Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE)

No abstract available

The evolution of post-intensive care syndrome

No abstract available

The health and social consequences of an alcohol related admission to critical care: a qualitative study

Objective: To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design: In-depth, semistructured interviews with participants ( patients) 3–7 months post intensive care discharge. Setting: The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. Participants: 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. Interventions: None. Measurements and main results: Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. Conclusions: There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated

The health and social consequences of alcohol related admission to critical care

Introduction: Alcohol related admissions to critical care are increasing. However, there is uncertainty about the impact of excessive alcohol use on the intensive care stay and recovery from critical illness. Aim: The aim of this study was to understand the impact of alcohol use disorders on the critically ill patient's journey. Settings & participants: The setting for this study was a 20 bed mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk; harmful/hazardous or alcohol dependency. Methods: This was a mixed methods study. An 18 month prospective observational cohort study was undertaken. In addition, 21 in depth, semi structured interviews were undertaken with patients with and without alcohol use disorders, three to seven months after discharge from critical care. Results: 580 ICU patients were screened for the presence of alcohol use disorders during the study period. 34.4% of patients were admitted with a background of alcohol misuse. ICU stay was significantly different between the three study groups, with those in the alcohol dependency group having a longer stay (p=0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p=0.01). Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience; impact and support for activities of daily living; social support and cohesion; and the impact of alcohol use disorders on recovery. Conclusions: Alcohol related admissions account for a significant proportion of admissions to critical care and alcohol dependency is independently associated with ICU outcome. A more targeted rehabilitation pathway for all patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, needs to be generated

Critical care survival rates in COVID-19 patients improved as the first wave of the pandemic developed

No abstract available

Understanding the Impact of Critical Illness on Families: A Call for Standardization of Outcomes and Longitudinal Research.

No abstract available

COVID-19: Moving beyond the pandemic

Severe acute respiratory syndrome Coronavirus 2 (SARS‐CoV‐2) is the cause of COVID‐19. As of June 1st 2020, there were over 6 million cases of COVID‐19 internationally and over 370,000 deaths (John Hopkins University, 2020). There has been significant effort to increase hospital and healthcare capacity to reduce the number of fatalities associated with this global pandemic (Choi & Logsdon, 2020). Public health measures have been universally enforced, including the use of social distancing and self‐isolation for those most at risk. Due to this appropriate high demand in the acute phase of this pandemic, the long‐term sequalae of COVID‐19 has had less attention, and clinically much less focus

Acute respiratory distress syndrome as a precursor to post-intensive care syndrome

More than 6 million patients are cared for in an intensive care unit annually in the United States, and millions more internationally. Acute respiratory failure (ARF) is a common indication for intensive care unit admission, one that afflicts more than half of critically ill patients. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening form of ARF. With advances in care over the last 50 years, the majority of ARF and ARDS patients survive. The survivorship literature is largely one that describes functional impairments and reduced quality of life after critical illness. In this review article, we put forth the concept that ARDS is a precursor to post-intensive care syndrome, defined as new or worsening impairments in cognition, mental health, and/or physical health after critical illness. This "precursor" paradigm is suggested as a means to a better end for patients with ARDS, by detailing care provisions and strategies to optimize short-term and long-term outcomes

The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Purpose: This study aimed to establish which prognostic scoring tool provides the greatest discriminative ability when assessing critically ill cirrhotic patients in a general intensive care unit (ICU) setting.<p></p> Methods: This was a 12-month, single-centered prospective cohort study performed in a general, nontransplant ICU. Forty clinical and demographic variables were collected on admission to calculate 8 prospective scoring tools. Patients were followed up to obtain ICU and inhospital mortality. Receiver operating characteristic curve analysis was used to determine the discriminative ability of the scores. Univariate and multivariate analyses were used to identify any independent predictors of mortality in these patients. The incorporation of any significant variables into the scoring tools was assessed.<p></p> Results: Fifty-nine cirrhotic patients were admitted over the study period, with an ICU mortality of 31%. All scores other than the renal-specific Acute Kidney Injury Network score had similar discriminative abilities, producing area under the curves of between 0.70 and 0.76. None reached the clinically applicable level of 0.8. The Sequential Organ Failure Assessment score was the best performing score. Lactate and ascites were individual predictors of ICU mortality with statistically significant odds ratios of 1.69 and 5.91, respectively. When lactate was incorporated into the Child-Pugh score, its prognostic accuracy increased to a clinically applicable level (area under the curve, 0.86).<p></p> Conclusions: This investigation suggests that established prognostic scoring systems should be used with caution when applied to the general, nontransplant ICU as compared to specialist centers. Our data suggest that serum arterial lactate may improve the prognostic ability of these scores

The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit

Purpose: Patients with alcohol-related disease constitute an increasing proportion of those admitted to intensive care unit. There is currently limited evidence regarding the impact of alcohol use on levels of agitation, delirium and sedative requirements in intensive care unit. This study aimed to determine whether intensive care unit-admitted alcohol-abuse patients have different sedative requirements, agitation and delirium levels compared to patients with no alcohol issues. Methods: This retrospective analysis of a prospectively acquired database (June 2012–May 2013) included 257 patients. Subjects were stratified into three risk categories: alcohol dependency (n ¼ 69), at risk (n ¼ 60) and low risk (n ¼ 128) according to Fast Alcohol Screening Test scores and World Health Organisation criteria for alcohol-related disease. Data on agitation and delirium were collected using validated retrospective chart-screening methods and sedation data were extracted and then log-transformed to fit the regression model. Results: Incidence of agitation (p ¼ 0.034) and delirium (p ¼ 0.041) was significantly higher amongst alcohol-dependent patients compared to low-risk patients as was likelihood of adverse events (p ¼ 0.007). In contrast, at-risk patients were at no higher risk of these outcomes compared to the low-risk group. Alcohol-dependent patients experienced suboptimal sedation levels more frequently and received a wider range of sedatives (p ¼ 0.019) but did not receive higher daily doses of any sedatives. Conclusions: Our analysis demonstrates that when admitted to intensive care unit, it is those who abuse alcohol most severely, alcohol-dependent patients, rather than at-risk drinkers who have a significantly increased risk of agitation, delirium and suboptimal sedation. These patients may require closer assessment and monitoring for these outcomes whilst admitted