Post–intensive care syndrome: A review of preventive strategies and follow-up care

2019 ◽  
Vol 76 (2) ◽  
pp. 119-122 ◽  
Author(s):  
Andre Fernandes ◽  
Morgen Schmitt Jaeger ◽  
Melissa Chudow
Keyword(s):  
Intensive Care ◽  
Preventive Strategies ◽  
Follow Up Care ◽  
Post Intensive Care Syndrome

scholarly journals Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Françoise Rousseau ◽  
Pauline Minguet ◽  
Camille Colson ◽  
Isabelle Kellens ◽  
Sourour Chaabane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Inpatient Rehabilitation ◽  
Quadriceps Strength ◽  
Biological Parameters ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
Post Intensive Care Syndrome

Abstract Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

What Actually Happened

2000 ◽  
Vol 9 (1) ◽  
pp. 135-135
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Valves ◽  
Home Country ◽  
Ethics Committee ◽  
Follow Up Care ◽  
Intent To Return ◽  
Pitting Edema

The ethics committee was in agreement that the patient should be operated on, given his emergent status. Initially, he was too medically unstable, and for three weeks was in an intensive care unit until his condition stabilized to the point that he could tolerate the surgery. He became sufficiently stable to permit surgery and both of his heart valves were replaced. He did very well after surgery. His pitting edema and jaundice reversed, and he was discharged after a week to the care of a relative. He received follow-up care in the hospital's cardiac clinic and was provided needed medications. He stated his intent to return to his home country once he recovered from the surgery.

scholarly journals Physiotherapy during the Covid-19 pandemic: management of critically ill patients in the ICU and follow-up care

2021 ◽  
Vol 1 (1) ◽  
pp. 1-8
Author(s):  
Clément Médrinal ◽  
Tristan Bonnevie ◽  
Pauline Smondack ◽  
Francis Edouard Gravier ◽  
Marius Lebret ◽  
...  
Keyword(s):  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Respiratory Infection ◽  
Care Providers ◽  
Severe Acute Respiratory Infection ◽  
Follow Up Care ◽  
The World

The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is responsible for the current pandemic and results in a large number of hospitalizations. This highly contagious disease causes severe acute respiratory infection; thus, many patients require management in intensive care. At a time when there is a high influx of patients with COVID-19 in Intensive Care Units (ICU) all over the world, there is little literature concerning the physiotherapy management of these patients. This article provides information based on the latest evidence to help physiotherapists optimize care, to protect patients and care providers in the ICU, and for follow-up care.

Computerized Nursery Discharge Summary

1977 ◽  
Vol 16 (04) ◽  
pp. 199-204 ◽  
Author(s):  
R. Smith ◽  
L. Blackmon ◽  
W. Hammond ◽  
F. Jelovsek
Keyword(s):  
Intensive Care ◽  
Medical Record ◽  
Medical Personnel ◽  
Discharge Summary ◽  
Full Term ◽  
Discharge Diagnosis ◽  
Medical Providers ◽  
Follow Up Care ◽  
Intensive Care Nursery

Expansion of a computerized obstetric medical record to include newborn nursery information is described. Data sheets are entered for each infant discharged, and a computer-typed discharge summary is generated which abstracts information originally gathered by both obstetric and pediatric medical personnel. The system has improved communication with medical providers who administer follow-up care after discharge and has replaced some physician dictation effort, especially in the Full Term Nursery. In the Intensive Care Nursery the summary has not been successful because data collected is not felt adequate to describe the chronology of a long hospitalization. Comparison of the computer record and manual discharge diagnosis sheet is presented.

Cerebral venous thrombosis after caesarean section

2021 ◽  
Vol 86 (5) ◽  
pp. 339-342
Author(s):  
Lucie Drábková ◽  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Report ◽  
Caesarean Section ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Interdisciplinary Collaboration ◽  
Contextual Knowledge ◽  
Follow Up Care

Objective: Case report of a patient with cerebral venous thrombosis after caesarean section. Case report: We present a case of a 22-year-old patient after an acute caesarean section, which was complicated by cerebral venous thrombosis. The etiology of the thrombosis was multifactorial. Diagnosis was determined using imaging methods once the neurological symptoms were expressed. Follow-up care for the patient included comprehensive care in the intensive care unit, including a temporary decompresive craniectomy. Conclusion: Cerebral venous thrombosis is a rare disease with a varied clinical manifestation whose development is aff ected by a number of acquired and congenital factors. The incidence is increased in women in the puerperium, but we can also see it in gynecological practice in young contraception users. Contextual knowledge is essential in early dia gnosis as well as using a correct treatment strategy with a multidisciplinary approach and interdisciplinary collaboration. Key words: cerebral venous thrombosis – caesarean section – laparotomy dehiscence – headache

scholarly journals Implementing Structured Follow-Up of Neonatal and Paediatric Patients: An Evaluation of Three University Hospital Case Studies Using the Functional Resonance Analysis Method

2021 ◽  
Author(s):  
Véronique Bos ◽  
Daniëlle Roorda ◽  
Eleonore de Sonnaville ◽  
Menne van Boven ◽  
Jaap Oosterlaan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Analysis Method ◽  
Long Term Outcomes ◽  
Resonance Analysis ◽  
Follow Up Care ◽  
Long Term Follow Up ◽  
And Performance ◽  
Programme Effectiveness

Abstract Background: In complex neonatal and paediatric clinical practice, little is known about long-term patient outcomes and what follow-up care is most valuable for patients. Emma Children’s Hospital, Amsterdam UMC (Netherlands), implemented a follow-up programme called Follow Me for neonatal and paediatric patient groups, to gain more insight into long-term outcomes and to use such outcomes to implement a learning cycle for clinical practice, improve follow-up care and facilitate research. Three departments initiated re-engineering and change processes. Each introduced multidisciplinary approaches to long-term follow-up, including regular standardised check-ups for defined age groups, based on medical indicators, developmental progress, and psychosocial outcomes in patients and their families. This research evaluates the implementation of the three follow-up programmes, comparing predefined procedures (work-as-imagined) with how the programmes were implemented in practice (work-as-done). Methods: This study was conducted in 2019–2020 in the outpatient settings of the neonatal intensive care, paediatric intensive care and paediatric surgery departments of Emma Children’s Hospital. It focused on the organisational structure of the follow-up care. The functional resonance analysis method (FRAM) was applied, using documentary analysis, semi-structured interviews, observations and feedback sessions.Results: One work-as-imagined model and four work-as-done models were described. The results showed vast data collection on medical, developmental and psychosocial indicators in all work-as-done models; however, process indicators for programme effectiveness and performance were missing. In practice there was a diverse allocation of roles and responsibilities and their interrelations to create a multidisciplinary team; there was no one-size-fits-all. Although control and feedback loops for long-term outcomes were specified with respect to the follow-up groups within the programmes, they were found to overlap and misalign with other internal and external long-term outcome monitoring practices. Conclusion: Implementing structured long-term follow-up may provide insights for improving daily practice and follow-up care, with the precondition of standardised measurements. Lessons learned from practice are (1) to address fragmentation in data collection and storage, (2) to incorporate the diverse ways to create a multidisciplinary team in practice, and (3) to include timely actionable indicators on programme effectiveness and performance, alongside medical, developmental and psychosocial indicators.

scholarly journals Nocturnal dexmedetomidine alleviates post–intensive care syndrome following cardiac surgery: a prospective randomized controlled clinical trial

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chun-hui Dong ◽  
Chao-nan Gao ◽  
Xiao-hua An ◽  
Na Li ◽  
Le Yang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Placebo Group ◽  
Study Endpoint ◽  
Primary Study ◽  
Link Type ◽  
Post Surgery ◽  
Psychological Impairment ◽  
Post Intensive Care Syndrome

Abstract Background Dexmedetomidine is a sedative agent that may have the potential to reduce the risk of post-intensive care syndrome (PICS). This study aimed to establish whether prophylactic nocturnal dexmedetomidine safely reduces postoperative PICS incidence and to develop an easy-to-use model for predicting the risk of PICS following cardiac surgery. Methods This was a single-center, double-blind, randomized, prospective, placebo-controlled trial. Patients undergoing cardiac surgery were randomly assigned (1:1) to dexmedetomidine or placebo (normal saline) groups between January 2019 and July 2020. Dexmedetomidine or a similar volume of saline was administered, with an infusion rate up to 1.2 μg/kg/h until the RASS remained between − 1 and 0. The primary study endpoint was PICS incidence at 6 months follow-up, as defined by cognitive, physical, or psychological impairments. Results We assessed 703 individuals for eligibility, of whom 508 were enrolled. Of these, there were 251 in the dexmedetomidine group and 257 in the placebo group that received the trial agent, forming a modified intention-to-treat population. PICS incidence at 6-month follow-up was significantly decreased in the dexmedetomidine group (54/251, 21.5%) relative to the placebo group (80/257, 31.1%) (odds ratio [OR] 0.793, 95% CI 0.665–0.945; p = 0.014). Psychological impairment was significantly reduced in the dexmedetomidine group relative to the placebo group (18.7% vs. 26.8%, OR 0.806, CI 0.672–0.967, p = 0.029). However, dexmedetomidine treatment was associated with a higher rate of hypotension. A nomogram revealed that age, education, a medical history of diabetes and smoking, dexmedetomidine treatment, postoperative atrial fibrillation, and sequential organ failure assessment scores at 8 h post-surgery were independent predictors of PICS. Conclusions Prophylactic nocturnal dexmedetomidine administration significantly reduced PICS incidence by a marked reduction in psychological impairment within a 6-month follow-up period. Trial registration ChiCTR, ChiCTR1800014314. Registered 5 January 2018, http://www.chictr.org.cn/index.aspx

Neonatal Intensive Care: Satisfaction Measured From a Parent's Perspective

PEDIATRICS ◽  
1999 ◽  
Vol 103 (Supplement_E1) ◽  
pp. 336-349 ◽  
Author(s):  
Jeanette M. Conner ◽  
Eugene C. Nelson
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Care Delivery ◽  
Parent Satisfaction ◽  
Neonatal Care ◽  
Follow Up Care

Health care systems today are complex, technically proficient, competitive, and market-driven. One outcome of this environment is the recent phenomenon in the health care field of “consumerism.” Strong emphasis is placed on customer service, with organized efforts to understand, measure, and meet the needs of customers served. The purpose of this article is to describe the current understanding and measurement of parent needs and expectations with neonatal intensive care services from the time the expectant parents enter the health care system for the birth through the discharge process and follow-up care. Through literature review, 11 dimensions of care were identified as important to parents whose infants received neonatal intensive care: assurance, caring, communication, consistent information, education, environment, follow-up care, pain management, participation, proximity, and support. Five parent satisfaction questionnaires—the Parent Feedback Questionnaire, Neonatal Index of Parent Satisfaction, Inpatient Parent Satisfaction–Children's Hospital Minneapolis, Picker Institute-Inpatient Neonatal Intensive Care Unit Survey, and the Neonatal Intensive Care Unit-Parent Satisfaction Form—are critically reviewed for their ability to measure parent satisfaction within the framework of the neonatal care delivery process. An immense gap was found in our understanding about what matters most and when to parents going through the neonatal intensive care experience. Additional research is required to develop comprehensive parent satisfaction surveys that measure parent perceptions of neonatal care within the framework of the care delivery process.

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