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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.

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This information booklet is largely aimed at assisting the patient in recovery following a period of critical illness. However, from experience, it is evident that the relatives need to read this first. During the first few days after leaving the ICU, the patient may be unable to concentrate, understand and apply the information to
themselves. By reading this booklet the relatives will hopefully gain an understanding of what the patient is going through and this helps them to be actively involved in the patient's recovery and rehabilitation. The RaCI team are available to support both the patient and the relatives throughout the rehabilitation process - the contact number for the team is on the cover and page 2 of this booklet.

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Cam ICU Pocket Cards help the medical practitioner to do "delirium assessment" and " Sedation Assessment".

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Today we welcome Giora Netzer M.D., M.S.C.E., Associate Professor of Medicine here at the University of Maryland Medical Center. Dr. Netzer was trained at the great bastion of intensive care medicine, the University of Pennsylvania, where he also earned a master’s degree in clinical epidemiology. Since joining the University of Maryland Pulmonary and Critical Care Medicine department he has proven to be one the greatest minds the ICU has to offer, earning him the title: Wiki-Netzer. His passion for knowledge led to his appointment as the Director of Clinical Research and has yielded a tremendous breadth of publications. Today he focuses on his true passion: how to assist family members care for their loved ones both in the ICU and in the post-ICU setting. Trust me, this is a topic that is often overlooked and one that can truly mean life or death for your patients! You cannot miss it!!

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Ronan’s lingering symptoms aren’t unique to COVID-19 patients. In as many as 80% of them leaving the ICU, researchers have documented what they call post-intensive care syndrome (PICS) -- a group of physical, mental, and psychiatric symptoms that result from an ICU stay. Although their illness plays a role in these symptoms, the amount of time spent in critical care is
a major factor.

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The number of Americans hospitalized with the virus is increasing again, reaching 41,000 late last week, many with a circle of loved ones holding vigil in their minds, even if they can’t sit at the bedside. A decade ago, critical care clinicians coined the term post-intensive care syndrome, or PICS. It describes the muscle weakness, cognitive changes, anxiety and other physical and mental symptoms that some ICU patients cope with after leaving the hospital. Those complications are fallout from the medications, immobility and other possible components of being critically ill. Now they worry that some family members of critically ill COVID patients may develop a related syndrome, PICS-Family.

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Experiencing treatment on a modern intensive care
unit (ICU) is a potentially traumatic event. People who
experience traumatic events have an increased risk of
depression, anxiety disorders and post-traumatic stress
disorder (PTSD). Extended follow-up has confi rmed
that many patients suff er physical and psychological
consequences of the ICU treatment up to 12 months
after hospital discharge. PTSD in particular has become
increasingly relevant in both the immediate and
longer-term follow-up care of these patients. The
extent to which the consequences of critical illness
and the treatments received in the ICU contribute to
the development of PTSD is poorly understood and
more rigorous studies are needed. Understanding the
factors associated with a poor psychological recovery
after critical illness is essential to generate models of
causality and prognosis, and to guide the delivery of
eff ective, timely interventions.

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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.

“A lot of work has been done around post-intensive care syndrome. We’re realizing the people who are surviving are often terribly wounded, and they have emotional and psychological distress as severe as combat veterans returning from war,” said Samuel M. Brown, MD, lead author of the study and director of the Center for Humanizing Critical Care at Intermountain Medical Center. “They may have profound weakness or shortness of breath or other important limitations to their quality of life after they survive.”

Results of the new study, which was funded by the National Heart Lung and Blood Institute, are published inThorax, one of the world’s leading journals for specialists in respiratory and critical care medicine.

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Background:Because critical illness survivors frequently experience several long-term psychological impairments altering quality of life after ICU, there is a trend towards increasing follow-up care, mainly via ICU follow-up clinics.Despite these and other initiatives, understanding of patient’s post-ICU needs to help them cope with their problems and subsequently improve quality of life is largely lacking. Our aim was therefore to assess the needs,expectations and wishes in ICU survivors to receive information with the purpose to help them better grasp ICU treatment. In addition, we assessed the perceived burden of psychological trauma after ICU treatment and the health-related quality of life (HRQoL) up to 2.5 years after ICU discharge.
Methods:In a multicentre, retrospective cross-sectional cohort study, the needs and preferred intervention methods were assessed using a self-composed inventory in adult mechanically ventilated ICU survivors (n= 43). Additionally, the Impact of Event Scale Revised, the Beck Depression Inventory, the EuroQol-5D-5L, and the Short-Form 12 were used to assess psychological burden and HRQoL.
Results:A substantial proportion of all ICU survivors (59%, 95% CI 44% to 74%) suffered from psychological impairments after ICU treatment. Seventy-five percent of these patients expressed a wish to receive information,but only 36% desired to receive this information using a commonly used information brochure. In contrast, 71% of these patients had a wish to receive information using a video film/VR. Furthermore, only 33% of these patients was satisfied with the information provided by their treating hospital. Patients with psychological PICS reported aworse HRQoL as compared to a normative Dutch sample (P< 0.001) and as compared to patients without psychological PICS (P< 0.01).
Conclusions:In a Dutch cohort of critical illness survivors, a substantial part of ICU survivors suffer from psychological impairments, such as PTSD and depression, which was associated with a worse HRQoL. These patients are in need of information, have no desire using an information brochure, but are willing to receive information using a video film/virtual reality module. These results support the exploration of such an intervention.

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Improvements in quality of care have resulted in a growing population of patients who survive critical illness each year. However, these intensive care unit (ICU) survivors frequently report a wide range of complications that may persist for months to years after their hospital discharge, calling attention to a need for extended support.

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A cancer diagnosis can be a life-changing moment marked by uncertainty. As patients and their families prepare for treatment, they may not know what to expect, though it’s important to remember that the five-year survival rates for many types of cancer have risen dramatically over the last several decades.

A remission or recovery from cancer can bring about great happiness and relief. However, for some people, it may be the beginning of another set of hurdles, particularly if treatment involved time spent in intensive care.

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The prevalence of psychiatric symptoms ranges from 17% to 44% in intensive care unit (ICU) survivors. The relationship between the comorbidity of psychiatric symptoms and quality of life (QoL) in ICU survivors has not been carefully examined. This study examined the relationship between psychiatric comorbidities and QoL in 58 survivors of ICU delirium. Patients completed 3 psychiatric screens at 3 months after discharge from the hospital, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for anxiety, and the Post-Traumatic Stress Syndrome (PTSS-10) questionnaire for posttraumatic stress disorder. Patients with 3 positive screens (PHQ-9 ≥ 10; GAD-7 ≥ 10; and PTSS-10 > 35) comprised the high psychiatric comorbidity group. Patients with 1 to 2 positive screens were labeled the low to moderate (low-moderate) psychiatric comorbidity group. Patients with 3 negative screens were labeled the no psychiatric morbidity group. Thirty-one percent of patients met the criteria for high psychiatric comorbidity. After adjusting for age, gender, Charlson Comorbidity Index, discharge status, and prior history of depression and anxiety, patients who had high psychiatric comorbidity were more likely to have a poorer QoL compared with the low-moderate comorbidity and no morbidity groups, as measured by a lower EuroQol 5 dimensions questionnaire 3-level Index (no, 0.69 ± 0.25; low-moderate, 0.70 ± 0.19; high, 0.48 ± 0.24; P = 0.017). Future studies should confirm these findings and examine whether survivors of ICU delirium with high psychiatric comorbidity have different treatment needs from survivors with lower psychiatric comorbidity.