Post-intensive care syndrome: A concept analysis

Being a patient in the intensive care unit: a narrative approach to understanding patients' experiences of being awake and on mechanical ventilation

PURPOSE

Intensive care patients often struggle to communicate due to the technical equipment used for mechanical ventilation and their critical illness. The aim of the study was to achieve a deeper understanding of how mechanically ventilated intensive care patients construct meaning in the unpredictable trajectory of critical illness.

METHODS

The study was a part of a larger study in which ten patients were video recorded while being in the intensive care. Five patients engaged in interviews about their experiences from the intensive care stay after being discharged and were offered the possibility to see themselves in the video recordings. A narrative, thematic analysis was applied to categorize the patients' experiences from the intensive care.

RESULTS

A pattern of shared experiences among intensive care patients were identified. Three main themes capture the patient's experiences: 1) perceiving the intensive care stay as a life-changing turning point, 2) being dependent on and cared for by others, and 3) living with negative and positive ICU experiences.

CONCLUSION

The patients' narratives revealed how being critically ill affected them, and how they understood their experiences in relation to themselves and their surroundings. The results can be used to pose important questions about our current clinical practice.

A scoping review of incidence and assessment tools for post-intensive care syndrome following cardiac surgery

BACKGROUND

Post-intensive care syndrome is a new or worsening persistent deterioration in cognitive, mental, and/or physical health following a prolonged admission to an intensive care unit. Post-intensive care syndrome remains underexplored following cardiac surgery, with a lack of understanding of the incidence and tools used to measure the symptoms. A scoping review was conducted to determine the incidence and to identify the tools commonly used to measure symptoms of post-intensive care syndrome following cardiac surgery.

METHODS

The electronic databases Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Scopus, and CINAHL (EBSCOhost) and Google Scholar were searched with keywords and controlled vocabulary to describe both cardiac surgery and post-intensive care syndrome (cardiac surgical procedures, heart surgery, and post-intensive care symptoms) and symptoms (delirium, depression, mobility and quality of life). Included were articles written in English and published after 2005 that described cognitive, mental, and physical symptoms of post-intensive care syndrome following cardiac surgery. 3,131 articles were found, with 565 duplicates, leaving 2,566 articles to be screened. Of these, seven unique studies were included.

RESULTS

Five studies explored cognitive health, three mental health, one cognitive and mental health, and none physical health. No identified studies reported the overall incidence of post-intensive care syndrome following cardiac surgery. The incidence of cognitive health issues ranged from 21% to 38%, and mental health issues ranged from 16% to 99%. In total, 17 different tools were identified - 14 for cognitive health and three for mental health. No identified studies used the same tools to measure symptoms. No single tool was found to measure all three domains.

CONCLUSION

This scoping review identified a literature gap specific to the incidence and inconsistency of assessment tools for post-intensive care syndrome in cardiac surgery patients.

CLINICAL IMPLICATIONS

This work impacts clinical practice for the bedside nurse by raising awareness of an emerging health issue.

Artificial intelligence and machine learning: Definition of terms and current concepts in critical care research

With increasing computing power, artificial intelligence (AI) and machine learning (ML) have prospered, which facilitate the analysis of large datasets, especially those found in critical care. It is important to define these terminologies, to inform a standardized approach to critical care research. This manuscript hopes to clarify these terms with examples from medical literature. Three major components that are required for a successful ML implementation: (i) reliable dataset, (ii) ML algorithm, and (iii) unbiased model evaluation, are discussed. A reliable dataset can be structured or unstructured with limited noise, outliers, and missing values. ML, a subset of AI, is typically focused on supervised or unsupervised learning tasks in which the output is based on inputs and derived from iterative pattern recognition algorithms, while AI is the overall ability of a machine to "think" or mimic human behavior; and to analyze data free from human influence. Even with successful implementation, advanced AI and ML algorithms have faced challenges in adoption into practice, mainly due to their lack of interpretability, which hinders trust, buy-in, and engagement from clinicians. Consequently, traditional algorithms, such as linear and logistic regression, that may have reduced predictive power but are highly interpretable, continue to be widely used.

Predictive factors for critical care dependency after posterior spinal fusion for adolescent idiopathic scoliosis

Aims

Historically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with posterior spinal fusion (PSF).

Methods

We retrospectively reviewed all AIS patients who had undergone PSF between January 2018 and January 2020 in a specialist tertiary spinal referral centre. All patients were assessed preoperatively in an anaesthetic clinic. Postoperative care was defined as ward-based (WB) or critical care (CC), based on the preoperative FEV1, FVC, major curve Cobb angle, and the planned number of instrumented levels.

Results

Overall, 105 patients were enrolled. Their mean age was 15.5 years (11 to 25) with a mean weight of 55 kg (35 to 103). The mean Cobb angle was 68° (38° to 122°). Of these, 38 patients were preoperatively scored to receive postoperative CC. However, only 19% of the cohort (20/105) actually needed CC-level support. Based on these figures, and an average paediatric intensive care unit stay of one day before stepdown to ward-based care, the potential cost-saving on the first postoperative night for this cohort was over £20,000. There was no statistically significant difference between the Total Pathway Score (TPS), the numerical representation of the four factors being assessed, and the actual level of care received (p = 0.052) or the American Society of Anesthesiologists grade (p = 0.187). Binary logistic regression analysis of the TPS variables showed that the preoperative Cobb angle was the only variable which significantly predicted the need for critical care.

Conclusion

Most patients undergoing posterior fusion surgery for AIS do not need critical care. Of the readily available preoperative measures, the Cobb angle is the only predictor of the need for higher levels of care, and has a threshold value of 74.5°.

Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care

Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another location or level of care. Transitions theory is a middle-range nursing theory that aims to provide guidance for safe and effective nursing care and research while an individual experiences a transition. Intensive care unit nurses are well positioned to provide ICU transitional care planning early. This article applies the transitions theory as a theoretical model to guide the study of the transition to home after acute hospital care for ICU patients and their families. This theory application can help ICU nurses provide holistic patient- and family-centered transitional care to achieve optimal outcomes by addressing the predischarge and postdischarge needs of patients and families.

Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention

Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.

Peer support in intensive care unit follow-up: A qualitative evaluation

BACKGROUND

Patients formerly admitted to an intensive care unit and their relatives seek information about life after critical illness to understand their symptoms and what to expect as survivors, and they express a desire to talk to others with similar experiences. Various operational models of post-intensive care peer support exist, and studies have reported potential beneficial mechanisms in patients involved in peer support programs. However, most models have not been formally evaluated.

AIM

To evaluate the content and setting of structured group meetings and explore participants' experiences of meeting peers.

STUDY DESIGN

A qualitative evaluation combining focused ethnographic observations and semi-structured interviews with 22 participants attending three intensive care unit café meetings in a university hospital. A thematic analysis was conducted using all data collected.

FINDINGS

Three main themes emerged; 'Accommodating the diversity of patients and relatives', 'A range of possibilities for identification' and 'A newfound community'. Findings indicate that the content, setting and timing of the café meetings were of minor concern for the participants. Patients and relatives should attend together because the consequences of surviving a critical illness affect both. Larger groups of participants appeared to increase the likelihood of encountering broad variances in participants' experiences from the critical illness trajectory. The findings indicate that before attending a meeting, the participants did not find previous experiences sufficient in managing their new life situations and they felt alone in their experiences.

CONCLUSION

Peer support invited participants into a secure community and eased their sense of being alone in their struggles. Meeting peers seemed to be more important than following a specific model of peer support.

RELEVANCE TO CLINICAL PRACTICE

When setting up peer support for former intensive care patients, the most important aspect is to create a secure space for patients and their relatives to meet.

Integrating Perspectives on Family Caregiving After Critical Illness: A Qualitative Content Analysis

BACKGROUND

To date, no intervention has definitively improved outcomes for families of critical illness survivors. An integrated perspective on caregivers' needs after critical illness could help identify high-priority intervention targets and improve outcomes.

OBJECTIVES

To obtain diverse perspectives on the needs, barriers and facilitators, and social determinants of health associated with family caregiving across the critical illness continuum and assess the extent to which successful caregiving interventions in other populations may be adapted to the critical illness context.

METHODS

This qualitative content analysis of 31 semistructured interviews and 10 focus groups with family caregivers, health care providers, and health care administrators explored family caregivers' needs during post- intensive care unit (ICU) transitions and the barriers and facilitators associated with addressing them. Trained coders analyzed transcripts, identified patterns and categories among the codes, and generated themes.

RESULTS

Caregivers have 3 instrumental needs: formal and informal support, involvement in care planning, and education and training. Only caregivers described their self-care and mental health needs. Social determinants of health are the key barriers and facilitators shaping the caregivers' journey, and caregiving as a social determinant of health was a prominent theme.

CONCLUSIONS

Caregivers have instrumental, self-care, and mental health needs after critical illness. Adapting hands-on and skills training interventions to the post-ICU setting, while tailoring interventions to caregivers' health-related social context, may improve caregiver outcomes.

Development and validation of a risk score to predict unplanned hospital readmissions in ICU survivors: A data linkage study

BACKGROUND

Intensive Care Unit (ICU) follow-up clinics are growing in popularity internationally; however, there is limited evidence as to which patients would benefit most from a referral to this service.

OBJECTIVES

The objective of this study was to develop and validate a model to predict which ICU survivors are most likely to experience an unplanned hospital readmission or death in the year after hospital discharge and derive a risk score capable of identifying high-risk patients who may benefit from referral to follow-up services.

METHODS

A multicentre, retrospective observational cohort study using linked administrative data from eight ICUs was conducted in the state of New South Wales, Australia. A logistic regression model was developed for the composite outcome of death or unplanned readmission in the 12 months after discharge from the index hospitalisation.

RESULTS

12,862 ICU survivors were included in the study, of which 5940 (46.2%) patients experienced unplanned readmission or death. Strong predictors of readmission or death included the presence of a pre-existing mental health disorder (odds ratio [OR]: 1.52, 95% confidence interval [CI]: 1.40-1.65), severity of critical illness (OR: 1.57, 95% CI: 1.39-1.76), and two or more physical comorbidities (OR: 2.39, 95% CI: 2.14-2.68). The prediction model demonstrated reasonable discrimination (area under the receiver operating characteristic curve: 0.68, 95% CI: 0.67-0.69) and overall performance (scaled Brier score: 0.10). The risk score was capable of stratifying patients into three distinct risk groups-high (64.05% readmitted or died), medium (45.77% readmitted or died), and low (29.30% readmitted or died).

CONCLUSIONS

Unplanned readmission or death is common amongst survivors of critical illness. The risk score presented here allows patients to be stratified by risk level, enabling targeted referral to preventative follow-up services.

Quality of life in ICU survivors and their relatives with post-intensive care syndrome: A systematic review

BACKGROUND

Post-intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status.

AIM

This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post-intensive care syndrome (PICS-F) and to report anxiety, depression and Post-Traumatic Stress Disorders (PTSD) in studies investigating PICS.

STUDY DESIGN

A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123).

RESULTS

We included 19 studies of PICS and PICS-F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post-traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain-related symptoms and sleep disorders were problems encountered by ICU relatives with PICS-F.

CONCLUSION

PICS and PICS-F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS-F on QoL.

RELEVANCE TO CLINICAL PRACTICE

PICS and PICS-F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission.

Incidence rate and risk factors for post-intensive care syndrome subtypes among critical care survivors three months after discharge: A prospective cohort study

OBJECTIVES

To investigate the incidence of post-intensive care syndrome subtypes and their risk factors among intensive care unit survivors.

RESEARCH METHODOLOGY/DESIGN

This prospective observational cohort study assessed post-intensive care syndrome at three months after discharge in 475 survivors (median age of 62 years, 59.4 % male) admitted for more than 24 hours to 19 intensive care units.

SETTING

19 intensive care units at four university hospitals in Korea.

MAIN OUTCOME MEASURES

Three months after discharge, the Hospital Anxiety and Depression Scale, Posttraumatic Diagnosis Scale, Montreal Cognitive Assessment, and Activities of Daily Living were used to evaluate post-intensive care syndrome.

RESULTS

Participants exhibited eight subtypes of post-intensive care syndrome: post-intensive care syndrome free (50.3 %), impaired in physical (3.4 %), mental (13.5 %), cognitive (12.4 %), physical and mental (7.8 %), physical and cognitive (2.3 %), mental and cognitive (4.0 %) and all three domains (6.3 %). Age, unemployment, education, comorbidities, unplanned admission, longer stay, and place of discharge were risk factors for each domain. Age ≥ 65 years (OR 9.234, p < .001), female gender (OR = 5.143, p = .002), two or more comorbidities (OR = 8.701, p = .002), and discharge to an extended care facility (OR = 36.040, p < .001) were associated with increased probability of impairment in all three domains.

CONCLUSION

The type with impaired in both mental and physical domains was the most prevalent in cases of co-occurrence. Discharge to an extended care facility was one of the most significant risk factor for the occurrence of each domain and intensity of post-intensive care syndrome.

IMPLICATIONS FOR CLINICAL PRACTICE

Nurses must promote prevention strategies by proactively evaluating intensive care unit survivors for post-intensive care syndrome risk factors. Additionally, it is necessary to raise healthcare providers' awareness of post-intensive care syndrome evaluation and management in extended care facilities.

Perceptions of adult intensive care unit patients regarding nursing presence and their intensive care experiences: A descriptive-correlational study

AIMS AND OBJECTIVES

This study aims to determine the relationship between perceptions of nursing presence and intensive care experiences in adult intensive care unit patients'.

BACKGROUND

Intensive care units (ICUs) are settings where patients have many negative emotions and experiences, which affect both treatment and post-discharge outcomes. The holistic presence of nurses may help patients turn their negative emotions and experiences into positive ones.

DESIGN

A descriptive-correlational design was used and reported according to the STROBE checklist.

METHODS

The sample consisted of 182 participants. Data were collected using a personal information form, the Glasgow Coma Scale (GCS), the Intensive Care Experience Scale (ICES), and the Presence of Nursing Scale (PONS).

RESULTS

A strong positive correlation existed between total ICES and PONS scores (r = 0.889, p < 0.001). There was a strong positive correlation between PONS total score and ICES subscales (awareness of surroundings (r = 0.751, p < 0.001), frightening experiences (r = 0.770, p < 0.001), recall of experience (r = 0.774, p < 0.001), and satisfaction with care (r = 0.746, p < 0.001)). Males (β = -0.139, p < 0.05), and patients who were university and higher education graduate (β = 0.137, p < 0.05) had higher positive ICU experiences. It was also found length of ICU stay was correlated with ICU experiences and nursing presence.

CONCLUSIONS

The more positively the patients perceive nurses, the better ICU experiences they have. Gender and education level were found determinants of adult ICU patients' experiences. ICU length of stay predicted what kind of experience patients have and how much they feel the presence of nurses.

RELEVANCE TO CLINICAL PRACTICE

Nurses should make their presence felt completely and holistically by using their communication skills for patients have more positive intensive care experiences. Nurses should consider variables which affects patients' ICU experiences and nursing presence.

The intensive care unit diary as a valuable care tool: A qualitative study of patients' experiences

OBJECTIVES

The aim is to learn about patients' experience of reading the diary, assess attributed meaning and explore patients' experience and memories during their stay in the intensive care unit.

SETTING

Eleven patients who received the diary after a stay in a nine-bed cardiac intensive care unit in Southern Switzerland, from November 2019 to October 2021.

MAIN OUTCOME MEASURES

Descriptive qualitative research was performed using semi-structured interviews, followed by thematic analysis. Three research nurses conducted individual telephone or face-to-face interviews.

FINDINGS

Fifteen sub-themes emerged from the data interviews and were grouped into five main categories: a) the experience in the intensive care unit; b) Post Intensive Care Syndrome symptoms; c) the patient diary; d) new meaning of life; and e) sharing. Patients showed difficulties in remembering and understanding what happened during the hospitalization period. Reading the diary enabled them to understand the impact that the illness had on their daily experience. For some of them, reading the diary was helpful in reacting positively during moments of discouragement.

CONCLUSION

Qualitative approach allowed us to assess how patients perceive the diary in the intensive care unit in a cultural context of Central and Southern Europe, which is still poorly investigated. The diary responded to the person's need to know what happened during a period that they had no memory of. Its use demonstrated important benefits, allowing people to understand the impact that the illness had on everyday life. It allowed them to relate to the difficulties encountered during the healing process. Thus, the diary played an important role during the healing process.

IMPLICATIONS FOR CLINICAL PRACTICE

The diary was appreciated by patients during all stages of recovery from severe and acute illness. Gaps within the narration were avoided, in order to provide patients with a better timeline of the events occurred during the time they were unconscious.

Cognitive impairment in critically ill patients and former critically ill patients: A concept analysis

OBJECTIVES

This concept analysis aimed to clarify the meaning of the concept of cognitive impairment in critically ill patients throughout the trajectory of their rehabilitation during and after an intensive care unit admission.

REVIEW METHODS USED

This study used concept analysis based on Rodgers' evolutionary method.

DATA SOURCES

A systematic search was conducted in Cumulative Index to Nursing and Allied Health Literature, Public MEDLINE, and American Psychological Associations PsycINFO. The web was searched for grey literature.

REVIEW METHODS

Overall search terms used were "patients with cognitive impairments" AND "intensive care unit". Literature published between 2008 and 2022 was included and screened by title and abstract using systematic review software. The descriptive analysis focussed on surrogate terms/related concepts, attributes, and contextual basis.

RESULTS

Thirty studies were included, representing variability in study design and country of origin. The analysis uncovered descriptions of the general terminology and the temporal trajectory of the concept, spanning from the acute phase to a long-term perspective. Attributes of the concept were described as delirium and domains of cognition. Antecedents were juxtaposed to risk factors, which were multifactorial. Consequences of cognitive impairment related to patients' quality of life, such as a decline in their ability to function independently, return to work, and manage everyday life. Also, cognitive impairment was identified as a significant public health problem.

CONCLUSION

Cognitive impairment is a complex concept with many surrogate and related terms. Furthermore, the concept is inextricably intertwined with the concepts of delirium and post-intensive care syndrome. Cognitive impairment may manifest as symptoms that can be challenging to identify and assess due to limitations in current screening tools and the absence of a consensus on timing. In relation to assessment and preventive strategies, the findings underline the need to distinguish between acute and long-term cognitive impairment.

REGISTRATION

There is no study registration number.

Barriers and facilitators to offering post-intensive care follow-up services from the perspective of critical care professionals: A qualitative study

BACKGROUND

Various programmes and models for post-intensive care unit (ICU) follow-up services have been developed worldwide. In China, post-ICU follow-up remains in the exploratory stage and little is known regarding the appropriate form and challenges of implementation, which need to be further explored.

AIM

This study aimed to explore and describe the barriers to and facilitators of post-ICU follow-up services from the perspective of critical care professionals.

DESIGN

This was a descriptive qualitative study. Semi-structured interviews were conducted with 21 health care workers whose units had offered ICU survivors different forms of follow-up services; the data were analysed by qualitative content analysis during August 2022 and December 2022.

SETTING

The study was conducted at 14 ICUs in 11 tertiary hospitals in Shanghai, China.

FINDINGS

Seventeen subthemes were extracted as barriers and facilitators in the follow-up of ICU survivors. In the initiating process, the barriers included the restriction of decision-making rights and scope of practice, indifferent attitude towards survivors and repeated work. The facilitators included admitted significance, the needs of ICU survivors, the conscientiousness of professionals and the pioneers and leadership support. In the implementation process, lack of confidence, lack of cooperation in medical consortium, distrusted relationships, restrictions of medical insurance, ageing problems and insufficient human resources acted as barriers, whereas lessons learned, positive feedback and digital support served as facilitators. Furthermore, recommendations and tips were identified for offering follow-up services.

CONCLUSION

Medical personnel can better utilize available resources and develop strategies to overcome constraints by gaining insights into the abovementioned barriers and facilitators. The findings of this study can provide a useful reference for structured and systematic follow-ups to ameliorate post-intensive care syndrome in low- and middle-income countries.

RELEVANCE TO CLINICAL PRACTICE

Publicity and educational measures play a crucial role in enhancing the awareness of survivors and the consensus of health care professionals from medical consortium regarding impairments after critical care. Leadership and policy support can address numerous obstacles to guiding follow-up services.

Critical illness survivors' experiences of attending an intensive care unit follow-up service: a systematic review protocol

OBJECTIVE

The objective of this review is to explore critical illness survivors' experiences of attending an intensive care unit (ICU) follow-up service.

INTRODUCTION

A significant proportion of critical illness survivors will require ICU follow-up care to support adverse symptoms in health domains, including cognition, mental health, and physical and social function. While there is consensus on the need for ICU follow-up services, systematic reviews to date have not identified any significant impact of ICU follow-up services on clinical health outcomes. An understanding of survivors' experiences of attending an ICU follow-up service may improve the effectiveness and design of such services.

INCLUSION CRITERIA

This review will include studies that explore the experiences of adult ( 18 years of age) critical illness survivors who attended an ICU follow-up service following discharge from an ICU, regardless of the admitting diagnosis or ICU length of stay.

METHODS

This review will be conducted in line with the JBI methodological framework for qualitative systematic reviews. Electronic databases, including MEDLINE, CINAHL, PsycINFO, Embase, and Web of Science Core Collection, will be searched to identify relevant studies for inclusion in the review. Studies will be screened by 2 independent reviewers. Critical appraisal, data extraction, and data synthesis will be completed by 2 independent reviewers using a meta-aggregation method for data synthesis. Confidence in the research findings will be assessed and assigned a ConQual score.

REVIEW REGISTRATION

PROSPERO CRD42023404585.

Functional Status in Older Adults following Hospitalization for COVID-19: A Cohort Study

BACKGROUND

Coronavirus disease 2019 (COVID-19) can cause multiple acute complications. This study evaluated the long-term functional status of older patients hospitalized for acute COVID-19.

METHODS

We analyzed data from a multicenter ambispective cohort study on patients aged >60 years who were hospitalized for COVID-19 at two tertiary care hospitals in Argentina. The participants were contacted by telephone between November 2021 and September 2022 to collect data on their functional status. Ordinal logistic regression was used to identify factors associated with functional limitations after discharge.

RESULTS

Among the 374 included patients, 205 (55%) showed functional limitations, including 58 (28%) who died during follow-up. The factors independently associated with functional limitations were low baseline functional status (odds ratio [OR]=9.19; 95% confidence interval [CI], 3.35-25.17) and admission to the intensive care unit (OR=4.41; 95% CI, 2.28-8.53). Men had lower odds of functional impairment (OR=0.55; 95% CI, 0.35-0.86).

CONCLUSION

Older patients had high mortality rates and poor functional status at 2 years post-discharge for COVID-19. Several factors at the time of discharge were associated with a higher risk of functional limitations and can be used to identify patients' long-term needs for support and rehabilitation services.

A comparation of dexmedetomidine and midazolam for sedation in patients with mechanical ventilation in ICU: A systematic review and meta-analysis

BACKGROUND

The use of dexmedetomidine rather than midazolam may improve ICU outcomes. We summarized the available recent evidence to further verify this conclusion.

METHODS

An electronic search of PubMed, Medline, Embase, Cochrane Library, and Web of Science was conducted. Risk ratios (RR) were used for binary categorical variables, and for continuous variables, weighted mean differences (WMD) were calculated, the effect sizes are expressed as 95% confidence intervals (CI), and trial sequential analysis was performed.

RESULTS

16 randomized controlled trials were enrolled 2035 patients in the study. Dexmedetomidine as opposed to midazolam achieved a shorter length of stay in ICU (MD = -2.25, 95%CI = -2.94, -1.57, p<0.0001), lower risk of delirium (RR = 0.63, 95%CI = 0.50, 0.81, p = 0.0002), and shorter duration of mechanical ventilation (MD = -0.83, 95%CI = -1.24, -0.43, p<0.0001). The association between dexmedetomidine and bradycardia was also found to be significant (RR 2.21, 95%CI 1.31, 3.73, p = 0.003). We found no difference in hypotension (RR = 1.44, 95%CI = 0.87, 2.38, P = 0.16), mortality (RR = 1.02, 95%CI = 0.83, 1.25, P = 0.87), neither in terms of adverse effects requiring intervention, hospital length of stay, or sedation effects.

CONCLUSIONS

Combined with recent evidence, compared with midazolam, dexmedetomidine decreased the risk of delirium, mechanical ventilation, length of stay in the ICU, as well as reduced patient costs. But dexmedetomidine could not reduce mortality and increased the risk of bradycardia.

Quality of Life of Sepsis Survivors

OBJECTIVE

To determine the differences between the quality of life for sepsis and nonsepsis survivors, factors affecting the quality of life for sepsis survivors, and their changes over time.

DESIGN

A prospective longitudinal study with a quantitative comparative design.

SETTING

A university hospital in the greater Tokyo area of Japan.

PATIENTS

The study included 41 and 40 patients in the sepsis and nonsepsis groups, respectively.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Health-related quality of life (HRQOL), independence in activities of daily living (ADL), stress levels, and spirituality were compared between the sepsis and nonsepsis groups at ICU discharge, hospital discharge, and 1 month after discharge. Comparison of HRQOL between the sepsis and nonsepsis groups showed significantly low HRQOL in the sepsis group compared with the nonsepsis group at ICU discharge and hospital discharge. Factors such as stress levels and spirituality affected the HRQOL in the nonsepsis group at ICU discharge. At discharge, stress and spirituality affected HRQOL in both the sepsis and nonsepsis groups. One month after discharge, ADL, stress, and spirituality affected HRQOL in both the sepsis and nonsepsis groups. In terms of changes over time, HRQOL at ICU discharge in the sepsis group was significantly lower than at discharge and 1 month after discharge. The two-way analyses of variance showed no interactions between the groups and time regarding HRQOL.

CONCLUSIONS

HRQOL of sepsis survivors was significantly lower than that of nonsepsis survivors. ADL and stress influenced HRQOL. The study suggests the importance of ADL training and stress alleviation during the ICU stay.

Effect of CICARE communication nursing model combined with motivational psychological intervention in patients with post-intensive care unit syndrome

BACKGROUND

Post-intensive care syndrome (PICS) is a term used to describe a constellation of new or worsened dysfunctions in the physical, cognitive, or mental health status of critically ill patients after their discharge from the intensive care unit (ICU). These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family. Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication advocates that patients should be respected and accepted when receiving medical services. Clinicians should attach importance to the communication mode of feelings, including connection, introduction, communication, ask, response, and exit 6 steps.

AIM

To assess the impact of CICARE communication on the reduction of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms in patients transitioning from the ICU to other care settings.

METHODS

This prospective, randomized, controlled study was performed between October 2021 and March 2023. Intensive Care Unit Memory Tool was used to evaluate patients' ICU memory. The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms. Impact of Event Scale-Revised was utilized to assess the presence of PTSD. All data were processed and analyzed using R language software version 4.1.0. The measurement data were expressed as mean ± SD, and the t test was used. The count data were analyzed by the χ2 test and expressed as [n (%)].

RESULTS

In total, 248 subjects were included in this study. Among them, 206 were successfully followed up for three months after transfer from the ICU, and 42 cases were lost to follow-up. There was no significant difference in the composition of ICU memory between the two groups. The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model, as well as the adoption of only the motivational psychological intervention nursing model, demonstrated favorable effects on PICS. Both groups of patients showed a reduction in anxiety scores, depression scores, and PTSD scores following the implementation of these two nursing models. However, it is noteworthy that the experimental group exhibited greater improvements compared to the control group.

CONCLUSION

Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.

Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review

BACKGROUND

Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life.

OBJECTIVES

We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies.

METHOD

A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines.

FINDINGS

We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools.

CONCLUSION

These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.

Practices of the ABCDEF care bundle in intensive care units as reported by nurses: A cross-sectional study from Turkey

BACKGROUND

Recent critical care guidelines recommended the evidence-based ABCDEF care bundle for intensive care unit (ICU) patients. However, limited information is available on the implementation of the bundle in Turkish ICUs.

AIM

To assess the current practices of the ABCDEF care bundle as reported by ICU nurses.

STUDY DESIGN

A cross-sectional study using a web-based survey was conducted. Researchers invited nurses with at least 1 year of ICU experience to participate by sending the link to the research questionnaires they created in Google Forms to the one ICU nurse association and one communication group of which they are members.

RESULTS

A total of 342 ICU nurses completed the survey. Although 92% of the participants performed pain assessments in their ICUs, 52.7% reported not using protocols. Based on the responses of the nurses, spontaneous awakening and breathing trials are performed in 88.8% and 92.4%, respectively, of ICUs. Fewer than half of the participants reported following a sedation protocol in their ICUs. Only 54.7% of ICU nurses surveyed reported routinely monitoring patients for delirium. It was reported that early mobilization was practised in 68.7% of ICUs, but non-ventilated patients were mobilized more frequently (70.2%), and 9.7% of ICUs had mobilization teams. Family members were actively involved in 95% of ICUs; however, 9.7% used dedicated staff to support families and 3.5% reported that their unit was open 24 h/day for visits.

CONCLUSIONS

While the implementation of most pain and sedation evaluations in ICUs were reported by nurses, many of them did not use structured delirium assessments. There is a need to encourage early mobilization programs and family participation.

RELEVANCE TO CLINICAL PRACTICE

Health institutions can improve patient care and outcomes by establishing and standardizing a protocol for each component of the ABCDEF care bundle in ICUs.

Proposal of nursing diagnosis "adult disuse syndrome": A conceptual derivation and integrative review

PURPOSE

To develop a nursing diagnosis proposal derived from the concept of "disuse syndrome" based on an integrative review.

METHODS

The conceptual derivation technique, proposed by Walker and Avant, was used in the following phases: an integrative review of the literature was carried out, applying the parameters of Whitermore and Knalf, where 43 articles were selected that covered the existence of the concept in the nursing discipline and other health sciences, the concepts were subsequently analyzed, and the new concept was redefined following the middle-range theory of causality and validation of nursing diagnoses proposed by Oliveira-Lopes et al.

FINDINGS

The proposal of the new nursing diagnosis was developed, including the following elements: diagnostic label adult disuse syndrome, the corresponding definition, 25 defining characteristics, eight related factors, eight risk populations, and 14 associated problems.

CONCLUSIONS

The concept of the proposed new diagnosis describes adult disuse syndrome as a phenomenon that transcends the physiological component and should be viewed from a multidimensional view, expressing a clinical judgment related to a series of nursing diagnoses that appear together.

IMPLICATIONS FOR NURSING PRACTICE

The results of this study will help nursing professionals to identify the phenomenon of adult disuse syndrome in any setting and in turn guide optimal care interventions that decrease the consequences of adult disuse syndrome.

Critical care: A concept analysis

Objective

The terms critical care and the Intensive Care Unit (ICU) are often used interchangeably to describe a place of care. Defining critical care becomes challenging because of the colloquial use of the term. Using concept analysis allows for the development of definition and meaning. The aim of this concept analysis is to distinguish the use of the term critical care to develop an operational definition which describes what constitutes critical care.

Method

Walker and Avant's eight-step approach to concept analysis guided this study. Five databases (CINAHL, Scopus, PubMed, ProQuest Dissertation Abstracts and Medline in EBSCO) were searched for studies related to critical care. The search included both qualitative and quantitative studies written in English and published between 1990 and 2022.

Results

Of the 439 papers retrieved, 47 met the inclusion criteria. The defining attributes of critical care included 1) a maladaptive response to illness/injury, 2) admission modelling criteria, 3) advanced medical technologies, and 4) specialised health professionals. Antecedents were associated with illness/injury that progressed to a level of criticality with a significant decline in both physical and psychological functioning. Consequences were identified as either death or survival with/without experiencing post-ICU syndrome.

Conclusion

Describing critical care is often challenging because of the highly technical nature of the environment. This conceptual understanding and operational definition will inform future research as to the scope of critical care and allow for the design of robust evaluative instruments to better understand the nature of care in the intensive care environment.

Multidisciplinary ICU Recovery Clinic Visits: A Qualitative Analysis of Patient-Provider Dialogues

BACKGROUND

Research confirms the heterogeneous nature of patient challenges during recovery from the ICU and supports the need for modifying care experiences, but few data are available to guide clinicians seeking to support patients' individual recovery trajectories.

RESEARCH QUESTION

What is the content of patient-provider dialogues in a telemedicine multidisciplinary ICU recovery clinic (ICU-RC)?

STUDY DESIGN AND METHODS

We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the southeastern United States. The sample included 19 patients and 13 caregivers (≥ 18 years of age) attending a telemedicine ICU-RC visit after critical illness resulting from septic shock or ARDS. Patients and caregivers met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 33 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches.

RESULTS

Two themes were identified from the patient-provider dialogue: (1) problem identification and (2) problem-solving strategies. We identified five subthemes that capture the types of problems identified: health status, mental health and cognition, medication management, health-care access and navigation, and quality of life. Problem-solving subthemes included facilitating care coordination and transitions, providing education, and giving constructive feedback and guidance.

INTERPRETATION

Patients surviving a critical illness experience a complexity of problems that may be addressed best by a multidisciplinary ICU-RC. Through analysis of our telemedicine ICU-RC dialogues, we were able to identify problems and solutions to address challenges during a critical transitional phase of ICU recovery.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT03926533; URL: www.

CLINICALTRIALS

gov.

Patient and caregiver experiences with a telemedicine intensive care unit recovery clinic

BACKGROUND

Intensive Care Unit Recovery Clinics (ICU-RCs) were founded to address post-intensive care syndrome among ICU survivors. Telemedicine ICU-RCs may facilitate access for more ICU survivors, however, patient and caregiver experiences with telemedicine ICU-RCs have not been explored qualitatively.

OBJECTIVE

To explore patient and informal caregiver experiences with a telemedicine ICU-RC.

METHODS

Our qualitative exploratory cross-sectional study was guided by qualitative description methodology. Telemedicine ICU-RC visits were conducted at 3- and 12-weeks post-discharge following critical illness. Patients, and caregivers when available, met with an ICU pharmacist, ICU physician, and a neuropsychologist via Zoom. Thereafter, we conducted qualitative (1:1) telephone interviews with 14 patients and 12 caregivers recruited purposefully. Data were analyzed using conventional content analysis.

RESULTS

Five themes were identified: (1) general impressions of the intervention; (2) intervention organization and delivery; (3) intervention substance; (4) caregiver participation; and (5) ways to improve the intervention. Participants found the telemedicine delivery acceptable, convenient, time-saving, and conducive to thorough discussions. Participants appreciated the information, reassurance, and validation. Attention to mental health during the visits was strongly endorsed. Caregiver involvement depended on patient self-management and technical ability. Suggestions included scheduling a 1-week post-discharge visit, more follow-up visits, and individualizing content for in-depth discussions, including mental health evaluation.

CONCLUSIONS

The study results enhance the understanding of patient and caregiver experiences with a telemedicine ICU-RC. Participants' narratives helped to formulate recommendations to improve telemedicine ICU-RC delivery and content. Acceptability of this intervention indicates the potential for wider implementation of telemedicine ICU-RCs to reach more ICU survivors.

Influence of Deep Sedation in Intensive Care Medicine Memories of Critical COVID-19 Survivors

Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.

Logistic regression technique is comparable to complex machine learning algorithms in predicting cognitive impairment related to post intensive care syndrome

To evaluate the performance of machine learning (ML) models and to compare it with logistic regression (LR) technique in predicting cognitive impairment related to post intensive care syndrome (PICS-CI). We conducted a prospective observational study of ICU patients at two tertiary hospitals. A cohort of 2079 patients was screened, and finally 481 patients were included. Seven different ML models were considered, decision tree (DT), random forest (RF), XGBoost, neural network (NN), naïve bayes (NB), and support vector machine (SVM), and compared with logistic regression (LR). Discriminative ability was evaluated by area under the receiver operating characteristic curve (AUC), calibration belt plots, and Hosmer-Lemeshow test was used to assess calibration. Decision curve analysis was performed to quantify clinical utility. Duration of delirium, poor Richards-Campbell sleep questionnaire (RCSQ) score, advanced age, and sepsis were the most frequent and important candidates risk factors for PICS-CI. All ML models showed good performance (AUC range: 0.822-0.906). NN model had the highest AUC (0.906 [95% CI 0.857-0.955]), which was slightly higher than, but not significantly different from that of LR (0.898 [95% CI 0.847-0.949]) (P > 0.05, Delong test). Given the overfitting and complexity of some ML models, the LR model was then used to develop a web-based risk calculator to aid decision-making ( https://model871010.shinyapps.io/dynnomapp/ ). In a low dimensional data, LR may yield as good performance as other complex ML models to predict cognitive impairment after ICU hospitalization.

Long-term quality of life after obstetric intensive care unit admission: A cross-sectional cohort study

OBJECTIVE

To assess the long-term quality of life (QoL) after obstetric Intensive Care Unit (ICU) admission.

DESIGN

Cross-sectional survey study.

SETTING

Tertiary care centre.

POPULATION

Women admitted to the level 3 ICU during pregnancy or ≤6 weeks postpartum, between 2000 and 2015.

METHODS

Quality of life measures were compared with the population reference values. Associations with baseline ICU parameters were assessed with multivariable linear regression. Patient-reported outcome and experience measures (PROMs/PREMs) were described.

MAIN OUTCOME MEASURES

Quality of life according to the Linear Analogous Scale (LAS), the Satisfaction with Life Scale (SWLS) and the SF-36 questionnaire; PROMs/PREMs using the Pregnancy and Childbirth outcome set of the International Consortium for Health Outcomes Measurement.

RESULTS

Of all 265 obstetric ICU admissions, 230 were eligible and 94 (41%) were included (median follow-up time 14 years). The LAS (75.7 versus 78.7, p = 0.077) and SWLS (25.2 versus 26, p = 0.176) sum scores were not different from the population reference values. The SF-36 subdomains bodily pain (55.3 versus 73.9), general health (58.2 versus 73.9) and vitality (56.9 versus 69.1) were lower than the reference values (all p < 0.001). PROMs/PREMs were low in 46.2% for pain, 15.1% for depression, 11.8% for satisfaction with care and 52.7% for healthcare responsiveness. An indirect obstetric ICU admission diagnosis was independently associated with a reduced physical health score (B -1.7, 95% confidence interval [CI] -3.4 to -0.1) and severe neonatal morbidity with a reduced mental health score (B -6.6, 95% CI -11.3 to -1.8).

CONCLUSION

Obstetric ICU admission is associated with reductions in long-term physical health QoL and in some patients with mental health QoL. We suggest multidisciplinary rehabilitation and long-term psychosocial support.

Post-intensive care syndrome: A review for the primary care NP

ABSTRACT

Post-intensive care syndrome is a costly and complicated collection of physical, cognitive, and mental health problems experienced by survivors of critical illness. The primary care NP is uniquely positioned to assess, monitor, manage, and treat patients with this syndrome following hospital discharge.

Instruments to measure postintensive care syndrome: a scoping review protocol

INTRODUCTION

There is an increasing need for evaluating postintensive care syndrome in adults concerning their long-term physical, psychological, cognitive and/or social outcomes, yet there is no consensus regarding the choice of instruments to measure these. This scoping review aims to identify and examine instruments used to measure postintensive care syndrome in adults.

METHODS AND ANALYSIS

This scoping review will be conducted following the Arksey and O'Malley and its extended framework, and the Joanna Briggs Institute guideline. It will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Review checklists. Medline via EBSCO, CINAHL complete, EMBASE, Web of Science, AME and APA PsycINFO databases and grey literature will be searched from 2010 to the present. Reference lists of included studies will be manually checked to identify additional sources. The quality of included studies will be appraised using the Crowe Critical Appraisal Tool. All review steps will involve at least two reviewers. Data charting will be performed narratively, comprising study characteristics and findings, and instrument properties. This review will also aim to identify research gaps.

ETHICS AND DISSEMINATION

There is no ethics disclosure for this review protocol. This scoping review will identify instruments used to measure postintensive care syndrome in adults. The findings will be disseminated through professional bodies, conferences and research papers.

Assessing oral comprehension with an eye tracking based innovative device in critically ill patients and healthy volunteers: a cohort study

PURPOSE

Communication of caregivers and relatives to patients is a major difficulty in intensive care units (ICU). Patient's comprehension capabilities are variable over time and traditional comprehension tests cannot be implemented. Our purpose was to evaluate an oral comprehension test adapted for its automatic implementation using eye-tracking technology among ICU patients.

METHODS

Prospective bi-centric cohort study was conducted on 60 healthy volunteers and 53 ICU patients. Subjects underwent an oral comprehension test using an eye-tracking device: Their results and characteristics were collected. The total duration of the test was 2 and a half minutes.

RESULTS

While performing the test, 48 patients (92%) received invasive ventilation. Among healthy volunteers, the median rate of right answers was very high (93% [interquartile range 87, 100]), whereas it was lower (33% [20, 67]) for patients. For both groups, a significantly lower right answers rate was observed with advancing age (67% [27, 80] vs. 27% [20, 38] among patients and 93% [93, 100] vs. 87% [73, 93] among healthy volunteers, below and above 60 years of age, respectively) and in case of lack of a bachelor's degree (60% [38, 87] vs. 27% [20, 57] among patients and 93% [93, 100] vs. 87% [73, 93] among healthy volunteers). For patients, the higher the severity of disease was, the lower the rate of correct answers was.

CONCLUSION

The eye-tracking-adapted comprehension test is easy and fast to use among ICU patients, and results seem coherent with various potential levels of comprehension as hypothesized in this study.

Corporeal rehabilitation to manage acute stress in critically ill patients

Background

Intensive care unit (ICU) patients often endure discomfort and distress brought about by their medical environment and the subjective experience of their stay. Distress, pain, and loss of control are important predictors of future neuropsychiatric disorders. Depression, anxiety, and post-traumatic stress are common after discharge. We aimed at mitigating acute stress and discomfort via a novel intervention based on body image rehabilitation and rehabilitation of senses performed following a holistic approach guided by positive communication (corporeal rehabilitation care, CRC).

Results

We conducted a prospective observational study on 297 consecutively enrolled patients participating in at least one CRC session. Benefits of CRC were assessed on both subjective analogical scales of stress, pain, and well-being criteria, and objective clinical measures of dyspnea, respiratory rate, and systolic arterial pressure, just after CRC and long after (a median of 72 min later) to estimate its remote effect. Results showed that CRC had a positive effect on all overt measures of distress (acute stress, pain, discomfort) just after CRC and remotely. This beneficial effect was also observed on dyspnea and respiratory rate. Results also showed that best CRC responders had higher baseline values of stress and heart rate and lower baseline values of well-being score, indicating that the care targeted the population most at risk of developing psychological sequelae. Interestingly, a positive CRC response was associated with a better survival even after adjustment for physiologic severity, indicating a potential to identify patients prompt to better respond to other therapeutics and/or rehabilitation.

Conclusion

This study demonstrated the feasibility of an innovative holistic patient-centered care approach and its short-term positive effects on critical parameters that are considered risk factors for post-intensive care syndrome. Further studies are warranted to study long-term benefits for patients, and overall benefits for relatives as well as ICU staff.

Eye Tracking communication with intubated critically ill patients: a proof-of-concept multicenter pilot study

BACKGROUND

Communication is essential to establish patient-caregivers relationship in the intensive care unit. Intubated patients are not able to speak because the tracheal tube prevents vocalization. Use of communication tools such as eye tracking device could improve communication with intubated patients. The objective of this feasibility pilot study was to demonstrate that an eye tracking device specifically developed for the intensive care could be used easily by awake intubated patient with a very short training time.

METHODS

This prospective multicenter study was conducted in four intensive care units. We included awake adult intubated patients. The device used included an eye-tracking infrared detection and a communication interface specifically developed.

RESULTS

A total of 151 patients were included: the median age of patients was 66 years (56-72) and 97 (64%) were male, 97 patients (64%) succeed totally (installation; calibration, succeed to select all three icons), 124 (82%) succeed to select at least one icon, and 111 (74%) succeed to point to at least two icons. The main reasons for failure to use the device were: difficulties to open or to keep the eyes open, difficulties to installing the device occurred, and patient fatigue.

CONCLUSIONS

This study shows that the use of an eye tracking technology device specifically designed for the intensive care setting, with a short training is easy to use for intubated patient. Patients, relatives and caregivers showed high satisfaction.

Patients' experiences of cognitive impairment following critical illness: a scoping review protocol

INTRODUCTION

Critical illness and admission to an intensive care unit (ICU) can affect patients for months or years following discharge as many suffer from cognitive impairment. Long-term cognitive impairment affects patients' quality of life and ability to adapt to everyday life. Exploring their experiences on how and which cognitive impairments are affecting their everyday lives facilitates planning of relevant research on interventions that may serve to alleviate the burden of post-ICU cognitive impairment. The objective of this scoping review is to map the existing research on patients' experiences of cognitive impairment following critical illness.

METHODS AND ANALYSIS

The methodology will follow the Joanna Briggs Institute guidelines for scoping reviews. The databases MEDLINE, CINAHL, PsycINFO and Embase will be searched to identify studies appropriate for inclusion. Any peer-reviewed original studies meeting the inclusion criteria and include statements from adult patients about how they experience cognitive impairment following critical illness and ICU admission will be considered. Studies published in English and Scandinavian languages will be included, with no further geographical or cultural limitations. The included studies will be screened by two independent researchers using a standardised data extraction tool and the Mixed Methods Appraisal Tool will be used for critical appraisal. The results will be presented in a tabular form, and data will be supported by narrative descriptions or a narrative summary.

ETHICS AND DISSEMINATION

Since the scoping review methodology aims at synthetising existing research on patients' experiences of cognitive impairment following critical illness, the scoping review does not require ethical approval. The results will be disseminated though a peer-reviewed publication in a scientific journal.

Practice of family-centred care in intensive care units before the COVID-19-pandemic: A cross-sectional analysis in German-speaking countries

OBJECTIVES

To provide insights into visiting policies and family-centred care practices with a focus on children as visitors in Intensive Care Units in German-speaking countries.

METHODS/DESIGN

Online-survey with a mixed methods approach. Leading clinicians (n = 1943) from German-speaking countries were invited to participate. Outcomes included the percentage of intensive care units with open visiting policies, age restrictions, family-centred care activities and barriers.

SETTING

Paediatric, mixed and adult units RESULTS: In total, 19.8% (n = 385) of the clinicians responded. Open visiting times were reported by 36.3% (n = 117), with significant differences between paediatric (79.2%), adult (21.3%) and mixed-age (41.2%) units (p < 0.01). Two-thirds of clinicians stated that their units had no age restrictions for children as visitors (n = 221, 68.4%). The family-centred care activities most frequently implemented were open visiting times and dissemination of information. Significantly more German units have open visiting policies and more Swiss units allow children as visitors, compared to the other countries (both p < 0.001). Barriers to family-centred care were concerns about children being traumatized, infection and workload.

CONCLUSION

The majority reported that family-centred care policies had been implemented in their units, including open visiting policies, allowing children as visitors without age restriction and other family-centred care activities.

Post-Intensive Care Syndrome in Children: A Concept Analysis

PROBLEM

Post-intensive care syndrome in paediatrics (PICS-p) is a term used to describe newly acquired or worsened impairment in one or more aspects of a child's physical, psychological, cognitive, and social functioning after discharge from the paediatric intensive care unit (PICU). However, consensus, conceptual insights, and assessment guidance are lacking for this syndrome. Therefore, this analysis aimed to define the concept of PICS-p to help practitioners and researchers understand the syndrome in detail using the Walker and Avant approach.

ELIGIBILITY CRITERIA

We reviewed studies retrieved from several databases, namely PubMed, Google Scholar, Web of Science, Ovid, ScienceDirect, and the Springer database, using the following keywords: 'post-intensive care syndrome', 'PICU', 'children', 'PICS-p', and 'concept analysis'. Both quantitative and qualitative studies on PICS-p were included in the search. The articles were limited to those published up to November 21, 2020.

SAMPLE

Of the 762 publications selected, 24 publications met the inclusion criteria.

RESULTS

PICS-p is defined on the basis of the following aspects: (1) Physical dysfunction; (2) Cognitive dysfunction; (3) Psychological dysfunction; and (4) Social dysfunction.

CONCLUSION

With the increasing success rate of PICU treatment, reduced case fatality is no longer the only outcome of critical illness in children. The long-term outcomes in children discharged from hospitals have attracted attention from families, hospitals, and communities.

IMPLICATIONS

A clear definition of PICS-p will help medical staff understand PICS-p in detail and provide a theoretical basis for the diagnosis and treatment of this syndrome.

Aeromedical Implications of Long-Term COVID-19 Sequelae

BACKGROUND: While many COVID-19 studies focus on acute effects of the infection, few examine the intermediate and long-term sequelae of the illness. Studies have shown that a good portion of patients have chronic effects in several body systems for several months or longer. Such effects can potentially adversely impact pilot performance in flight. We sought to determine the long-term effects of COVID-19 infection, how such effects can affect pilot performance, and how to best evaluate pilots for aeromedical flight clearance.METHODS: We used the PubMed literature search engine to review peer-reviewed articles that focused on the intermediate and long-term effects of COVID-19 infection. Chronic signs and symptoms were subdivided based on the particular body organ system affected. Merging information obtained from case reviews, article reviews, and aeromedical standards, we created a risk stratification guide to assist with the aeromedical disposition of affected pilots.RESULTS: Long-term effects of COVID-19 infection can last for several months or longer. The most common effects are fatigue, weakness, pulmonary diffusion defects, depression, and anxiety.DISCUSSION: This review article focuses on the most common intermediate- and long-term COVID-19 conditions of aeromedical significance and the corresponding course of actions recommended for the aeromedical examiner. Aeromedical evaluation should take into consideration factors related to the pilot, aircraft type, and specific aviation environment. Such evaluation may include diagnostic testing, medical specialist consultation, preflight simulation in an altitude chamber, human centrifuge testing, and/or a flight simulator checkride.Ko SY, Nguyen NK, Lee CL, Lee LA, Nguyen KUT, Lee EC. Aeromedical implications of long-term COVID-19 sequelae. Aerosp Med Hum Perform. 2021; 92(11):898-907.

Stabilizing life: A grounded theory of surviving critical illness

OBJECTIVES

The experience of critical illness among patients is both complex and multifaceted. It can make patients vulnerable to long-term consequences such as impairment in cognition, mental health and physical functional ability which affects health related quality of life. This study aims to explore patients' patterns of behaviour during the process from becoming critical ill to recovery at home.

DESIGN

We used a classic grounded theory methodology to explore the main concern for intensive care patients. Thirteen participants were interviewed and seven different participants were observed.

SETTING

Three general intensive care units in Sweden, consisting of a university hospital, a county hospital and a district hospital.

FINDINGS

The theory Stabilizing life explains how patients' main concern, being out of control, can be resolved. This theory involves two processes, recapturing life and recoding life, and one underlying strategy, emotional balancing that is used during the whole process.

CONCLUSION

The process from becoming critically ill until recovery home is perceived as a constant fight in actions and mind to achieve control and stabilize life. This theory can form the basis for further qualitative and quantitative research about interventions that promotes wellbeing during the whole process.

Reduced quality of life in ICU survivors - the story behind the numbers: A mixed methods study

PURPOSE

To gain insight into the daily functioning of ICU survivors who reported a reduced quality of life (QoL) one year after ICU admission.

MATERIALS AND METHODS

A two-phase mixed method study design. QoL was assessed using the SF-36 questionnaire before admission and after one year (Phase 1). Participants reporting a reduced QoL were invited for an in-depth interview (Phase 2). Interview data were coded thematically using the PROMIS framework.

RESULTS

Of the 797 participants, 173 (22%) reported a reduced QoL, of which 19 purposively selected patients were interviewed. In line with their questionnaire scores, most participants described their QoL as reduced. They suffered from physical, mental and/or cognitive problems, impacting their daily life, restricting hobbies, work, and social activities. A new balance in life, including relationships, had to be found. Some interviewees experienced no changes in their QoL; they were grateful for being alive, set new life priorities, and were able to accept their life with its limitations.

CONCLUSIONS

Reduction in QoL is due to physical, mental, and cognitive health problems, restricting participants what they want to do. However, QoL was not only affected by the critical illness, but also by factors including independency, comorbidity, and life events. Registration: NCT03246334 (clinical trials.gov).