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The concept of so-called long COVID has gained prominence in recent months, with some patients reporting persistent neurological manifestations, from milder symptoms such as headaches, hyposmia, hypo-geusia, and fatigue to more severe conditions including sleep disorders, pain, cognitive impairment, and (in very rare cases) Guillain-Barré syndrome. WHO updated their living guidance for the clinical management of COVID-19 in January, 2021, which now incorporates a new practice statement on caring for patients with persistent, new, or changing symptoms after suspected or confirmed COVID-19. The guidance notes that clini-cal characterisation of long COVID is inadequate and, therefore, further research on long-term sequelae is warranted.

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COVID-19 symptoms can sometimes persist for months. The virus can damage the lungs, heart and brain, which increases the risk of long-term health problems.

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I write to announce a major new NIH initiative to identify the causes and ultimately the means of prevention and treatment of individuals who have been sickened by COVID-19, but don’t recover fully over a period of a few weeks. Large numbers of patients who have been infected with SARS-CoV-2 continue to experience a constellation of symptoms long past the time that they’ve recovered from the initial stages of COVID-19 illness. Often referred to as “Long COVID”, these symptoms, which can include fatigue, shortness of breath, “brain fog”, sleep disorders, fevers, gastrointestinal symptoms, anxiety, and depression, can persist for months and can range from mild to incapacitating.

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Objectives: Calcium channel blockers are highly protein-bound medications frequently used in the management of hypertension. Overdose results in severe hypotension and is the fourth most common cause of toxicity-related deaths in the United States. Management is mostly supportive, with currently no standard role for targeted drug removal. The protein-bound nature of these medications presents the option of utilizing albumin dialysis for their removal and for the reversal of associated shock.
Design and Subjects: We present two cases of life-threatening intentional amlodipine overdoses successfully treated with albumin dialysis. Both patients experienced profound distributive shock in the setting of preserved cardiac contractility that was refractory to maximal vasoactive agent support.
Interventions and Results: After initiation of albumin dialysis, the patients showed rapid hemodynamic improvement and were able to be weaned off vasopressor support.
Conclusions: These cases demonstrate the safety and efficacy of albumin dialysis in the management of near-fatal calcium channel blocker overdoses related to amlodipine and offer an additional therapeutic option apart from conventional supportive care. Importantly, these cases were not associated with impaired cardiac contractility, thereby making venoarterial extracorporeal membrane oxygenation a less preferable option. Furthermore, this therapeutic benefit of albumin dialysis can potentially be extended to the management of toxicity related to other highly protein-bound drugs and toxins.

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Introduction: As the intensive care unit (ICU) survival rate increases, the Post-Intensive Care Syndrome (PICS) of the ICU survivor is attracting attention. PICS refers to new or worsened mental health, cognitive and physical impairment after ICU treatment.

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Objectives: The severe acute respiratory syndrome coronavirus 2 pandemic has stretched ICU resources in an unprecedented fashion and outstripped personal protective equipment supplies. The combination of a novel disease, resource limitations, and risks to medical personnel health have created new barriers to implementing the ICU Liberation (“A” for Assessment, Prevention, and Manage pain; “B” for Both Spontaneous Awakening Trials and Spontaneous Breathing Trials; “C” for Choice of Analgesia and Sedation; “D” for Delirium Assess, Prevent, and Manage; “E” for Early Mobility and Exercise; and “F” for Family Engagement and Empowerment [ABCDEF]) Bundle, a proven ICU care approach that reduces delirium, shortens mechanical ventilation duration, prevents post-ICU syndrome, and reduces healthcare costs. This narrative review acknowledges barriers and offers strategies to optimize Bundle performance in coronavirus disease 2019 patients requiring mechanical ventilation.
Data Sources, Study Selection, and Data Extraction: The most relevant literature, media reports, and author experiences were assessed for inclusion in this narrative review including PubMed, national newspapers, and critical care/pharmacology textbooks.
Data Synthesis: Uncertainty regarding coronavirus disease 2019 clinical course, shifts in attitude, and changes in routine behavior have hindered Bundle use. A domino effect results from: 1) changes to critical care hierarchy, priorities, and ICU team composition; 2) significant personal protective equipment shortages cause; 3) reduced/restricted physical bedside presence favoring; 4) increased depth of sedation and use of neuromuscular blockade; 5) which exacerbate drug shortages; and 6) which require prolonged use of limited ventilator resources. Other identified barriers include manageable knowledge deficits among non-ICU clinicians unfamiliar with the Bundle or among PICU specialists deploying pediatric-based Bundle approaches who are unfamiliar with adult medicine. Both groups have been enlisted to augment the adult ICU work force to meet demand. Strategies were identified to facilitate Bundle performance to liberate patients from the ICU.
Conclusions: We acknowledge current challenges that interfere with comprehensive management of critically ill patients during the coronavirus disease 2019 pandemic. Rapid response to new circumstances precisely requires established safety mechanisms and protocols like the ABCDEF Bundle to increase ICU and ventilator capacity and help survivors maximize recovery from coronavirus disease 2019 as early as possible.
Key Words: ABCDEF bundle; agitation; ARDS; coronavirus disease 2019; delirium; intensive care

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Survivors of critical Illness and their caregivers frequently face long-term impairment of cognition, mental health, mobility and beyond, which demand for a patient-centered transition management and well – coordinated, outpatient post-ICU care.

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In this Article, we aim to summarise the current management of Post Intensive Care Syndrome (PICS) and Post- Intensive Care Syndrome- Family (PICS-F), understand the need for continuum assessment and support throughout critical disease.

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Persistent critical illness acquired morbidities have been well known to affect adults since our attention was drawn to this in the landmark publication by Herridge et al. in 2003. What was first labelled as intensive care unit-acquired weakness, was broadened as we began to understand the physical, neurocognitive, and psychological sequelae that can affect not only patients, but their caregivers. The Post-Intensive Care Syndrome (PICS) was coined in a 2012 publication, to capture the three key affected domains of mental health, cognitive function and physical sequalae that adult survivors experience (Needham et al. 2012). This understanding of long-term impact of critical illness on patients has prompted clinicians and researchers to expand our focus beyond acute care and survival, to optimising survivorship and longer-term functional and health-related quality of life (HRQL) outcomes in our patients and families.

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Expert speakers discussed about post-icu syndrome found in Covid-19 patients.

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Expert speaker suggested how to help patients transition through the ICU.

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Q&A section during the Covid-19 resources: Patient and Family Communication, question 7 is about communication between patients and family.