICU patients.

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In 226 consecutive critically ill primarily postoperative patients, we determined survival and quality of life, hospitalizaron charges, and consumption of blood and blood products. The patients were physiologically unstable and required intensive physician and nursing care. By one month, 123 patients had died (54 percent), 70 were still hospitalized, and 31 were home; only one of 103 survivors had fully recovered. By 12 months, 164 patients (73 per cent) had died, 10 were still hospitalized, and 51were home. Twenty-seven of 64 survivors had fully recovered.
Hospitalization charges averaged $14,304 per patient. The total charge for blood and blood fractions was $617,710—21 per cent of the total hospitalization charge; $ 515, 71 (83 per cent) of the blood charge went to 164 nonsurvivors, whereas $101,939 (17 per cent) went to the 62 survivors.
These data document the use of increasingly limited resources in the management of critically ill patients. The medical profession must make difficult decisions to allocate these resources effectively. (N Engl J Med 269:982-987,1976)

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Advances in critical care medicine have led to improved outcomes; as a result, most patients will survive their critical illness episode. However, many survivors do not return to their pre critical illness functional levels. Rather, survivors of critical illness often experience impairments in cognition, mental health, and physical health that endure. Research over the past 2 decades has increased our knowledge and awareness of these morbidities after critical illness. Post–intensive care syndrome (PICS), a term coined in 2012 to raise awareness of these impairments, is common after critical illness. Specifically, 34% of patients who experience shock and/or require invasive mechanical ventilation experience cognitive impairment at 12 months at a level consistent with moderate traumatic brain injury.
Symptoms of anxiety, depression, and/or posttraumatic stress disorder (PTSD) afflict approximately 25% of survivors of critical illness, and 27% of survivors are physically impaired at 1 year after critical illness. Together, 56% of survivors experience a new, enduring impairment in 1 or more of these domains, and 21% experience 2 or more impairments at 1 year.
Similarly, findings from a small telephone-based study that used patient report of problems found that 54% of patients developed impairments and 56% of patients had 2 or more impairments after critical illness. Related to the 3 domains that define PICS—impairments in cognition, mental health, and physical health survivors experience a myriad of challenges and functional impairments, including pulmonary dysfunction, particularly among survivors of acute respiratory distress syndrome (ARDS); chronic pain; sexual dysfunction; and functional disability related to contractures.These impairments contribute to the reduced health-related quality of life that has been observed among survivors of critical illness as well as the inability to return to full-time employment.

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Delirium is one of the most common behavioral manifestations of acute brain dysfunction in Intensive Care Unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools (e.g., CAM-ICU, ICDSC). In delirious patients, a search for all reversible precipitants is the first line of action and pharmacological treatment should be considered when all causes have been ruled out, and not contraindicated. Long-term morbidity, in the forms of cognitive, physical and psychological impairments, has significant consequences for survivors of critical illness and for their caregivers. ICU patients may develop PTSD anchored to their critical illness experience, with ICU-related PTSD incidence rates of 10%. Using ICU diaries during a critical illness may minimize the occurrence of future ICU-related PTSD.

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Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU
admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.