Brief description of media:

While the short-term outcomes of ICU patients have dramatically improved over the last half-century, it is increasingly recognized that many ICU survivors experience declines in physical and cognitive functioning that persist well beyond their acute hospitalization. Psychiatric sequelae, including anxiety, depression, and post-traumatic stress disorder (PTSD) are also prevalent among both ICU survivors and their family members. Attendees of a 2010 meeting of the Society of Critical Care Medicine coined the term Post Intensive Care Syndrome (PICS) to describe new and persistent declines in physical, cognitive, and mental health functioning that follow an ICU stay and for which other causes, such as traumatic brain injury (TBI) or cerebrovascular accident (CVA), have been excluded. The term PICS-F is applied to the close family members of ICU patients who experience subsequent adverse mental health outcomes, the most common of which are sleep deprivation, anxiety, depression, and complicated grief.

Brief description of media:

What is post intensive care syndrome (PICS)? Each year, approximately 800,000 patients in the United States develop an illness that results in admission to an ICU and need for mechanical ventilation. Most survive to hospital discharge. This transition, while positive, often begins a new, challenging phase of recovery. ICU survivors, particularly those who require prolonged mechanical ventilation, experience high mortality. Compromises in physical, psychological, and/or cognitive function are common. Both patients and family caregivers are at risk for symptoms of anxiety, depression, post traumatic stress disorder (PTSD), and sleep disorders. Studies suggest that as many as 40% of ICU survivors and family
members experience physical, psychological, and/or cognitive dysfunction. Termed post intensive care syndrome, this consequence is defined as “new or worsening impairment in physical, cognitive, or mental health status arising after critical illness and persisting beyond discharge from the acute care setting.”6 Both patients and family caregivers may be affected, a consequence termed PICS (patient) or PICS-F (family member) This review will discuss risk factors, clinical manifestations, and strategies for prevention and management of PICS.

Brief description of media:

As ICU mortality decreases, post-ICU morbidity has been reported in
over 50% of ICU survivors. Hallmark features of post-ICU morbidity are the new or worsened functioning in one or more of the following domains after critical
illness: Physical, Cognitive, Psychological

Brief description of media:

Aim: In this review, we sought to succinctly review what Post intensive care syndrome is, it’s risk factors, consequences, assessment, diagnosis, prevention and treatment among family members of intensive care patients.
Background: The proportion of family members caring for a patient in intensive care units is expected to proportionally increase with increase in utilization of intensive care units due to various reasons. Subsequently, unfavorable physical, psycho-social responses due to exposure to complications following admission of a family member in intensive care due to critical illness will consequently increase among family members. These unfavorable family responses to critical illness have been termed “Post intensive care syndrome-family (PICS-F).” Post intensive care syndrome-family encompasses: anxiety, acute stress disorder, post-traumatic stress, depression and complicated grief. Healthcare providers as well as family members need to be knowledgeable on the extent, diagnosis, prevention and outcomes of these sequelae. Relationship to the patient, younger patients, prior experience of ICU, low economic status, length of ICU stay, unmet self-care, communication needs and distance from the hospital seem to predispose family members to PICS-F. Longer distance from hospital and higher resilience seem to protect family members from PICS-F. Prevention of PICS-F includes: effective family-ICU staff communication, enhancing resilience and coping, post discharge planning and follow-up interventions.
Conclusion: results highlight the importance of acknowledging experiences of family members having a patient admitted in intensive care unit. Healthcare professionals need to have insights into this phenomenon and optimally intervene to prevent these physiological and psycho-social sequelae.

Brief description of media:

The COVID-19 patients may be flooding some hospital systems across our nation presently. However, the reality is they will soon need post-acute rehabilitative care, and we as care providers need to be ready to serve them.

Our acute-care counterparts are working tirelessly on improved care and survival rates while also initiating the recovery process.

As a result, many post-acute care providers are left asking themselves the following questions:

“What is the best practice for treating the COVID-19 patient?”

“What are the long-term impacts of the disease?”

“What is length of stay of the recovery process going to look like?”

Brief description of media:

My daughter spent 114 days in the NICU. As she is approaches 2 years old, I’m still suffering the after-effects. I launched my blog during NICU Awareness month, so I’ve focused heavily on my experience during those 114 days. Looking back at all the photos and recounting what I went to has dredged up bucketfuls of “yuck.” In my past life, I was a data and research driven person. I still read studies, research outcomes and the like when I’m interested in something. Recently, I read studies about acute stress disorder (ASD) and post traumatic stress disorder (PTSD), specifically for parents in the NICU. Through all the studies I found myself asking:

Do I have PTSD? Is this what has been going on all this time?

Brief description of media:

Introduction
To study the level and predictors of post traumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.
Methods
Of 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for post traumatic stress symptoms with high probability of a post traumatic stress disorder (PTSD) was ≥ 35. Case level of HADS-Anxiety or Depression was ≥ 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.
Results
Mean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES ≥ 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P < 0.001. No differences in post traumatic stress, anxiety or depression between medical, surgical and trauma patients were found. High educational level (OR 0.4, 95%CI 0.2 to 1.0), personality trait (optimism) OR 0.9, 95%CI 0.8 to 1.0), factual recall (OR 6.6, 95%CI 1.4 to 31.0) and memory of pain (OR 1.5, 95%CI 1.1 to 2.0) were independent predictors of post traumatic stress symptoms at one year. Optimism was a strong predictor for less anxiety (OR 0.8, 0.8 to 0.9) and depression symptoms (OR 0.8, 0.8 to 0.9) after one year.

Brief description of media:

Objective To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.
Design Retrospective cohort study.
Setting NHS hospitals in England.
Participants 47 780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.
Main outcome measures Rates of hospital readmission (or any admission for controls), all-cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.
Results Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).
Conclusions Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.

Brief description of media:

For those patients presenting with post-COVID syndrome, a medical workup with a primary care physician will be of the essence. I have encouraged my patients to invest in a blood pressure cuff if possible, or if this isn’t possible, to consider checking blood pressure at the grocery store or pharmacy at their next visit.

Brief description of media:

In the United States, nearly 27% of hospital admissions involve the use of intensive care unit (ICU) services. Due to advancements in acute care, survival rates have increased among patients admitted to the ICU. However, these individuals are at high risk for mortality and readmission following discharge, along with numerous long-term challenges that are collectively referred to as post-intensive care syndrome (PICS).

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy.
NICE considered the evidence relating to the efficacy and safety of intraoperative blood cell salvage in obstetrics&nbsp;(IPG144) and for intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy (IPG258) in response to concerns expressed about theoretical risks associated with the procedure. These concerns were the possibility of amniotic fluid embolism and haemolytic disease in future pregnancies when used in obstetrics, and reinfusion of malignant cells when used in radical prostatectomy/cystectomy.
The evidence relating to safety of cell salvage in these procedures was considered adequate and therefore NICE does not intend to review its use in other specific clinical situations unless notified of new indications for intraoperative cell salvage in which there may be new safety concerns.
Description
Intraoperative blood cell salvage involves the collection of the solid components of the blood lost during an operation which is then transfused back to the same patient.
Coding&nbsp;and clinical classification codes&nbsp;for this guidance.

Brief description of media:

When the patient's airway has been difficult to manage, an airway follow-up should be instituted. This guideline recommends these steps:

review the patient clinically

talk to the patient

make adequate notes

write to the patient

complete an Airway alert form