Brief description of media:

This guideline covers care for adults (aged 18 and over) having elective or emergency surgery, including dental surgery. It covers all phases of perioperative care, from the time people are booked for surgery until they are discharged afterward. The guideline includes recommendations on preparing for surgery, keeping people safe during surgery and pain relief during recovery.
 The recommendations in this guideline were developed before the COVID-19 pandemic. See NICE’s COVID-19 rapid guideline on arranging planned care in hospitals and diagnostic services and NHS England’s operating framework for urgent and planned services in hospital settings during COVID-19 for guidance on minimising the risk from COVID-19.
Recommendations
This guideline includes recommendations on:

information and support for people having surgery
enhanced recovery programmes
preoperative care
intraoperative care
postoperative care
managing pain

Who is it for?

Healthcare professionals, including dentists, in primary, secondary and tertiary care
Commissioners, planners and service providers, including those in non-NHS organisations commissioned to provide services for the NHS or local authorities
Adults having elective or emergency surgery, their families and carers

Guideline development process
How we develop NICE guidelines
This guideline updates and replaces NICE medical technologies guidance 3 (published March 2011).

Brief description of media:

Surgical intensive care unit (ICU) stay of longer than 10 days is often described by the experienced intensivist as a ‘‘complicated clinical course’’ and is frequently attributed to persistent immune dysfunction. ‘‘Systemic inflammatory response syndrome’’ (SIRS) followed by‘‘compensatory anti-inflammatory response syndrome’’ (CARS) is a conceptual framework to explain the immunologic trajectory that ICU patients with severe sepsis, trauma, or emergency surgery for abdominal infection often traverse, but the causes, mechanisms, and reasons for persistent immune dysfunction remain unexplained. Often involving multiple-organ failure (MOF) and death, improvements in surgical intensive care have altered its incidence, phenotype, and frequency and have increased the number of patients who survive initial sepsis or surgical events and progress to a persistent inflammation, immunosuppression, and catabolism syndrome (PICS). Often observed, but rarely reversible, these patients may survive to transfer to a long-term care facility only to return to the ICU, but rarely to self-sufficiency. We propose that PICS is the dominant patho physiology and phenotype that has replaced late MOF and prolongs surgical ICU stay, usually with poor outcome. This review details the evolving epidemiology of MOF, the clinical presentation of PICS, and our understanding of how persistent inflammation and immunosuppression define the pathobiology of prolonged intensive care. Therapy forPICS will involve innovative interventions for immune system rebalance and nutritional support to regain physical function and well-being. (J Trauma Acute Care Surg. 2012;72: 1491Y1501. Copyright*2012 by Lippincott Williams & Wilkins)

Brief description of media:

Guidelines for the provision of continuous analgesia, sedation, and neuromuscular blockade for critically ill patients requiring ventilator management. In this research the guidelines used a five-step process that included evaluation, analgesia, sedation, neuromuscular junction blockade, and dosage adjustment. A distinct end point for each class of agents was preserved. An academic detailing process was used to educate practitioners about the use of guidelines. Daily interventions were performed, and the prescribers were made aware, by direct and written communication, when their regimens varied from the suggested guidelines. The cost implications of such deviations were also brought to the attention of the prescribers.

Brief description of media:

The 2 purposes of this systematic review were to identify the scope and magnitude of physical problems associated with PICS during the first year after critical illness and to use the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to elucidate impairments of body functions and structures, activity limitations, and participation restrictions associated with PICS.

Brief description of media:

At least half of all patients who survive treatment in an intensive care unit will experience at least one of a triad of problems associated with post-intensive care syndrome, or PICS, and this may be true for people recovering from COVID-19 following ICU care.

PICS can manifest as problems with physical function, cognition and mental health, according to a fact sheet from the American Thoracic Society.

PICS is a relatively under-recognized issue, despite the fact that it affects a large number of people treated in an ICU, according to Patricia Ohtake, associate professor in the physical therapy program, School of Public Health and Health Professions.

Brief description of media:

Post-intensive care syndrome (PICS) is a collection of symptoms, limitations, and impairments that are present in people who have recently been treated in a hospital’s intensive care unit (ICU). These impairments may be chronic and may limit your full participation in your normal activities upon discharge from the ICU.

If you have been recently discharged from the intensive care unit, you may benefit from the care of a physical therapist to help you recover fully and return to your previous level of work and recreational activity.

Brief description of media:

Authors' objectives
To examine the effect of intensive care unit (ICU) physician staffing on patient outcomes, in terms of hospital and ICU mortality and length of stay (LOS).

Brief description of media:

Introduction

Although many terminally ill people are admitted to an intensive care unit (ICU) at the end of life, their care is often inadequate because of poor communication by physicians and lack of patient- and family-centred care. The aim of this systematic literature review was to describe physician-related barriers to adequate communication within the team and with patients and families, as well as barriers to patient- and family-centred decision-making, towards the end of life in the ICU. We base our discussion and evaluation on the quality indicators for end-of-life care in the ICU developed by the Robert Wood Johnson Foundation Critical Care End-of-Life Peer Workgroup.
Method

Four electronic databases (MEDLINE, Embase, CINAHL and PsycINFO) were searched, using controlled vocabulary and free text words, for potentially relevant records published between 2003 and 2013 in English or Dutch. Studies were included if the authors reported on physician-related and physician-reported barriers to adequate communication and decision-making. Barriers were categorized as being related to physicians’ knowledge, physicians’ attitudes or physicians’ practice. Study quality was assessed using design-specific tools. Evidence for barriers was graded according to the quantity and quality of studies in which the barriers were reported.
Results

Of 2,191 potentially relevant records, 36 studies were withheld for data synthesis. We determined 90 barriers, of which 46 were related to physicians’ attitudes, 24 to physicians’ knowledge and 20 to physicians’ practice. Stronger evidence was found for physicians’ lack of communication training and skills, their attitudes towards death in the ICU, their focus on clinical parameters and their lack of confidence in their own judgment of their patient’s true condition.
Conclusions

We conclude that many physician-related barriers hinder adequate communication and shared decision-making in ICUs. Better physician education and palliative care guidelines are needed to enhance knowledge, attitudes and practice regarding end-of-life care. Patient-, family- and health care system–related barriers need to be examined.

Brief description of media:

Those who tested positive for coronavirus, taken treatment, tested negative after 14 days, of them some suffer weakness, lost balance while walking etc. Some medicos too don’t have the solution to these problems, but physiotherapists have. Most people post-Covid are experiencing tremendous improvement thanks to physiotherapy. ‘The Hitavada’ talked to some well-known physiotherapists who elaborated the importance of physiotherapy vis-a-vis Covid-19 pandemic.

Brief description of media:

Even healthcare professionals may not be aware and prepared for a condition called Post-ICU Syndrome (PICS) that can occur in the aftermath of COVID-19. What about those who were hospitalized for COVID-19, treated in ICU, and are unaware of the possible long-term impact and rehabilitation phase? There is a tendency to think that once the patient is discharged from the hospital, has tested negative, and looks well, the problem is resolved. However, the struggle of COVID-19 survivors and family members or caregivers may not end there.

Brief description of media:

The objective of this power point is to: Define Post-intensive care Syndrome (PICS), Associated risk factor, and long term consequences; recognize available resources to address PICS through education, therapy, and support groups; and integrate knowledge into practice to guide at risk patient/families toward available resources.

Brief description of media:

the one pager explains the effect of post intensive care syndrome (PICS) on the ICU patients and their families.