Survivors Of Critical Illness Research Articles

Mobile Mindfulness Intervention for Psychological Distress Among Intensive Care Unit Survivors

Although psychological distress is common among survivors of critical illness, there are few tailored therapies. To determine the optimal method for delivering a mindfulness intervention via a mobile app for critical illness survivors. This randomized clinical trial used a 2 × 2 × 2 factorial design and was conducted at 3 sites among survivors of critical illness with elevated postdischarge symptoms of depression. The study was conducted between August 2019 and July 2023. Participants were randomized to 1 of 8 different groups as determined by 3 two-level intervention component combinations: intervention introduction method (mobile app vs therapist call), mindfulness meditation dose (once daily vs twice daily), and management of increasing symptoms (mobile app vs therapist call). The primary outcome was the 9-item Patient Health Questionnaire (PHQ-9) depression scale score (range, 0-27) at 1 month. Secondary outcomes included anxiety (7-item Generalized Anxiety Disorder) and posttraumatic stress disorder (Posttraumatic Stress Scale) symptoms at 1 and 3 months, adherence, and feasibility. General linear models were used to compare main effects and interactions of the components among intervention groups. A formal decisional framework was used to determine an optimized intervention version. A total of 247 participants (mean [SD] age, 50.2 [15.4] years; 104 [42.1%] women) were randomized. Twice-daily meditation compared with once-daily meditation was associated with a 1.2 (95% CI, 0.04-2.4)-unit lower mean estimated PHQ-9 score at 1 month and a 1.5 (95% CI, 0.1-2.8)-unit lower estimated mean score at 3 months. The other 2 intervention components had no main effects on the PHQ-9. Across-group adherence was high (217 participants [87.9%] using the intervention at trial conclusion) and retention was strong (191 [77.3%] and 182 [73.7%] at 1 and 3 months, respectively). A mindfulness intervention for survivors of critical illness that included an app-based introduction, twice-daily guided meditation, and app-based management of increasing depression symptoms was optimal considering effects on psychological distress symptoms, adherence, and feasibility. ClinicalTrials.gov Identifier: NCT04038567.

Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest

Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. Despite these symptoms indicating potential balance deficits, systematic investigations and validated assessments are lacking. Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. Balance was assessed post-ICU discharge (V1) and at discharge from inpatient neurorehabilitation (V2) in patients with ≥ 5 days of invasive ventilation. Mini-BESTest measurement characteristics were evaluated in an ambulatory subgroup. A multiple linear regression was conducted. The prospective cohort study comprised 250 patients (34% female, 62 ± 14 years, median ICU stay 55 days). Median Mini-BESTest scores improved significantly from V1 (5 (IQR 0–15)) to V2 (18.5 (10–23)) with a large effect size. Excellent inter-rater and test–retest reliabilities of the Mini-BESTest were observed (ICC = 0.981/0.950). Validity was demonstrated by a very high correlation with the Berg Balance Scale (ρ = 0.90). No floor or ceiling effects were detected. Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. Due to its excellent psychometric properties, the Mini-BESTest is suitable for use in critical illness survivors.Registration: The study was registered at the German Clinical Trials Register (DRKS00021753, date of registration: 2020-09-03).

Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia: A 6-month follow-up questionnaire study.

Psychological assessment after intensive care unit (ICU) discharge is increasingly used to assess patients' cognitive and psychological well-being. However, few studies have examined those who recovered from coronavirus disease 2019 (COVID-19). There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19. To evaluate anxiety and depression among patients who had severe COVID-19. This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for > 24 h for COVID-19. Eligible patients were contacted via telephone. The patient's anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the mean HADS score. The secondary outcomes were risk factors of anxiety and/or depression. Patients who were admitted to the ICU because of COVID-19 were screened (n = 518). Of these, 48 completed the questionnaires. The mean age was 56.3 ± 17.2 years. Thirty patients (62.5%) were male. The main comorbidities were endocrine (n = 24, 50%) and cardiovascular (n = 21, 43.8%) diseases. The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4 (SD ± 8.5). A HADS score of > 7 for anxiety and depression was detected in 15 patients (30%) and 18 patients (36%), respectively. Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression [odds ratio (OR) 39.06, 95% confidence interval: 1.309-1165.8; P < 0.05]. Six months after ICU discharge, 30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression. To compare the psychological status of patients following an ICU admission (with vs without COVID-19), further studies are warranted.

Association of Psoas Muscle Mass at Intensive Care Unit Admission With Physical Function and Post-discharge Destination in Survivors of Critical Illness.

Survivors of critical illness may have physical impairments, known as post-intensive care syndrome (PICS). Early screening for the risk of PICS is recommended to prevent PICS. Skeletal muscle mass is a clinically important indicator associated with various outcomes. This study aimed to examine the association of psoas muscle mass at intensive care unit (ICU) admission with the destination and physical function at hospital discharge. In this single-center retrospective cohort study, we reviewed the medical records of adult patients who had required emergency ICU admission and who had been intubated and mechanically ventilated. Psoas major muscle was measured as an indicator of skeletal muscle mass from abdominal computed tomography images at ICU admission. Physical function was assessed using the functional status score for the ICU and ICU mobility scale at hospital discharge. Multinomial logistic and multivariable linear regression were used to analyze the associations of the psoas muscle mass with the discharge destination and physical function at discharge. We enrolled 124 patients (79 men and 45 women) with a median (interquartile range) age of 72.0 (62.0-80.0) years; 39 (31.5%) were discharged to home, 50 (40.3%) were transferred to rehabilitation wards, and 35 (28.2%) were transferred to long-term care settings.The psoas muscle area and volume were 16.9 (11.3-20.6) cm2 and228.3 (180.2-282.0) cm3in home discharge patients, 17.5 (11.5-21.5) cm2 and248.4 (162.0-311.4) cm3in rehabilitation ward patients, and 15.9 (10.3-19.5) cm2 and184.0 (137.0-251.1) cm3in long-term care patients. The areas and volumes of the psoas muscle were not significantly different in the three groups. Furthermore, psoas muscle mass was not significantly associated with the discharge destination and physical function. Discharge destination and physical function at hospital discharge were not significantly associated with psoas muscle mass at ICU admission.

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

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. 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. 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. 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. 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.

Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials

Objective This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. Design Systematic review and meta-analysis of RCTs. Data sources We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. Review methods Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. Results Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03–0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0–5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD −1.4 (95% CI: −2.7 to −0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. Conclusion Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.

Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study

Background Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes.Methods This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses.Results Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, − 0.23 to − 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, − 23.9 to − 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months.Conclusions Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline.

Post-COVID-19 Clinic Utilization Among Survivors of Critical Illness in Two Waves of SARS-CoV-2 Infection

Post-COVID-19 Clinic Utilization Among Survivors of Critical Illness in Two Waves of SARS-CoV-2 Infection

New-onset mental illness and long-term survival in survivors of critical illness: population-based cohort study in South Korea.

Critical care unit (CCU) survivors have a high risk of developing mental illness. We aimed to examine the incidence and associated factors of newly developed mental illness among CCU survivors of critical illness. Moreover, we examined the association between newly developed mental illness and 2-year all-cause mortality. All adult patients (≥20 years) who were admitted to the CCU during hospitalisation between 2010 and 2018 and survived for 1 year were defined as CCU survivors and were included in this nationwide population-based cohort study. CCU survivors with a history of mental illness before CCU admission were excluded from the study. A total of 1 353 722 CCU survivors were included in the analysis; of these, 33 743 survivors (2.5%) had newly developed mental illness within 1 year of CCU admission. Old age, longer CCU stay, hospital admission through the emergency room, increased total cost of hospitalisation, mechanical ventilatory support, extracorporeal membrane oxygenation support and continuous renal replacement therapy were associated with an increased incidence of newly developed mental illness. Moreover, the newly developed mental illness group showed a 2.36-fold higher 2-year all-cause mortality rate than the no mental illness group (hazard ratio: 2.36; 95% CI: 2.30-2.42; P < 0.001). In South Korea, 2.5% of CCU survivors had newly developed mental illness within 1 year of CCU admission. Moreover, newly developed mental illness was associated with an increased 2-year all-cause mortality.

Comparison of energy intake in critical illness survivors, general medical patients, and healthy volunteers: A descriptive cohort study.

Intensive care unit (ICU) survivors have reduced oral intake; it is unknown whether intake and associated barriers are unique to this group. To quantify energy intake and potential barriers in ICU survivors compared with general medical (GM) patients and healthy volunteers. A descriptive cohort study in ICU survivors, GM patients, and healthy volunteers. Following an overnight fast, participants consumed a 200 ml test-meal (213 kcal) and 180 min later an ad libitum meal to measure energy intake (primary outcome). Secondary outcomes; taste recognition, nutrition-impacting symptoms, malnutrition, and quality of life (QoL). Data are mean ± SD, median (interquartile range [IQR]) or number [percentage]). Twelve ICU survivors (57 ± 17 years, BMI: 30 ± 6), eight GM patients (69 ± 19 years, BMI: 30 ± 6), and 25 healthy volunteers (58 ± 27 years, BMI: 25 ± 4) were included. Recruitment ceased early because of slow recruitment and SARS-CoV-2. Energy intake was lower in both patient groups than in health (ICU: 289 [288, 809], GM: 426 [336, 592], health: 815 [654, 1165] kcal). Loss of appetite was most common (ICU: 78%, GM: 67%). For ICU survivors, GM patients and healthy volunteers, respectively, severe malnutrition prevalence; 40%, 14%, and 0%; taste identification; 8.5 [7.0, 11.0], 8.5 [7.0, 9.5], and 8.0 [6.0, 11.0]; and QoL; 60 [40-65], 50 [31-55], and 90 [81-95] out of 100. Energy intake at a buffet meal is lower in hospital patients than in healthy volunteers but similar between ICU survivors and GM patients. Appetite loss potentially contributes to reduced energy intake.

Psychotropic prescribing after hospital discharge in survivors of critical illness, a retrospective cohort study (2012-2019).

Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups. This retrospective cohort study included 23,340 critical care and 367,185 non-critical care hospitalised adults from 2012 through 2019 in Lothian, Scotland, who survived to discharge. One-third of critical care survivors (32%; 7527/23,340) received a psychotropic prescription within 90 days after hospital discharge (25% antidepressants; 14% anxiolytics/hypnotics; 4% antipsychotics/mania medicines). In contrast, 15% (54,589/367,185) of non-critical care survivors received a psychotropic prescription (12% antidepressants; 5% anxiolytics/hypnotics; 2% antipsychotics/mania medicines). Among patients without psychotropic prescriptions within 180 days prior to hospitalisation, after hospital discharge, the critical care group had a higher incidence of psychotropic prescription (10.3%; 1610/15,609) compared with the non-critical care group (3.2%; 9743/307,429); unadjusted hazard ratio (HR) 3.39, 95% CI: 3.22-3.57. After adjustment for potential confounders, the risk remained elevated (adjusted HR 2.03, 95% CI: 1.91-2.16), persisted later in follow-up (90-365 days; adjusted HR 1.38, 95% CI: 1.30-1.46), and was more pronounced in those without recorded comorbidities (adjusted HR 3.49, 95% CI: 3.22-3.78). Critical care survivors have a higher risk of receiving psychotropic prescriptions than hospitalised patients, with a significant proportion receiving benzodiazepines and other hypnotics. Future research should focus on the requirement for and safety of psychotropic medicines in survivors of critical illness, to help guide policy for clinical practice.

MicroRNA-centered theranostics for pulmoprotection in critical COVID-19

Elucidating the pathobiological mechanisms underlying post-acute pulmonary sequelae following SARS-CoV-2 infection is essential for early interventions and patient stratification. Here, we investigated the potential of microRNAs (miRNAs) as theranostic agents for pulmoprotection in critical illness survivors. Multicenter study including 172 ICU survivors. Diffusion impairment was defined as a lung diffusing capacity for carbon monoxide (DLCO)<80% within 12 months post-discharge. A disease-associated 16-miRNA panel was quantified in plasma samples collected at ICU admission. Bioinformatic analyses were conducted using KEGG, Reactome, GTEx and Drug-Gene Interaction databases. The results were validated using an external RNA-seq dataset. A 3-miRNA signature linked to diffusion impairment (miR-27a-3p, miR-93a-5p, and miR-199a-5p) was identified using Random Forest. Levels of miR-93a-5p and miR-199a-5p were independently associated with the outcome, improving patient classification provided by the electronic heatlh record. The experimentally-validated targets of these miRNAs exhibited enrichment across diverse pathways, with telomere length quantification in an additional set samples (n=83) supporting the role of cell senescence in sequelae. Analysis of an external dataset refined the pathobiological fingerprint of pulmonary sequelae. Gene-drug interaction analysis revealed four FDA-approved drugs. Overall, this study advances our understanding of lung recovery in post-acute respiratory infections, highlighting the potential of miRNAs and their targets for pulmonoprotection.

Determinants of Subjective Mental and Functional Health of Critical Illness Survivors: Comparing Pre-ICU and Post-ICU Status.

To compare ICU survivors' subjective mental and functional health before ICU admission and after discharge and to assess determinants of subjective health decline or improvement. Secondary analysis of the multicenter cluster-randomized Enhanced Recovery after Intensive Care trial ( ClinicalTrials.gov : NCT03671447). Ten ICU clusters in Germany. Eight hundred fifty-five patients with 1478 follow-up assessments. None. At two patient follow-ups scheduled 3 and 6 months after ICU discharge, patients rated their subjective mental and functional/physical health on two separate visual analog scales from 0 (worst) to 10 (best) in the previous week and before ICU admission. We compared pre-ICU and post-ICU subjective health and used mixed-effects regression to assess determinants of a health decline or improvement. At the first follow-up, 20% ( n = 165/841) and 30% ( n = 256/849) of patients reported a decline in subjective mental and functional health of at least three points, respectively; 16% ( n = 133/841 and n = 137/849) outlined improvements of mental and functional health. For 65% ( n = 543/841) and 54% ( n = 456/849), mental and functional health did not change three points or more at the first follow-up. Multivariable mixed-effects logistic regressions revealed that the ICU length of stay was a predictor of mental (adjusted odds ratio [OR] per ICU day, 1.04; 95% CI, 1.00-1.09; p = 0.038) and functional health (adjusted OR per ICU day, 1.06; 95% CI, 1.01-1.12; p = 0.026) decline. The odds of a mental health decline decreased with age (adjusted OR per year, 0.98; 95% CI, 0.96-0.99; p = 0.003) and the odds of a functional health decline decreased with time after discharge (adjusted OR per month, 0.86; 95% CI, 0.79-0.94; p = 0.001). The majority of ICU survivors did not experience substantial changes in their subjective health status, but patients with long ICU stays were prone to subjective mental and functional health decline. Hence, post-ICU care in post-ICU clinics could focus on these patients.

The psychometric properties and minimal clinically important difference for health-related quality of life assessment using the EuroQol 5-dimension 5-level in survivors of critical illness

The psychometric properties and minimal clinically important difference for health-related quality of life assessment using the EuroQol 5-dimension 5-level in survivors of critical illness

Digital Psychosocial Follow-up for Childhood Critical Illness Survivors: A Qualitative Interview Study on Health Professionals' Perspectives.

Digital solutions have been reported to provide positive psychological and social outcomes to childhood critical illness survivors, a group with an increased risk for long-term adverse psychosocial effects. To explore health professionals' perspectives on the potential of digital psychosocial follow-up for childhood critical illness survivors. Using a qualitative approach, expert interviews with six health professionals working at a Norwegian hospital were conducted. Transcribed interviews were analyzed using Braun and Clarke's six-phase thematic analysis framework. Concurrent data collection and analysis using inductive coding was also employed, and a model of codes was constructed. The interview yielded thirteen unique codes regarding the health professionals' perspectives on the potential for digital psychosocial follow-up for childhood critical illness survivors, organized in a model comprising the two main themes: Affecting Factors and Digital Usage. Demographic factors (the child's medical condition, age, gender, and residence) and environmental factors (the child's family and health professionals) tended to affect the current psychosocial follow-up. Hospital limitations concerning a lack of digital solutions, worse relationship building with video communication, and children's already high screen time reflected the current state of digital usage. However, ongoing digitalization, existing successful digital solutions, children's good digital skills, and an ongoing process of creating an artifact are also seen as opportunities for digital usage in future psychosocial follow-up for childhood critical illness survivors. Researchers can build further on these findings to investigate the potential of digital psychosocial follow-up for childhood critical illness survivors, and clinicians can use it as a starting point for improving psychosocial follow-up.

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

The objective of this review is to explore critical illness survivors' experiences of attending an intensive care unit (ICU) follow-up service. 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. 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. 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. PROSPERO CRD42023404585.

The impact of critical illness on patients’ physical function and recovery: An explanatory mixed-methods analysis

ObjectivesTo determine how the perception of physical function 6-months following critical illness compares to objectively measured function, and to identify key concerns for patients during recovery from critical illness. Research methodology and designA nested convergent parallel mixed methods study assessed physical function during a home visit 6-months following critical illness, with semi-structured interviews conducted at the same time. SettingParticipants were recruited from two hospitals at one healthcare network in Melbourne, Australia from September 2017 to October 2018 with follow-up data completed in April 2019. Main Outcome MeasuresPhysical function was assessed through four objective outcomes: the functional independence measure, six-minute walk test, functional reach test, and grip strength. Semi structured interviews focused on participants function, memories of the intensive care and hospital stay, assistance required on discharge, ongoing limitations, and the recovery process. FindingsAlthough many participants (12/20, 60%) stated they had recovered from their critical illness, 14 (70%) had function below expected population norms. Decreased function on returning home was commonly reported, although eleven participants were described as independent and safe for discharge from hospital-based staff. The importance of family and social networks to facilitate discharge was highlighted, however participants often described wanting more support and issues accessing services. The effect of critical illness on the financial well-being of the family network was confirmed, with difficulties accessing financial support identified. ConclusionSurvivors of critical illness perceived a better functional state than measured, but many report new limitations 6-months after critical illness. Family and friends play a crucial role in facilitating transition home and providing financial support. Implications for clinical practiceImplementation of specific discharge liaison personnel to provide education, support and assist the transition from hospital-based care to home, particularly in those without stable social supports, may improve the recovery process for survivors of critical illness.

Iron and erythropoietin to heal and recover after intensive care (ITHRIVE): A pilot randomised clinical trial

ObjectiveTo determine the feasibility of a pivotal randomised clinical trial of intravenous (IV) iron and erythropoietin in adult survivors of critical illness with anaemia requiring treatment in the intensive care unit. DesignAn investigator-initiated, parallel group, placebo-controlled, randomised feasibility trial. SettingA tertiary intensive care unit (ICU) in Perth, Western Australia. ParticipantsAdults with anaemia (haemoglobin <100 g/L), requiring ICU-level care for more than 48 h, and likely to be ready for ICU discharge within 24 h. InterventionsA single dose of IV ferric carboxymaltose and Epoetin alfa (active group) or an equal volume of 0.9% saline (placebo group). Main outcome measuresStudy feasibility was considered met if the pilot achieved a recruitment rate of ≥2 participants per site per month, ≥90% of participants received their allocated study treatment, and≥ 90% of participants were followed up for the proposed pivotal trial primary outcome - days alive and at home to day 90 (DAH90). ResultsThe 40-participant planned sample size included twenty in each group and was enrolled between 1/9/2021 and 2/3/2022. Participants spent a median of 3.4 days (interquartile range 2.8–5.1) in the ICU prior to enrolment and had a mean baseline haemoglobin of 83.7 g/L (standard deviation 6.7). The recruitment rate was 6.7 participants per month [95% confidence interval (CI) 4.8–9.0], DAH90 follow-up was 100% (95% CI 91.2%–100%), and 39 (97.5%, 95% CI 86.8%–99.9%) participants received the allocated study intervention. No serious adverse events were reported. ConclusionThe iron and erythropoietin to heal and recover after intensive care (ITHRIVE) pilot demonstrated feasibility based on predefined participant recruitment, study drug administration, and follow-up thresholds.

The optimal dose of mobilisation therapy in the ICU: a prospective cohort study

BackgroundThis study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge.MethodsProspective single-centre cohort study conducted in two ICUs in Germany. In 684 critically ill patients surviving an ICU stay > 24 h, out-of-bed mobilisation of more than 40 min was evaluated.ResultsDaily mobilisation ≥ 40 min was identified as an independent predictor of an improved functional status upon ICU discharge. This effect on the primary outcome measure, change of Mobility-Barthel until ICU discharge, was observed in three different models for baseline patient characteristics (average treatment effect (ATE), all three models p < 0.001). When mobilisation parameters like level of mobilisation, were included in the analysis, the average treatment effect disappeared [ATE 1.0 (95% CI − 0.4 to 2.4), p = 0.16].ConclusionsA mobilisation duration of more than 40 min positively impacts functional outcomes at ICU discharge. However, the maximum level achieved during ICU stay was the most crucial factor regarding adequate dosage, as higher duration did not show an additional benefit in patients with already high mobilisation levels.Trial registration: Prospective Registry of Mobilization-, Routine- and Outcome Data of Intensive Care Patients (MOBDB), NCT03666286. Registered 11 September 2018—retrospectively registered,https://classic.clinicaltrials.gov/ct2/show/NCT03666286.

Early weight measures and long-term neuropsychological outcome of critically ill neonates and infants: a secondary analysis of the PEPaNIC trial

Neonates and infants surviving critical illness show impaired growth during critical illness and are at risk for later neuropsychological impairments. Early identification of individuals most at risk is needed to provide tailored long-term follow-up and care. The research question is whether early growth during hospitalization is associated with growth and neuropsychological outcomes in neonates and infants after pediatric intensive care unit admission (PICU). This is a secondary analysis of the PEPaNIC trial. Weight measurements upon PICU admission, at PICU discharge, at hospital discharge, at 2- and 4-year follow-up, and of different subgroups were compared using (paired) t-tests. Multiple linear regression analyses were performed to investigate the association between early growth in weight measures and neuropsychological outcomes at 4-year follow-up. One hundred twenty-one infants were included, and median age upon admission was 21 days. Growth in weight per week was less than the age-appropriate norm, resulting in a decrease in weight-for-age Z-score during hospitalization. Weight is normalized at 2- and 4-year follow-up. Weight gain in kilograms per week and change in weight Z-score were not associated with neurodevelopmental outcome measures at 4-year follow-up. Lower weight-for-age Z-score at PICU admission and at hospital discharge was associated only with lower weight and height Z-scores at 4-year follow-up.Conclusion: Growth in weight during hospital stay of young survivors of critical illness is impaired. Worse early growth in weight is associated with lower weight and height but not with neuropsychological outcomes at 4-year follow-up.What is Known:• Critically ill neonates and infants show impaired early growth during admission and are at risk for later neuropsychological impairments.• Unraveling the association between early growth and later neuropsychological impairments is crucial since the first year of life is critical for brain development.What is New:• Critically ill neonates and infants had age appropriate weight measures at 4-year follow-up.• Poor growth in weight during hospital stay was not associated with poorer cognitive, emotional, or behavioral functioning four years after critical illness.