scholarly journals Post–Intensive Care Syndrome in COVID-19 Patients Discharged From the Intensive Care Unit

2021 ◽  
Vol 23 (6) ◽  
pp. E38-E38
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Post Intensive Care Syndrome

scholarly journals Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

2021 ◽  
Vol 10 (4) ◽  
pp. 614 ◽  
Author(s):  
Nobuto Nakanishi ◽  
Rie Tsutsumi ◽  
Kanako Hara ◽  
Masafumi Matsuo ◽  
Hiroshi Sakaue ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Muscle Atrophy ◽  
Critically Ill Patients ◽  
Chronic Illnesses ◽  
Rehabilitation Management ◽  
Muscle Dystrophy ◽  
Thin Filaments ◽  
Thick Filaments ◽  
Post Intensive Care Syndrome

Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interconnects the contraction of actin-containing thin filaments and myosin-containing thick filaments. Titin breaks down to form urinary titin N-fragments, which are measurable in urine. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies have reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients’ condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.

Post intensive care syndrome prevention and impact of COVID 19

2021 ◽  
Vol 11 (1) ◽  
pp. 112-117
Author(s):  
Dimitrios Alefragkis
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sleep Problems ◽  
Care Plan ◽  
Prevention Measures ◽  
Post Traumatic Stress ◽  
Maximum Increase ◽  
Post Traumatic ◽  
The Impact ◽  
Post Intensive Care Syndrome

In recent years, there has been a maximum increase in admissions to the intensive care unit, culminating in an exponential increase in admissions during the COVID 19 pandemic. Many patients who survived and were discharged from the intensive care unit have cognitive, physical, and psychological disorders that are reflected in the term post-intensive care syndrome. Patients and their families show symptoms of anxiety, depression, post-traumatic stress, and sleep problems. The result is that they negatively affect their quality of life. Numerous risk factors contribute to the development of this syndrome, mainly the sedation, the duration of mechanical ventilation, and the length of stay in the intensive care unit. For this reason, it is necessary to take measures to prevent this syndrome including ABCDEFGH care plan, physical rehabilitation, nutritional support, and intensive care unit diaries. Care must also be given to the creation of Post Intensive care unit clinics where they have a diagnostic, therapeutic, counseling, and rehabilitation role that will act as assistants in the care of patients after discharge from the intensive care unit. Also, special care should be taken with patients who have recovered from COVID 19 whose needs are increasing and need immediate treatment. This review aims to analyze post-intensive care syndrome, prevention measures, and the impact of COVID 19. In conclusion, it is necessary to take measures to treat post-intensive care unit syndrome with early diagnosis and treatment, to reduce the adverse effects on both patients and their families.

scholarly journals Sleeping Soundlessly in the Intensive Care Unit

2020 ◽  
Vol 4 (1) ◽  
pp. 6
Author(s):  
Kendall J. Burdick ◽  
Christine J. Callahan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mental Status ◽  
Sleep Disruption ◽  
Acoustic Environment ◽  
Stressful Environment ◽  
Monitor Alarms ◽  
Post Intensive Care Syndrome

An estimated 70% of patients who have been in the Intensive Care Unit (ICU) experience some form of Post-Intensive Care Syndrome (PICS). As a stressful environment, the ICU can be traumatic for any patient; however, the disruption of sleep experienced by patients in ICU negatively impacts their mental status and recovery. One of the most significant contributors to sleep disruption is the constant blare of monitor alarms, many of which are false or redundant. Through multisensory approaches and procedural redesign, the hostile acoustic environment of the ICU that causes so many to suffer from PICS may be alleviated. In this paper, we present suggestions for improving the ICU acoustic environment to possibly reduce the incidence of post-ICU complications such as PICS.

Approaches to Addressing Post–Intensive Care Syndrome among Intensive Care Unit Survivors. A Narrative Review

2019 ◽  
Vol 16 (8) ◽  
pp. 947-956 ◽  
Author(s):  
Samuel M. Brown ◽  
Somnath Bose ◽  
Valerie Banner-Goodspeed ◽  
Sarah J. Beesley ◽  
Victor D. Dinglas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Narrative Review ◽  
Post Intensive Care Syndrome

scholarly journals Urinary Titin N-fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome

2020 ◽  
Author(s):  
Nobuto Nakanishi ◽  
Rie Tsutsumi ◽  
Kanako Hara ◽  
Masafumi Matsuo ◽  
Hiroshi Sakaue ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Muscle Atrophy ◽  
Chronic Illnesses ◽  
Breakdown Product ◽  
Rehabilitation Management ◽  
Muscle Dystrophy ◽  
Thin Filaments ◽  
Thick Filaments ◽  
Post Intensive Care Syndrome

Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interplays the contraction of actin-containing thin filaments and myosin-containing thick filaments. The breakdown product of titin has been measurable in urine as urinary titin N-fragments. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients’ condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.

scholarly journals Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings – Results of an expert consensus and feasibility field test

2020 ◽  
pp. 175114372092359 ◽  
Author(s):  
Claudia D Spies ◽  
Henning Krampe ◽  
Nicolas Paul ◽  
Claudia Denke ◽  
Jörn Kiselev ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Outpatient Care ◽  
Outcome Measurement ◽  
Handgrip Strength ◽  
Measurement Instrument ◽  
Consensus Meeting ◽  
Mental Health Patient ◽  
Patient Health ◽  
Post Intensive Care Syndrome

Background There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. Methods We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal. Results We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)). Conclusions We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT04175236; first posted 22 November 2019).

Post–Intensive Care Syndrome: Educational Interventions for Parents of Hospitalized Children

2019 ◽  
Vol 28 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Stephanie A. Esses ◽  
Sara Small ◽  
Ashley Rodemann ◽  
Mary E. Hartman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Low Cost ◽  
Signs And Symptoms ◽  
Final Analysis ◽  
Educational Interventions ◽  
Educational Strategies ◽  
Model Framework ◽  
Sustainable Implementation ◽  
Post Intensive Care Syndrome

Background Targeted education to help parents and caregivers recognize the signs and symptoms of post–intensive care syndrome may increase their awareness and willingness to seek support during their child’s admission. The optimal strategy for this education has not been established. Methods A pilot study to test 3 educational strategies for caregivers of pediatric intensive care unit patients. The 3 strategies were compared using the Practical, Robust Implementation and Sustainability Model framework for effectiveness of the education, the effect of each educational intervention on the intensive care unit nursing environment, and costs. Nursing responses were scored on a 3-point Likert scale. Results A total of 62 caregivers randomly received 1 of 3 educational strategies: brochures (n = 22), scripted conversation (n = 20), or a 3-minute video (n = 20). All 3 strategies were associated with a notable improvement in understanding of post–intensive care syndrome, with no single strategy being superior. Nineteen bedside nurses completed a survey on how daily workflow was affected and education was perceived. The survey indicated that all 3 interventions minimally disrupted workflow and all were recognized as useful. Final analysis indicated that brochures have the greatest likelihood of successful and sustainable implementation in the study hospital. Conclusion Simple, low-cost education can improve caregivers’ knowledge of post–intensive care syndrome and can be well supported by nursing staff. To ensure sustainable implementation, the characteristics of the unit should be considered when selecting an educational program.

scholarly journals Prevalence of Post Intensive Care Syndrome Among Japanese Intensive Care Unit Patients: A Prospective, Multicenter, Observational J-PICS Study

2020 ◽  
Author(s):  
Daisuke Kawakami ◽  
Shigeki Fujitani ◽  
Takeshi Morimoto ◽  
Hisashi Dote ◽  
Mumon Takita ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Survey Questionnaire ◽  
Status Change ◽  
Icu Patients ◽  
Sf 36 ◽  
Post Intensive Care Syndrome ◽  
Subjective Significance

Abstract BackgroundMany studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls, instead of baseline quality of life. Furthermore, many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2 but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, the clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 health survey questionnaire subscales and interpreted the patients’ subjective significance of impairment.MethodsA prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 Japanese hospitals. Adult ICU patients expected to receive mechanical ventilation for > 48 hours were enrolled and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, change in SF-36 physical component score (PCS) ≥ 10 points; mental status, change in SF-36 mental component score ≥ 10 points; cognitive function, Short-Memory Questionnaire (SMQ) score worsened and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating.ResultsAmong 192 patients, 48 (29.6%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 19 (19.9%) patients. Physical, mental, and cognitive impairments occurred in 33.3%, 14.6%, and 37.5% patients, respectively. Low education level was associated with PICS occurrence (Odds ratio: 3.8, 95% confidence interval: 1.1–17.9, P=0.036). Based on the patients’ subjective assessment, a 10-point change in PCS indicated moderate negative change.ConclusionsAmong the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS occurrence was associated with low educational level. Future studies elucidating the minimal clinically important difference of SF-36 scores among the ICU patients and standardizing the PICS definition are required.Trial registrationUMIN000034072

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