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Around 10% of coronavirus sufferers still have symptoms months after being declared cured, and healthcare workers warn about a lack of resources to meet the demand for therapy services.

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Many patients who are discharged from the Intensive Care Unit (ICU) frequently suffer health problems long after they've left the hospital. The patient and their loved ones are often puzzled as to why, having survived a critical illness, that the former ICU patient is unable to work, enjoy activities, gain weight, and/or regain happiness after leaving the hospital. In researching this topic, I was alarmed at the number of individuals who are plagued by a profound range of serious mental health issues coupled with prolonged physical weakness.

The purpose of this piece is to bring attention to the widespread incidence of post-ICU depression and mental health and to encourage education and networking of professionals interested in assisting post-ICU patients and their caregivers. Hopefully, information contained in the article will provide caregivers and loved ones of former ICU patients with practical suggestions on how to initiate a successful dialog with a variety of health care professionals and mental health providers to ensure that the post-ICU care received results in the best possible outcome.

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BACKGROUND
There is widespread variability in clinical practice within cardiac surgery units worldwide on the use of haemofiltration. The clinical impact and safety of this modality is, however, unknown.
OBJECTIVES
The primary pilot trial objectives were as follows: to assess the feasibility of randomising 60 patients with impaired kidney function undergoing on-pump coronary artery bypass graft (CABG) surgery within 6 months; to assess the suitability and reliability of our chosen outcome measures; to explore issues that may impact on recruitment into a definitive trial; and to undertake an exploratory economic evaluation.
DESIGN
A pilot, single-centre, open-label randomised trial.
SETTING
Liverpool Heart and Chest Hospital NHS Foundation Trust between November 2010 and March 2012.
PARTICIPANTS
Men and women, aged >â 18 years of age, undergoing on-pump CABG surgery, who had pre-operative impaired kidney function indicated by an estimated glomerular filtration rate (eGFR) of <â 60â ml/minute adjusted for 1.73â m(2) of body surface area.
INTERVENTIONS
Group 1: patients who received haemofiltration during bypass (experimental group). Group 2: patients who did not receive haemofiltration during bypass (control group).
MAIN OUTCOME MEASURES
(1) Feasibility outcome measures: barriers to recruitment to a larger trial were documented as observations made during the recruitment period of the trial. Reliability of data collection methods was monitored using a 13-point case record form validation check for data entry against the patient clinical notes and the trial database. (2) The main clinical outcomes were frequency of intensive care unit (ICU) stay of duration >â 3 days and the length of ICU stay days. (3) Other clinical outcomes were the need for postoperative haemofiltration in the ICU, mechanical ventilation time, hospital stay, composite of outcome of unfavourable perioperative events and eGFR values at 6 weeks' follow-up. (4) Secondary health economic feasibility outcomes.
RESULTS
Recruitment into the pilot trial was from 21 November 2010 to 30 March 2012. Thirty-seven eligible patients were consented and successfully randomised into the trial arms (30%). The main issues impacting on recruitment were the high volume of off-pump CABG surgery within the centre; recruitment being restricted to research nurses' working hours of the week; issues arising associated with the screening process for identifying prospective eligible patients based on eGFR values; protocol deviations/treatment crossovers; and unexpected outbreaks of pandemic influenza and other infectious conditions. The data collection process was sufficiently robust, with few errors detected. The length of ICU stay days was deemed a suitable primary outcome. There was an overall trend towards reduction in the length of ICU stay for patients who were given intraoperative haemofiltration, more so for those with diabetes. The economic evaluation estimated that the incremental costs per person were £1744 lower for the intraoperative haemofiltration group, while the incremental benefits per person increased by 0.11.
CONCLUSION
Given sufficient resources and broadening of the inclusion criteria, the recruitment into a larger multicentre trial is feasible and may demonstrate potential clinical and cost benefits of using intraoperative haemofiltration in this group of patients. However, owing to the small sample size in this pilot trial, no firm conclusions can be drawn from the findings at this stage. The outcomes of this pilot study are very encouraging and suggest that it is feasible to design a continuous superiority trial with the length of ICU stay days or time to tracheal extubation as the primary outcome measure, provided that guidelines for avoiding bias are implemented. An alternative primary outcome measure that avoids bias is mortality. The inclusion criteria should also be widened to include all cardiac surgery patients with impaired renal function.

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This study aimed to explore the feasibility of an economic evaluation on continuous haemofiltration during on-pump coronary artery bypass graft surgery. The authors concluded that, given the exploratory nature of their study, there was considerable uncertainty around the results. The methods and results were largely well reported, and the authors' conclusions were appropriate.

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Despite reduced mortality and increasing survival rate of ICU treatment, a large group of patients surviving the ICU have a variety of complaints. Survivors of critical illness can undergo dramatic changes in their lives as a result of their experience, with many having some form of deficit in one or more domains of physical, psychological or cognitive functioning. There is still much to learn about the magnitude of the so-called Post ICU Syndrome (PICS) in patients surviving in the ICU.

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3 months after discharge from the Intensive Care Unit (ICU) and determine the impact of different components of PICS-P upon caregiver burden.
Design: A prospective observational study was conducted over 26 months (January 2013---February 2015).
Setting: Medical-surgical ICU and follow-up consultation in Portugal.
Patients or participants: Patients discharged after a minimum of 2 days in the ICU. Caregiver inclusion criteria: not paid, written and spoken Portuguese, and agreement to participate in the study.
Main variables of interest: In ICU: Patient gender, age, severity of illness (SAPS II) and length of ICU stay. At 3 months caregiver burden, physical (reduced mobility, weakness acquired in the ICU) and psychological components of PICS (anxiety, depression, post-traumatic stress disorder).
Results: A total of 168 caregivers completed the survey (response rate of 69%). A low degree of overburden was reported by 34.5% of caregivers, while 15.5% showed moderate to high levels of overburden.
Patient anxiety and depression 3 months after ICU discharge significantly influenced the presence of caregiver burden (p = 0.030 vs p = 0.008).
When physical components of PICS-P were evaluated, no influence on caregiver burden was observed. Patient demographics, severity of illness and length of stay also failed to influence caregiver burden.
Conclusions: The presence of psychological components of PICS-P 3 months after ICU seems to have a negative impact upon caregiver burden. On the other hand, physical problems showed no important impact upon caregiver overburden.

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Objective

To evaluate patient post-intensive care syndrome (PICS-P) and caregiver burden 3 months after discharge from the Intensive Care Unit (ICU) and determine the impact of different components of PICS-P upon caregiver burden.
Design

A prospective observational study was conducted over 26 months (January 2013–February 2015).
Setting

Medical-surgical ICU and follow-up consultation in Portugal.
Patients or participants

Patients discharged after a minimum of 2 days in the ICU. Caregiver inclusion criteria: not paid, written and spoken Portuguese, and agreement to participate in the study.
Main variables of interest

In ICU: Patient gender, age, severity of illness (SAPS II) and length of ICU stay. At 3 months caregiver burden, physical (reduced mobility, weakness acquired in the ICU) and psychological components of PICS (anxiety, depression, post-traumatic stress disorder).
Results

A total of 168 caregivers completed the survey (response rate of 69%). A low degree of overburden was reported by 34.5% of caregivers, while 15.5% showed moderate to high levels of overburden.

Patient anxiety and depression 3 months after ICU discharge significantly influenced the presence of caregiver burden (p=0.030 vs p=0.008).

When physical components of PICS-P were evaluated, no influence on caregiver burden was observed. Patient demographics, severity of illness and length of stay also failed to influence caregiver burden.
Conclusions

The presence of psychological components of PICS-P 3 months after ICU seems to have a negative impact upon caregiver burden. On the other hand, physical problems showed no important impact upon caregiver overburden.

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This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.

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More than a year after the first COVID-19 infections were reported in the UK, some people who contracted the virus in the early weeks of the pandemic are still struggling with symptoms.

"Long COVID" is thought to have affected thousands of people across the country, with ongoing physical effects reported to range from fatigue and "brain fog" to nerve pain and paralysis in some rare cases.

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More than a year after the first COVID-19 infections were reported in the UK, some people who contracted the virus in the early weeks of the pandemic are still struggling with symptoms.
"Long COVID" is thought to have affected thousands of people across the country, with ongoing physical effects reported to range from fatigue and "brain fog" to nerve pain and paralysis in some rare cases.
There are now calls for the condition to be recognised as an "occupational disease" for frontline workers - while concerns have been voiced about the long-term effect of the virus on some children.

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Advancements in critical care medicine result in a growing population of survivors of critical illness. Many intensive care unit (ICU) patients have physical, mental and cognitive sequelae after discharge from the ICU, known as post-intensive care syndrome (PICS). These problems are associated with long-lasting restrictions in daily functioning and reduced health-related quality of life (QoL), and can also negatively affect family members (PICS-F). The nature of these restrictions require interdisciplinary rehabilitation care, but to date there is no structured pathway for the prevention and treatment of the symptoms of PICS. The aim of this thesis was to explore the course and prognosis of functioning in ICU survivors, and to investigate means for early identification of PICS. In the studies assembled in this thesis, we found that patients with prolonged ICU-stay, longer duration of mechanical ventilation (> 48 hours), and/or ICU-AW, have a higher risk of short- and long-term functional impairments, limitations in activities and restrictions in participation. A majority of ICU survivors do not receive adequate rehabilitation care after discharge from the hospital. This implies, that patients and their close relatives should be closely monitored after discharge from the ICU to initiate interdisciplinary rehabilitation treatment. In order to improve the quality of survivorship, we propose a structured, stepped care rehabilitation pathway, consisting of clinical assessments with validated screening instruments, interdisciplinary rehabilitation interventions, tailored to the patients’ abilities and needs, and adequate handover in the transition of care.

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Improvements in devices and techniques used to provide life support for patients at intensive care units have reduced patient mortality. Increases in the number of survivors from a critical illness have brought long-term complications experienced during the post-intensive care period into question. The term post-intensive care syndrome (PICS) is defined as a new and deteriorating disorder in the cognitive, mental, and physical health status experienced by the survivor after intensive care unit discharge that might continue for months or even years. Opioid and sedation exposure, the severity of illnesses and injuries, dense life support interventions, length of stay in the intensive care unit,and social isolation constitute risk factors for PICS in children.These factors cause the child to experience deterioration in physical, cognitive, and psychological health domains. Such deteriorations occur on various levels and have negative effects on quality of life. The purpose of this article is to raise awareness and help pediatric nurses to develop an understanding of the condition. Increasing awareness by pediatric nurses about the magnitude and effects of complications after discharge from the intensive care unit will be the first step to protect survivors from new problems, to provide assistance for ongoing problems, and to develop follow-up strategies. PICS-related morbidities affect the majority of children discharged from PICUs. We need to understand the scope of those morbidities and develop efficient nursing interventions accordingly. It is time to expand our goal for critical and noncritical care from life-saving into improvement of functional health status and quality of life