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For most people—about 80%, according to the World Health Organization—COVID-19 won't result in serious illness. But that still means 1 in 5 people who contract the infection will end up with a more severe form of the disease, and will need hospitalization. In the most severe cases—typically in those with underlying conditions like high blood pressure, heart and lung problems, or diabetes—COVID-19 patients may be admitted to a hospital's intensive care unit (ICU), where they can benefit from respiratory support through a ventilator.

According to multiple studies, the majority of patients admitted to the ICU and require ventilation do not survive. Data from the Intensive Care National Audit and Research Center in London shows that, of outcome data available for 690 ICU patients, 346 (or 50.1%) patients died, while 344 (49.9%) were discharged alive. Similar findings were shown in an Italian study published in JAMA: Of 1,581 patients with available ICU disposition data at the end of the study, 920 patients were still in the ICU—but of the remaining 661 patients, 405 (61.3%) died while 256 (38.7%) were discharged.

Of course, being discharged from the ICU is the best-case scenario—but sometimes, even after coming off of respiratory support, hospitalized patients can experience another issue: ICU delirium.

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This midrange theory is derived from Sr. Calista Roy’s adaptation model and Professor Weick’s business model of sensemaking. In his sensemaking model Weick describes that people define themselves through actions taken in crisis. Also, leaders shape the vision of an organization’s well-being through messaging. In facilitated sensemaking, the nurse helps the family to cue sort, and interpret the meaning of those cues in the environment. The nurse provides the family purpose by facilitating individualized engagement in care and praising them for their efforts. Even in the worst of outcomes they can look back and say they did everything possible to help the team. Simple activities provide focus and modulate the limbic system response to stress which may mediate the development of stress disorders.

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My daughter spent 114 days in the NICU. As she is approaches 2 years old, I’m still suffering the after-effects. I launched my blog during NICU Awareness month, so I’ve focused heavily on my experience during those 114 days. Looking back at all the photos and recounting what I went to has dredged up bucketfuls of “yuck.” In my past life, I was a data and research driven person. I still read studies, research outcomes and the like when I’m interested in something. Recently, I read studies about acute stress disorder (ASD) and post traumatic stress disorder (PTSD), specifically for parents in the NICU. Through all the studies I found myself asking:

Do I have PTSD? Is this what has been going on all this time?

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Oct. 5 (UPI) -- Having a spouse in a hospital intensive care unit increases a person's risk for a heart attack or cardiac-related hospitalization, according to a study published Monday in the journal Circulation.

The analysis of health outcomes for more than 1 million married couples found that those with a spouse in the ICU were 27% more likely to be admitted to the hospital with some form of heart disease than those whose spouses were healthy, the data showed.

They also are at slightly higher risk for being diagnosed with high blood pressure, high cholesterol and diabetes, the researchers said.

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In collaboration with its Nevada Patient and Family Advisory Council, Comagine Health has created this 8.5"x14" infographic poster or handout that describes Post-Intensive Care Syndrome (PICS).

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Nic Brown is lucky, and he knows it.
The 38-year-old father of three is recovering from the coronavirus after spending 10 days in Cleveland Clinic’s intensive care unit. He was kept mostly sedated while hooked up to a ventilator to help him breathe.
“There was a time during this process where the hospital reached out to my wife to have the discussion about end-of-life options,” Brown, of Tuscarawas County, Ohio, said. “It was very emotional for all of us.”
While a majority of patients who become infected with the coronavirus appear to have mild symptoms or no symptoms at all, it’s becoming clear that those with the most severe complications must spend a significant amount of time in the ICU.

“We have people on ventilators for 20 to 30 days,” New York Gov. Andrew Cuomo said during a news conference this week.

It’s a similar situation at the Tulane Medical Center in New Orleans, which has become another hot spot in the coronavirus outbreak. Doctors there say COVID-19 patients rarely get better within two or three days, instead of remaining on mechanical oxygen for one to two weeks.

Critical care doctors know that the longer patients remain in the ICU, the more likely they are to suffer long-term physical, cognitive and emotional effects of being sedated.

In fact, those effects have a name: “post-intensive care syndrome.” Some physicians call it post-ICU delirium.

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The purpose of this study is to:•determine effect size of the Sensation Awareness Focused Training (SĀF-T) intervention on Post Intensive Care Syndrome (PICS) in Family Members, specifically spouses, and•explore if the effect of SĀF-T and sleep/rest are related.

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Background:The relatives of intensive care unit (ICU) patients must cope with both the severity of illness of their loved one and the unfamiliar and stressful ICU environment. This hardship may lead to post‑intensive care syndrome. French guidelines provide recommendations on welcoming and informing families of ICU patients. We questioned whether and how they are applied 5years after their publication.
Methods:We conducted a large survey among French ICUs to evaluate their visiting policies and how information was provided to patient’s family. A questionnaire was built up by intensivists and nurses. French ICUs were solicited, and the questionnaire was sent to all participating ICUs, for being filled in by the unit medical and/or nursing head. Data regarding the hospital and ICU characteristics, the visiting policy and procedures, and the management of family information were collected.
Results:Among the 289 French ICUs, 188 (65%) participated. Most ICUs have a waiting room 118/188 (62.8%) and a dedicated room for meeting the family 152/188 (80.8%). Of the 188 ICUs, 45 (23.9%) were opened on a 24‑h‑a‑day basis. In the remaining ICUs, the time period allowed for visits was 4.75±1.83h (median 5h). In ICUs where visit‑ing restrictions were reported, open visiting was allowed for end‑of‑life situations in 107/143 (74.8%). Children are allowed to visit a patientin 164/188 (87.2%) regardless of their age in 97/164 (59.1%) of ICUs. Families received an information leaflet in 168/188 (89.3%). Information was provided to families through structured meetings in 149/188 (79.2%) of ICUs at patient admission with participation of nurses and nursing assistants in 133/188 (70.4%) and 55/188 (29.2%), respectively. Information delivered to the family was reported in the patient chart by only 111/188 ICUs (59%). Participation in care was infrequent.
Conclusions:Although French ICUs do not follow the consensus recommendations, slow progress exists com‑pared to previous reports. Implementation of these recommendations is largely needed to offer better welcome and information improvement. Further studies on that topic would enable evaluating remaining obstacles and increasing caregivers’ awareness, both critical for further progresses on that topic.

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Rationale:The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort.
Objectives:To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians.
Methods:This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization.
Measurements and Main Results:Of 255 survivors, 181 and160 subjects were assessed for ICU-related PTSD at 3- and 12-monthfollow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score>50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV(DSM-IV). In the multivariable regression, pre-existingPTSD was independently associated with ICU-related PTSD at both3and12months(P,0.001), as was preexisting depression(P,0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-monthP= 0.01, 12-monthP= 0.48).
Conclusions:This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.

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Background: Family members of children hospitalized in the pediatric intensive care unit (PICU) can develop cognitive, psychological, and physical manifestations of post-intensive care syndrome (PICS).Targeted education to help parents/caregivers recognize the signs and symptoms of PICS may result in better awareness of the syndrome and greater willingness to seek and receive support during their child’s PICU admission.
Objective: to evaluate three targeted PICS educational interventions to increase PICS awareness among parents/caregivers in the St. Louis Children’s Hospital (SLCH) PICU.
Results:Atotal of 62 parents/caregivers received one of three educational interventions:informational brochures (n=22), scripted informational conversation (n=20), or three-minute educational video (n=20). An additional 19 bedside nurses completed surveys to describe how each educational intervention affected daily work flow. Changes in parental/caregiver PICS fund of knowledgewas evaluated using Fischer’s exact test. All three educational interventions were associated with a significant improvement in understanding of PICS, with no single intervention being superior. Nursing surveys indicated that work flow was minimally disrupted using PICS education and that all interventions were perceived to be important and useful.
Conclusions:Targeted educational interventions led to improvement in knowledge about PICS among parents/caregivers and were well supported by PICU nursing staff. Thus, providing support for a sustainable implementation of PICS education in the SLCH PICU.

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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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Rationale: Intensive care unit (ICU) admission of a relative is a stressful event that may cause symptoms of post-traumatic stress disorder (PTSD). Objectives: Factors associated with these symptoms need to be identified. Methods: For patients admitted to 21 ICUs between March and November 2003, we studied the family member with the main potential decision-making role. Measurements: Ninety days after ICU discharge or death, family members completed the Impact of Event Scale (which evaluates the severity of post-traumatic stress reactions), Hospital Anxiety and Depression Scale, and 36-item Short-Form General Health Survey during a telephone interview. Linear regression was used to identify factors associated with the risk of post-traumatic stress symptoms. Main results: Interviews were obtained for family members of 284 (62%) of the 459 eligible patients. Post-traumatic stress symptoms consistent with a moderate to major risk of PTSD were found in 94 (33.1%) family members. Higher rates were noted among family members who felt information was incomplete in the ICU (48.4%), who shared in decision making (47.8%), whose relative died in the ICU (50%), whose relative died after end-of-life decisions (60%), and who shared in end-of-life decisions (81.8%). Severe post-traumatic stress reaction was associated with increased rates of anxiety and depression and decreased quality of life. Conclusion: Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.