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“Last night the porters took me down to the basement in a supermarket trolley. I was met by hooded monks who stole my soul and turned me into a zombie. I woke up in my own coffin.”

“I heard the nurses whispering about me in the night behind the blue curtains. They are plotting to murder me and my baby, and I saw one of them take a gun from her handbag.”

“There was a wild animal rampaging through the marketplace in the hospital, attacking everyone until the police shot it.”

These are the terrifying or bizarre experiences I hear about daily as a psychologist working on the intensive care units (ICUs) and Covid-19 wards in a London hospital. The stories are hallucinations or delusions from ICU delirium, a syndrome caused by drugs, infections, lack of oxygen and other medical reasons. But to patients these visions are vividly and unarguably real.

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The article is a guide for medical practitioner to monitor ICU patients and prevent them to develop Delirium

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This article is to evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States.

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Objective—To evaluate the association between length of ICU stay and 1-year mortality for elderly patients who survived to hospital discharge in the United States.
Design and Setting—Retrospective cohort study of a random sample of Medicare beneficiaries who survived to hospital discharge, with 1 and 3-year follow-up, stratified by the number of days of intensive care and with additional stratification based on receipt of mechanical ventilation.
Interventions—None
Patients—The cohort included 34,696 Medicare beneficiaries older than 65 years who received intensive care and survived to hospital discharge in 2005.
Measurements and Main Results—Among 34,696 patients who survived to hospital
discharge, the mean ICU length of stay was 3.4 (±4.5) days. 88.9% of patients were in the ICU for 1–6 days, representing 58.6% of ICU bed-days. 1.3% of patients were in the ICU for 21+ days, but these patients used 11.6% of bed-days. The percentage of mechanically ventilated patients increased with increasing length of stay (6.3% for 1–6 days in the ICU and 71.3% for 21+ days). One-year mortality was 26.6%, ranging from 19.4% for patients in the ICU for one day, up to 57.8% for patients in the ICU for 21+ days. For each day beyond seven days in the ICU, there was an increased odds of death by 1-year of 1.04 (95% CI 1.03–1.05) irrespective of the need for mechanical ventilation.
Conclusions—Increasing ICU length of stay is associated with higher 1-year mortality for both mechanically ventilated and non-mechanically ventilated patients. No specific cut-off was associated with a clear plateau or sharp increase in long-term risk.

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As Covid cases rise in rural areas, a new report found that one in five Covid-19 patients develop mental illness within 90 days of recovery. That could spell trouble for rural residents who already have a harder time getting access to mental health services. The report, published this week in the Lancet, found that those who’ve had Covid-19 are likely to develop anxiety, depression, and insomnia, but can also develop post-traumatic stress disorder.

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Background: Critical illness and the problems faced after ICU discharge do not only affect the patient, it also negatively impacts patients' informal caregivers. There is no review which summarizes all types of burden reported in informal caregivers of ICU survivors. It is important that the burdens these informal caregivers suffer are systematically assessed so the caregivers can receive the professional care they need. We aimed to provide a complete overview of the types of burdens reported in informal caregivers of adult ICU survivors, to make recommendations on which burdens should be assessed in this population, and which tools should be used to assess them.

Method: We performed a systematic search in PubMed and CINAHL from database inception until June 2014. All articles reporting on burdens in informal caregivers of adult ICU survivors were included. Two independent reviewers used a standardized form to extract characteristics of informal caregivers, types of burdens and instruments used to assess these burdens. The quality of the included studies was assessed using the Newcastle-Ottawa and the PEDro scales.

Results: The search yielded 2704 articles, of which we included 28 in our review. The most commonly reported outcomes were psychosocial burden. Six months after ICU discharge, the prevalence of anxiety was between 15% and 24%, depression between 4.7% and 36.4% and post-traumatic stress disorder (PTSD) between 35% and 57.1%. Loss of employment, financial burden, lifestyle interference and low health-related quality of life (HRQoL) were also frequently reported. The most commonly used tools were the Hospital Anxiety and Depression Scale (HADS), Centre for Epidemiological Studies-Depression questionnaire, and Impact of Event Scale (IES). The quality of observational studies was low and of randomized studies moderate to fair.

Conclusions: Informal caregivers of ICU survivors suffer a substantial variety of burdens. Although the quality of the included studies was poor, there is evidence that burden in the psychosocial field is most prevalent. We suggest screening informal caregivers of ICU survivors for anxiety, depression, PTSD, and HRQoL using respectively the HADS, IES and Short Form 36 and recommend a follow-up period of at least 6 months.

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The long-term effects of COVID-19 continue to be a murky subject full of unsettling concerns such as lasting heart and nerve damage, but the effort to understand them is gaining strength and urgency.
In the past week the Centers for Disease Control updated its public guidance on what’s sometimes known as “Long COVID,” with sufferers known as “long haulers.” On Sunday, the United Kingdom’s National Health Service announced that it was organizing a network of more than 40 specialist clinics to help sufferers and launching a task force whose mission is to produce a better understanding of just what Long COVID is.

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British Columbia needs to act now to ensure people released from intensive care after COVID-19 treatment don’t end up back in hospital beds within months, according to a University of British Columbia researcher. Dr.

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British Columbia needs to act now to ensure people released from intensive care after COVID-19 treatment don’t end up back in hospital beds within months, according to a University of British Columbia researcher.

Dr. Fuchsia Howard, an assistant professor at the UBC School of Nursing, said the province needs to increase resources for post-intensive career recovery for all patients who experience serious illnesses.

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Rationale: Post–intensive care syndrome (PICS), defined as new or worsening impairment in cognition, mental health, or physical function after critical illness, is an important development in survivors. Although studies to date have focused on the frequency of these impairments, fundamental questions remain unanswered regarding the survivor experience and the impact of the critical illness event on survivor resilience and recovery.

Objectives: To examine the association between resilience and neuropsychological and physical function and to contextualize these findings within the survivors’ recovery experience.

Methods: We conducted a mixed-methods pilot investigation of resilience among 43 survivors from two medical intensive care units (ICUs) within an academic health-care system. We interviewed survivors to identify barriers to and facilitators of recovery in the ICU, on the medical ward, and at home, using qualitative methods. We used a telephone battery of standardized tests to examine resilience, neuropsychological and physical function, and quality of life. We examined PICS in two ways. First, we identified how frequently survivors were impaired in one or more domains 6–12 months postdischarge. Second, we identified how frequently survivors reported that neuropsychological or physical function was worse.

Measurements and Main Results: Resilience was low in 28% of survivors, normal in 63% of survivors, and high in 9% of survivors. Resilience was inversely correlated with self-reported executive dysfunction, symptoms of anxiety, depression, and post–traumatic stress disorder, difficulty with self-care, and pain (P < 0.05). PICS was present in 36 survivors (83.7%; 95% confidence interval, 69.3–93.2%), whereas 23 survivors (53.5%; 95% confidence interval, 37.6–68.8%) reported worsening of neuropsychological or physical function after critical illness. We identified challenges along the recovery path of ICU survivors, finding that physical limitations and functional dependence were the most frequent challenges experienced in the ICU, medical ward, and on return to home. Spiritual and family support facilitated recovery.

Conclusions: Resilience was inversely correlated with neuropsychological impairment, pain, and difficulty with self-care. PICS was present in most survivors of critical illness, and 54% reported neuropsychological or physical function to be worse, yet resilience was normal or high in most survivors. Survivors experienced many challenges during recovery, while spiritual and family support facilitated recovery.

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Record Status

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.
Health technology

The use of prophylactic treatment with respiratory syncytial virus immune globulin (RSVIG) in paediatric patients at risk of developing RSV bronchiolitis and in paediatric patients at risk of developing a respiratory illness that would require hospitalisation. The use of RSVIG was compared with no prophylaxis. RSVIG was administered intravenously (IV) by home-based infusions (dose 750 mg/kg monthly) during the RSV season (November to April).

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Survival rates following out-of-hospital cardiac arrest (OHCA) could be improved, but to achieve this requires attention to all aspects of the pathway of care for these patients.

Supported by two of NHS England’s National Clinical Directors, this guidance provides a professional consensus of what an optimum pathway might look like and how this could be more consistently applied in England. It builds on published guidance and research evidence where these are available, and otherwise brings together experts to provide consensus recommendations.