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Nathan Maryn walks in the post-surgical intensive care unit at The Johns Hopkins Hospital with his wife, Barbara Maryn, and Jennifer Sahm, a physical therapist. A nurse followed with a chair in case he became unsteady. Exercise in the ICU is associated with better long term outcomes.
One woman left Johns Hopkins' intensive-care unit believing her husband and nurse had been plotting to kill her. Another ICU patient had flashbacks of hospital walls covered in blood. A third had visions of big spiders riding bicycles in her room. Suddenly, a favorite hobby, gardening, felt creepy.
Doctors used to think patients returned to normal after the delusions and hallucinations of ICU delirium stopped. They're learning instead that some leave the hospital with terrifying false memories, often of being assaulted or imprisoned. The horrible visions help explain why a recent Johns Hopkins study found that one in four patients had post-traumatic stress symptoms two years after going home.

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Researchers in Denmark have developed a new algorithm that predicts an individual patient’s risk of mortality in the ICU. Their work, recently published in the journal Digital Health, demonstrates that the algorithm outperforms current non-computational methods of estimating mortality. Algorithms of this nature can help direct resources where they are needed most to best improve patient outcomes, and help catch problems early.

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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.

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Many patients who have been in the intensive care unit often experience ‘post-intensive care syndrome’ when they return home. The phenomenon, which is still relatively unknown to the general public and the healthcare sector, can cause physical, psychological and cognitive problems. “It is a misunderstood aspect of the pandemic,” reports the Federal Health Care Knowledge Center (KCE).

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Rationale: Many studies of critical illness outcomes have been restricted to short-term outcomes, selected diagnoses, and patients in one or a few intensive care units (ICUs).
Objectives: Evaluate a range of relevant outcomes in a population-based cohort of patients admitted to ICUs.
Methods: Among all adult residents of the Canadian province of Manitoba admitted to ICUs over a 9-year period, we assessed ICU, hospital, 30-day, and 180-day mortality rates; ICU and hospital lengths-of-stay; post-hospital use of hospital care, ICU care, outpatient physician care, medications, and home care; and post-hospital residence location. We explored data stratified by age, sex, and separate categories of geocoded income for urban and rural residents. For post-hospital use variables we compared ICU patients with those admitted to hospitals without the need for ICU care.
Measurements and Main Results: After ICU admission there was a high initial death rate, which declined between 30 and 180 days and thereafter remained at the lower value. Hospital mortality was 19.0%, with 21.7% dying within 6 months of ICU admission. Women had higher hospital mortality than men

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Checklist for ABCDE Protocol

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Bedside Treatments for ABCDE Protocol

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Background Post–intensive care syndrome–family (PICS-F) refers to acute and chronic psychological effects of critical care on family members of patients in intensive care units (ICUs). Evidence suggests that increased distress during the ICU stay increases risk of PICS-F. Sensation Awareness Focused Training (SAF-T) is a new, promising stress management intervention, but the feasibility of such training during the ICU stay for family caregivers who are acting as the surrogate decision-maker for patients who are undergoing mechanical ventilation is unknown.
Objectives To assess feasibility and acceptability of SAF-T to inform a future larger randomized controlled trial.
Methods This randomized controlled trial of SAF-T (n = 5) versus a control (n = 5) group was conducted at a level 1 trauma center. Participants assigned to SAF-T completed 1 session daily for 3 days. Measures included enrollment rate, data completion rate, acceptability of SAF-T, and symptoms of PICS-F. Scales used included Perceived Stress, Hospital Anxiety and Depression, Impact of Event, and National Institutes of Health Toolbox Emotion Battery.
Results Mean age was 58 (SD, 12) years; 70% of participants were female. Predetermined feasibility criteria were met in enrollment rate (67%), outcome measures completion rate (> 90%), and SAF-T acceptability (100% of doses completed during the ICU stay) without adverse events. Stress scores after SAF-T were significantly lower than scores before SAF-T ( ˉ z = −3.5, P = .01).
Conclusions SAF-T intervention during the ICU stay is feasible, acceptable, and may improve family caregivers’post-ICU outcomes. Larger clinical trial to assess the
effectiveness of SAF-T in preventing PICS-F seem war-ranted.

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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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The Coronavirus (COVID-19) Pandemic has put a strain on NHS critical care services. Whilst recovering from the acute phase of the pandemic, we need to think of the aftermath and seek solutions to provide effective recovery and rehabilitation services for affected patients and their families. This is a unique opportunity to elevate public understanding of the impact of critical illness on outcomes
and recovery.

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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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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.