What we have for post-ICU syndrome is essentially we've robbed Peter to pay Paul. We've all gotten very good at organ supplantation. We're able to keep the acute patient alive. And then we high five as they leave. The problem is most, not most, many of these patients do poorly at one year out. And this has multiple effects. The SCCM has sort of led the way on this. It coined the term post-ICU syndrome. And this is a video I'm gonna show you that is somewhat dated, but is still quite relevant, which is unfortunate, because it means we haven't been able to make that much progress in helping these patients with poor outcomes. It has gained some new attention with post-COVID, long-COVID syndrome, which is very similar, although we have to understand that different infections probably have different pathologies that can lead to the same issues. And this includes frailty, myopathy, cognitive impairment, increased risk of repeat sepsis. There's some cardiovascular risk. And then overall increased mortality at one to two years. It's a very complex syndrome that won't have one simple answer. And besides maximizing nutrition at this time, as well as early physical therapy, and following best practice measures, we don't have a lot right now. I would emphasize that when you get home, clinics are good. Follow-up is good. We don't have a standard way of doing it yet. Try to get involved in it. And then I'll answer any questions after this. All the studies that SCCM has kind of done, I put up in the slides that are available to you for taking the course. And SCCM, again, is trying to lead the way on many of these things in terms, even putting articles out about how important some form of post-ICO follow-up should be done, and who should be leading those, and what we need to make those work. I will be around. I can ask any questions on trauma, or this, or anything else you guys want to discuss about this, so you can get your money's worth, but I also know you're getting hungry and tired. So go ahead and roll the clip. Many people now survive critical illness. Healthcare professionals used to assume that patients who survived critical illnesses returned to how they were before. However, stories of patients with profound struggles after being hospitalized emerged, such as James, Maria's, and Ping's stories. James was a businessman. He had sepsis from a severe bout of pneumonia, and needed life support for 10 days. For months after his illness, he was forgetful, had difficulty concentrating, and frequently lost his train of thought. James was asked to copy this drawing, and he drew this. Maria was a professor. She had severe influenza. Her kidneys and lungs failed, meaning that she needed dialysis and a breathing machine for two weeks. After her hospitalization, Maria had profound weakness. She had to learn to walk again at a rehabilitation center. Ping was in fourth grade when he was hit by a car. After being in the intensive care unit, or ICU, he went to a rehabilitation hospital. Ping talked little at rehab, but learned how to use his arms and legs again. He had a hard time reconnecting with his friends. During the past 20 years, research has confirmed that these types of stories happen more often than not. In 2010, the Society of Critical Care Medicine, or SCCM, gathered together experts involved in the care of ICU survivors. The group named the combination of problems common to survivors of critical illness post-intensive care syndrome, or HICS. HICS includes new challenges to the brain, body, and emotions, and is seen in more than half of critical illness survivors. Children surviving critical illness often have similar problems, such as delayed developmental milestones, learning problems, and sadness. Families and friends are also affected. For example, James' persistent problems led to his wife giving up her job to be his caregiver. Researchers are working to prevent and treat PICS. SCCM believes that ICU survivors can share their stories to help each other, which is why its Thrive initiative is building a network of face-to-face groups for critical illness survivors. In 2015, six Thrive sites were launched. In 2016 and 2017, even more will join. If critical illness has touched you or a loved one, please join us. Let's create a better recovery together. More resources about PICS and the Thrive initiative can be found here. So instead of me going through the slides to show you that this is still going on, and been shown time and time and time again, we actually have quite a bit of the SCCM leadership that Thrive has evolved over time. I don't know if you guys can give any updated info about SCCM and sort of what we're doing for post-ICU syndrome or any other initiatives that are kind of in place right now. I have to use the microphone again. So there are a couple of things that are important. This is a two-part process. One is the ICU liberation approach. You may know this as the A through F or A to F approach. All of that reduces ICU time. It reduces delirogenic medications. It also engages the family. So that's the first piece. But the second piece, and this is where we have really fallen down nationally, is that we don't have many post-ICU clinics. Pieces that we take for granted. Of course we sent them out of the ICU, and naturally they'll turn off those medications. They'll realize they don't need those meds anymore. Doesn't happen. So that the rise of post-ICU clinics to integrate PharmDs, nurse practitioners, social workers, rehab physiatrists, neurocognitive specialists, so that you identify these patients early is important. Because your patient may come into the ICU. Now this happens for us all the time. They come in for a hip. They have a giant PE. They end up with pneumonia. They're in the ICU for two months. They survive. They go to rehab. And then when they get out, they go back to see their primary care person who has no idea what has happened with them. And the only thing they say is, my orthopedic surgeon saved my life. The orthopedic surgeon can't find the ICU door. And the people who know what this patient has gone through are absolutely remote. You use telecritical care in some part of your practice. Why are we not using it to link to where that person is in rehab? Not once. Trauma clinic is perfect. Many of the surgeons are intensivists. We have all the other pieces there. You know how many trauma clinics ask the questions that are relevant for PICS? It's less than a handful in terms of percentage. Very, very few. So we have opportunities, and those are the kinds of opportunities that SCCM is working towards. So you think about where you would put your post-ICU clinic. Who should be part of your team? How do you communicate with the primary care person? Who's got Epic? Lots of people. We will feel sad for the people that have Cerner. It's okay. Do you have a ICU discharge letter that goes to your primary care person for this individual that says, your patient is at high risk of PICS because of these things? Think about how easy that would be. There's a quality improvement project. And you put in that letter if, when this person comes to see you, they have any of the following things, these are the appropriate referrals. Make it easy for them. Especially if they use Epic in their outpatient practice. So those are the kinds of initiatives. You will have other ideas. You get to bring them back to us. Anybody want to add anything else? Any other leadership want to comment on PICS? Other, I would say, not at least Luke. Is that recorded? No, they said I was completely correct. I want a copy. Okay. Remember September is Sepsis Awareness Month. You don't, you just get the word out and get the word out that it's not just the beginning of what we discussed here. Try to latch this onto things that people care about and latch on to. If they understand why I'm COVID, they can understand this. They can understand why it's a priority. If they understand Alzheimer's disease, they can understand how this is associated with a significant increase in dementia and worse outcomes. All of it can be linked together. And with that, you can start bringing sort of the attention to this that needs to be done. Yes, question. I think part of it though is like we don't, I don't know how much of this we actually explain that okay, you're sick, he's gonna be sick, he's gonna be gone through a lot for the next half a year or a year. And that's just, you know, like before you agreed up, going through all this critical illness and all the things we do to try to save people, a whole other journey. And that's a whole another conversation. But that might be something that they start early on. You're correct. Every place that's instituted early palliative care has demonstrated that it's been efficacious and works and even improves outcomes and decreases length of stay. But it's a huge culture change. And Americans in general are not interested in sort of that kind of care. They wanna know how they can prolong their own life and not understand those concepts. But we are the ones at the front line. So we're the ones that are gonna have to push this into the unit, even though, you know, someone, as the surgeon, I'm a surgeon myself, but to say I didn't operate on this person to withdraw, I understand. But we have to have, times have changed. The population is much older. They're sicker. This is different. Whether you, whatever your belief pattern is, we were not created or evolved to live like this or be on a ventilator. Pseudomonas used to be a soil organism. I mean, so things have changed. And with that, we have to change as well. And again, through SCCM and other organizations and yourself, we have to sort of lead the way on this. Because if we don't, it's gonna come back and smack us anyway, because these patients are, it's just gonna be there anyway. So best that we who are the experts kind of lead the way. Other questions? Whew. And for the record, Lou is always correct. All right. Pfft.

Post-ICU syndrome

cognitive impairment

Thrive program

multidisciplinary teams

recovery pathways