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The quest at Mount Sinai began with a mystery. During the first wave of the coronavirus pandemic in New York City, Zijian Chen, an endocrinologist, had been appointed medical director of the hospital’s new Center for Post-COVID Care, dedicated both to research and to helping recovering patients “transition from hospital to home,” as Mount Sinai put it. One day last spring, he turned to an online survey of COVID 19 patients who were more than a month past their initial infection but still experiencing symptoms. Because COVID 19 was thought to be a two-week respiratory illness, Chen anticipated that he would find only a small number of people who were still sick. That’s not what he saw.
“I looked at the number of patients that were in the database and it was, I think, 1,800 patients,” he told me. “I freaked out a little bit. Oh my God, there’s so many patients telling us that they still have symptoms.” A realization dawned on him: America was not simply struggling to contain a once-in-a-century pandemic, caused by a virus far more dangerous than seasonal influenza. Many patients were, for unknown reasons, not recovering.

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In 2010, the Society of Critical Care Medicine organized a task force to raise awareness of the long-term cognitive, psychological, and physical impairments in survivors of critical illness. Impairments in these three domains are collectively known as post-intensive care syndrome (PICS). PICS affects 50–70% of intensive care unit (ICU) survivors, and its effects can persist for 5–15 years after ICU hospitalization. One major barrier in the assessment of PICS is the lack of a single, validated clinical tool to rapidly assess impairments in all three domains of PICS.

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The communication board helps the ICU patient to communication with the care giver.

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Aims of the study: Many centres have noticed a high number of venous thromboembolism (VTE) events among critically ill inpatients with COVID-19 pneumonia. The aims of this study were (1) to summarise the reported risk of VTE associated with COVID-19 infections and (2) to summarise guidance documents on thromboprophylaxis in COVID-19 patients, in a systematic review.

Methods: We systematically searched for peer-reviewed evidence on the risk of VTE in patients with COVID-19, in PubMed, Embase and Twitter, and for guidelines or guidance documents for thromboprophylaxis, from international or national societies relevant to the field of thrombosis and haemostasis, up to April 30 2020.

Results: We found 11 studies (1 clinical trial, 7 retrospective cohorts and 3 prospective cohorts), which included a range of 16 to 388 in patients with COVID-19 (total of 1369 inpatients). The diagnoses of COVID-19 and VTE were of high quality, but the follow-up was often unclear. Most studies reported universal in-hospital thromboprophylaxis. Among all inpatients and among intensive care unit (ICU) inpatients with COVID-19, reported risks of VTE were 4.4–8.2% (three studies) and 0–35.3% (six studies), respectively. Two studies at least partially screened for VTE in ICU inpatients with COVID-19, and found risks of 24.7–53.8%. We found 12 guidelines for thromboprophylaxis of COVID-19 patients. The majority suggested universal pharmacological thromboprophylaxis in all COVID-19 inpatients, but there was heterogeneity in the suggested intensity of thromboprophylaxis: seven advised considering intensified doses of heparin according to the clinical or biological severity of the disease, especially in the ICU setting.

Conclusions: Venous thromboembolism very commonly complicates the clinical course of inpatients with COVID-19, despite thromboprophylaxis. The risk appears highest among critically ill inpatients. We found no estimates of risks among outpatients. Many questions remain unresolved, as delineated by the heterogeneity of national and international guidelines. This situation calls for fast randomised clinical trials, comparing different schemes of thromboprophylaxis in COVID-19 inpatients.

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Virtual reality could be key to COVID-19 rehabilitation, according to a new paper published in BMJ Open Sport Exercise Medicine. Specifically, the authors of the publication pitch tailor-made rehabilitation services that can be administered remotely via a VR experience.

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Weaning covers the entire process of liberating the patient from respiratory mechanical support and from the endotracheal tube. This document aims to provide recommendations regarding the management of this process.

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There is a common misconception that people who come down with COVID-19 experience one of two disease courses: They have minimal or no symptoms that clear up in a week, or they get extremely ill and either die or recover after receiving intensive care treatment.
But now that the coronavirus has been under sharp focus for more than six months, physicians are noting that this binary belief is inaccurate. Some patients in both categories experience lingering symptoms and are at risk for long-term damage to organ systems weeks and months later.

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As awareness has grown of the great distress intensive care patients may suffer, units have begun recruiting psychologists to their teams. Intensive care unit psychologists aim to assess and reduce distress for patients, families and staff, to improve outcomes. This paper summarises research on the psychological impact of critical illness, highlights the growth of critical care health psychology as a speciality, and discusses potential roles of psychologists and the evidence base for psychological interventions in critical care departments.

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Patients will survive coronavirus—but that survival will likely come at a cost for some. Research on similar populations suggests that at least 50% of people who survive admission to an intensive care unit (ICU) can be left with what researchers now call “post-intensive care syndrome,” a constellation of emotional, cognitive, and physical symptoms that limit their functioning. Survivors of critical illness can often return to the world with memory problems and difficulty planning and processing that is similar to those with moderate traumatic brain injury or mild dementia. Other survivors experience post-traumatic stress disorder (PTSD), at an incidence ranging from 10% to 50%. Their caregivers, too, will often experience a cluster of adverse outcomes, including anxiety, PTSD, and depression.

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Health systems must start ramping up services for helping people recover from intensive care treatment for coronavirus, doctors are warning. After spending several weeks on a ventilator, people will need extensive physical and mental rehabilitation for weeks or even months.

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HEALTH systems must start ramping up services for helping people recover from intensive care treatment for coronavirus, doctors are warning. After spending several weeks on a ventilator, people will need extensive physical and mental rehabilitation for weeks or even months.

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In the UK, Scandinavia, and other European countries, patient diaries are being explored as a low cost technology to improve the quality of life after critical illness and mechanical ventilation (Combe, 2005; Egerod et al., 2007). Entries into the intensive care diary are made by nurses and in some countries also by relatives during the patient's stay. In other countries relatives are encouraged to write separate diaries (Gjengedal et al.,2010). The diary is written in everyday
language and contains daily entries on the current patient status and descriptions of situations and surroundings in which the patient might find recognition. The text is often supported by photos. It is written directly to the patient, using an empathetic and reflective style and therapeutic communication (Roulin et al., 2007).