Brief description of media:

Objective: To assess the long-term, health-related quality of life of intensive care unit survivors by systematic review.
Methods: The search for, and selection and analysis of, observational studies that assessed the health-related quality of life of intensive care unit survivors in the electronic databases LILACS and MEDLINE® (accessed through PubMed) was performed using the indexed MESH terms "quality of life [MeSH Terms]" AND "critically illness [MeSH Terms]". Studies on adult patients without specific prior diseases published in English in the last 5 years were included in this systematic review. The citations were independently selected by three reviewers. Data were standardly and independently retrieved by two reviewers, and the quality of the studies was assessed using the Newcastle-Ottawa scale.
Results: In total, 19 observational cohort and 2 case-control studies of 57,712 critically ill patients were included. The follow-up time of the studies ranged from 6 months to 6 years, and most studies had a 6-month or 1-year follow up. The health-related quality of life was assessed using two generic tools, the EuroQol and the Short Form Health Survey. The overall quality of the studies was low.
Conclusions: Long-term, health-related quality of life is compromised among intensive care unit survivors compared with the corresponding general population. However, it is not significantly affected by the occurrence of sepsis, delirium, and acute kidney injury during intensive care unit admission when compared with that of critically ill patient control groups. High-quality studies are necessary to quantify the health-related quality of life among intensive care unit survivors.

Brief description of media:

Introduction
Data on quality of life beyond 2 years after intensive care discharge are limited and we aimed to explore this area further. Our objective was to quantify quality of life and health utilities in the 5 years after intensive care discharge.

Methods
A prospective longitudinal cohort study in a University Hospital in the UK. Quality of life was assessed from the period before ICU admission until 5 years and quality adjusted life years calculated.

Results
300 level 3 intensive care patients of median age 60.5 years and median length of stay 6.7 days, were recruited. Physical quality of life fell to 3 months (P = 0.003), rose back to pre-morbid levels at 12 months then fell again from 2.5 to 5 years after intensive care (P = 0.002). Mean physical scores were below the population norm at all time points but the mean mental scores after 6 months were similar to those population norms. The utility value measured using the EuroQOL-5D quality of life assessment tool (EQ-5D) at 5 years was 0.677. During the five years after intensive care unit, the cumulative quality adjusted life years were significantly lower than that expected for the general population (P < 0.001).

Conclusions
Intensive care unit admission is associated with a high mortality, a poor physical quality of life and a low quality adjusted life years gained compared to the general population for 5 years after discharge. In this group, critical illness associated with ICU admission should be treated as a life time diagnosis with associated excess mortality, morbidity and the requirement for ongoing health care support.

Brief description of media:

This third edition of the 'Recipe Book' seeks to bridge the gap between audit and improvement, by providing anaesthetists with an introduction to the science of improvement and demonstrating some basic tools which can be used to drive positive patient centred change. A number of anaesthetists and intensivists throughout the UK have now learned improvement methodology, often from participation in one of the national or regional patient safety programmes. We have therefore included a number of examples from practising clinicians illustrating how they have identified problems using audit methodology, and then applied simple improvement techniques to achieve change.

Brief description of media:

Objectives for the rapid review were to establish the following:
•The epidemiology of COVID-19;
•The personal protective equipment (PPE) requirements;
•The requirements for hand hygiene;
•The environmental survivability of COVID-19;
•The requirements for cleaning/decontamination of the care environment;

Brief description of media:

The overall aim of this rapid risk assessment is to provide the European Commission and Member States with a set of public health objectives and considerations for epidemiological criteria, indicators and accompanying measures, supporting the implementation of this roadmap based on the available scientific evidence:

Public health objectives

A robust surveillance strategy based on enhanced testing

An expanded testing capacity and harmonised testing methodologies

A framework for contact tracing

Sufficient healthcare capacity and resilience

An assessment of the response to COVID-19 so far

A strong risk communication strategy

Brief description of media:

Rebecca has been hospitalized for weeks with what doctors believe could be Multisystem inflammatory syndrome in children (MIS-C), a rare, post-COVID-19 syndrome in children becoming more frequent in Montreal.

Brief description of media:

A rare syndrome specialists detected shortly after the pandemic began — seen in children who have recovered from COVID-19 — seems to be becoming more frequent and more severe in Montreal.

Multisystem inflammatory syndrome in children (MIS-C) manifests in the form of a fever, mainly, but also red eyes, red or cracked lips, and red spots on the body. The symptoms resemble those of Kawasaki disease, said Dr. Marie-Paule Morin, a pediatric rheumatologist at Montreal’s Ste-Justine Hospital, and they appear about three to four weeks after a COVID-19 diagnosis.

Brief description of media:

CRD summary
The authors assessed the impact of rationing intensive care unit beds on the process and outcomes of care and concluded that the observational nature, heterogeneity, moderate to poor methodological quality and lack of succinct conclusions of the individual studies precluded strong conclusions. The authors' conclusions reflect the evidence presented and appear reliable.
Authors' objectives
To assess the impact of rationing intensive care unit beds on the process and outcomes of care.

Brief description of media:

Background:The relatives of intensive care unit (ICU) patients must cope with both the severity of illness of their loved one and the unfamiliar and stressful ICU environment. This hardship may lead to post‑intensive care syndrome. French guidelines provide recommendations on welcoming and informing families of ICU patients. We questioned whether and how they are applied 5years after their publication.
Methods:We conducted a large survey among French ICUs to evaluate their visiting policies and how information was provided to patient’s family. A questionnaire was built up by intensivists and nurses. French ICUs were solicited, and the questionnaire was sent to all participating ICUs, for being filled in by the unit medical and/or nursing head. Data regarding the hospital and ICU characteristics, the visiting policy and procedures, and the management of family information were collected.
Results:Among the 289 French ICUs, 188 (65%) participated. Most ICUs have a waiting room 118/188 (62.8%) and a dedicated room for meeting the family 152/188 (80.8%). Of the 188 ICUs, 45 (23.9%) were opened on a 24‑h‑a‑day basis. In the remaining ICUs, the time period allowed for visits was 4.75±1.83h (median 5h). In ICUs where visit‑ing restrictions were reported, open visiting was allowed for end‑of‑life situations in 107/143 (74.8%). Children are allowed to visit a patientin 164/188 (87.2%) regardless of their age in 97/164 (59.1%) of ICUs. Families received an information leaflet in 168/188 (89.3%). Information was provided to families through structured meetings in 149/188 (79.2%) of ICUs at patient admission with participation of nurses and nursing assistants in 133/188 (70.4%) and 55/188 (29.2%), respectively. Information delivered to the family was reported in the patient chart by only 111/188 ICUs (59%). Participation in care was infrequent.
Conclusions:Although French ICUs do not follow the consensus recommendations, slow progress exists com‑pared to previous reports. Implementation of these recommendations is largely needed to offer better welcome and information improvement. Further studies on that topic would enable evaluating remaining obstacles and increasing caregivers’ awareness, both critical for further progresses on that topic.

Brief description of media:

This document provides guidance and recommendations for the planning or renovation of intensive care units (ICUs) with respect to the specific characteristics relevant to organizational and structural aspects of intensive care medicine.

Brief description of media:

Clinical research and technological innovation have greatly improved survival after admission to intensive care units (ICU), such that around 90% of patients are discharged.1 However, their recovery is often complicated and partial.2 Longitudinal studies have demonstrated that physical, cognitive, and psychiatric morbidity are prevalent post‐discharge, with impairment often persisting for years.3-6 Concerned with promoting quality of survival, the Society of Critical Care Medicine (SCCM) convened a 2‐day conference in 2012 to develop strategies for improving long‐term outcomes of critical illness for patients and family members.2 The term “post‐intensive care syndrome” (PICS) was coined to represent impairment and disability arising after a critical illness and persisting beyond acute hospitalization.

Brief description of media:

Background

In this case report, we describe the trajectory of recovery of a young, healthy patient diagnosed with coronavirus disease 2019 who developed acute respiratory distress syndrome. The purpose of this case report is to highlight the potential role of intensive care unit recovery or follow-up clinics for patients surviving acute hospitalization for coronavirus disease 2019.
Case presentation

Our patient was a 27-year-old Caucasian woman with a past medical history of asthma transferred from a community hospital to our medical intensive care unit for acute hypoxic respiratory failure due to bilateral pneumonia requiring mechanical ventilation (ratio of arterial oxygen partial pressure to fraction of inspired oxygen, 180). On day 2 of her intensive care unit admission, reverse transcription–polymerase chain reaction confirmed coronavirus disease 2019. Her clinical status gradually improved, and she was extubated on intensive care unit day 5. She had a negative test result for coronavirus disease 2019 twice with repeated reverse transcription–polymerase chain reaction before being discharged to home after 10 days in the intensive care unit. Two weeks after intensive care unit discharge, the patient returned to our outpatient intensive care unit recovery clinic. At follow-up, the patient endorsed significant fatigue and exhaustion with difficulty walking, minor issues with sleep disruption, and periods of memory loss. She scored 10/12 on the short performance physical battery, indicating good physical function. She did not have signs of anxiety, depression, or post-traumatic stress disorder through self-report questionnaires. Clinically, she was considered at low risk of developing post–intensive care syndrome, but she required follow-up services to assist in navigating the healthcare system, addressing remaining symptoms, and promoting return to her pre–coronavirus disease 2019 societal role.
Conclusion

We present this case report to suggest that patients surviving coronavirus disease 2019 with subsequent development of acute respiratory distress syndrome will require more intense intensive care unit recovery follow-up. Patients with a higher degree of acute illness who also have pre-existing comorbidities and those of older age who survive mechanical ventilation for coronavirus disease 2019 will require substantial post–intensive care unit care to mitigate and treat post–intensive care syndrome, promote reintegration into the community, and improve quality of life.