Comprehensive Health Assessment 3 Months After Recovery From Acute Coronavirus Disease 2019 (COVID-19)

Clinical Infectious Diseases, Journal Year: 2020, Volume and Issue: 73(5), P. e1089 - e1098

Published: Nov. 20, 2020

Long-term health sequelae of coronavirus disease 2019 (COVID-19) may be multiple but have thus far not been systematically studied.All patients discharged after COVID-19 from the Radboud University Medical Center, Nijmegen, Netherlands, were consecutively invited to a multidisciplinary outpatient facility. Also, nonadmitted with mild symptoms persisting >6 weeks could referred by general practitioners. Patients underwent standardized assessment including measurements lung function, chest computed tomography (CT)/X-ray, 6-minute walking test, body composition, and questionnaires on mental, cognitive, status, quality life (QoL).124 (59 ± 14 years, 60% male) included: 27 mild, 51 moderate, 26 severe, 20 critical disease. Lung diffusion capacity was below lower limit normal in 42% patients. 99% had reduced ground-glass opacification repeat CT imaging, X-rays found 93% Residual pulmonary parenchymal abnormalities present 91% correlated capacity. Twenty-two percent low exercise capacity, 19% fat-free mass index, problems mental and/or cognitive function 36% Health status generally poor, particularly domains functional impairment (64%), fatigue (69%), QoL (72%).This comprehensive revealed severe several substantial number ex-COVID-19 Longer follow-up studies are warranted elucidate natural trajectories find predictors complicated long-term recovery.

Language: Английский

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Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

The Lancet Respiratory Medicine, Journal Year: 2021, Volume and Issue: 9(3), P. 239 - 250

Published: Jan. 12, 2021

Language: Английский

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The ABCDEF Bundle: Science and Philosophy of How ICU Liberation Serves Patients and Families

Critical Care Medicine, Journal Year: 2017, Volume and Issue: 45(2), P. 321 - 330

Published: Jan. 18, 2017

Over the past 20 years, critical care has matured in a myriad of ways resulting dramatically higher survival rates for our sickest patients. For millions new survivors comes de novo suffering and disability called "the postintensive syndrome." Patients with syndrome are robbed their normal cognitive, emotional, physical capacity cannot resume previous life. The ICU Liberation Collaborative is real-world quality improvement initiative being implemented across 76 ICUs designed to engage strategically ABCDEF bundle through team- evidence-based care. This article explains science philosophy liberating patients families from harm that both inherent illness iatrogenic. liberation an extensive program facilitate implementation pain, agitation, delirium guidelines using bundle. Participating teams adapt data hundreds peer-reviewed studies operationalize systematic reliable methodology shifts culture harmful inertia sedation restraints animated filled who awake, cognitively engaged, mobile family members engaged as partners team at bedside. In doing so, "liberated" iatrogenic aspects threaten his or her sense self-worth human dignity. goal this 2017 plenary lecture 47th Society Critical Care Medicine Congress provide clinical synthesis literature led creation explain how patient- family-centered, novel, generalizable, practice changing.

Language: Английский

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Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness*

Critical Care Medicine, Journal Year: 2018, Volume and Issue: 46(9), P. 1393 - 1401

Published: May 22, 2018

To describe the frequency of co-occurring newly acquired cognitive impairment, disability in activities daily livings, and depression among survivors a critical illness to evaluate predictors being free post-intensive care syndrome problems.Prospective cohort study.Medical surgical ICUs from five U.S. centers.Patients with respiratory failure or shock, excluding those preexisting impairment livings.None.At 3 12 months after hospital discharge, we assessed patients for disability, depression. We categorized into eight groups reflecting combinations cognitive, mental health problems. Using multivariable logistic regression, modeled association between age, education, frailty, durations mechanical ventilation, delirium, severe sepsis odds free. analyzed 406 median age 61 years an Acute Physiology Chronic Health Evaluation II 23. At months, one more problems were present 64% 56%, respectively. Nevertheless, (i.e., two domains) 25% at 21% months. Post-intensive all three domains only 6% 4% More education was associated greater (p < 0.001 mo). frailty lower = 0.005 mo p 0.048 mo).In this multicenter study, majority survivors, but out four. Education protective predictive development Future studies are needed understand better heterogeneous subtypes identify modifiable risk factors.

Language: Английский

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Sepsis Pathophysiology, Chronic Critical Illness, and Persistent Inflammation-Immunosuppression and Catabolism Syndrome

Critical Care Medicine, Journal Year: 2016, Volume and Issue: 45(2), P. 253 - 262

Published: Sept. 15, 2016

To provide an appraisal of the evolving paradigms in pathophysiology sepsis and propose evolution a new phenotype critically ill patients, its potential underlying mechanism, implications for future management research.Literature search using PubMed, MEDLINE, EMBASE, Google Scholar.Sepsis remains one most debilitating expensive illnesses, prevalence is not declining. What changing our definition(s), clinical course, how we manage septic patient. Once thought to be predominantly syndrome over exuberant inflammation, now recognized as aberrant host protective immunity. Earlier recognition compliance with treatment bundles has fortunately led decline multiple organ failure in-hospital mortality. Unfortunately, more especially aged, are suffering chronic critical illness, rarely fully recover, often experience indolent death. Patients illness exhibit "a persistent inflammation-immunosuppression catabolism syndrome," it proposed here that this state persisting immunosuppression contributes many these adverse outcomes. The cause currently unknown, but there increasing evidence altered myelopoiesis, reduced effector T-cell function, expansion immature myeloid-derived suppressor cells all contributory.Although newer therapeutic interventions targeting inflammatory, immunosuppressive, protein catabolic responses individually, successful patient may require complementary approach.

Language: Английский

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