Thread by @ChrisCarrollMD

Another great @CHESTCritCare session! Post-intensive Care Syndrome with @PisaniMAP @crit_caring_MD @GioraNetzer @itsradu and @ICU_Recovery! #CHEST2020

@crit_caring_MD: #PICS is a new or worsening impairment of mental health, cognitive or physical impairments. #CHEST2020

@crit_caring_MD: A third of ICU survivors will have significant mental health, cognitive issues, and disabilities. Even in younger patients! #CHEST2020

@crit_caring_MD: And frequently ICU survivors have issues across multiple domains. #CHEST2020

@crit_caring_MD: Many of the common syndromes and treatments received in the ICU put patients at risk for #PICS. #CHEST2020

@crit_caring_MD: Incidence of #PICS may be increasing for a variety of reasons. #CHEST2020

@crit_caring_MD: Many of our #COVID19 patients are at increased risk of #PICS. Visitors & rehab restricted, patients sicker. #COVID also raising public awareness of #PICS. #CHEST2020

@GioraNetzer: Family (both biological and chosen) have significant impact on #PICS and are an important part of the healthcare team. #CHEST2020

@GioraNetzer: When you have good family support, you do better. Period. #CHEST2020

@GioraNetzer: Family suffer a constellation of morbidity in the ICU. #CHEST2020

@GioraNetzer: A third of family members develop PTSD post-ICU. And these effects last a long time after discharge. #CHEST2020

@GioraNetzer: Recurrent emotions are very common in families after an ICU admission. #CHEST2020

@GioraNetzer: Significant financial burdens and effects on employment post-ICU in patients and in families. #CHEST2020

@GioraNetzer: So how can we support families? Think about interventions that have worked in other areas. #CHEST2020

@GioraNetzer: Liberalizing family visitation and use of "family navigators" can also improve outcomes. May also benefit patients and families post-discharge. #CHEST2020

@GioraNetzer: #COVID19 is making all this worse for families (and for ICU clinicians!) for a variety of reasons. #CHEST2020

A personal aside from me: Thank you @GioraNetzer for bringing up arbitrary enforcement of COVID19 rules. It is a big problem to those of us at the bedside and highly susceptible to biases. #CHEST2020

@itsradu: We meet patients at one point in their illness, but there are many variables that affect their trajectory. #CHEST2020

@itsradu: Why are patients readmitted? There are several hypothesis. #CHEST2020

@itsradu: Readmissions are a significant burden to patients and to hospital costs in the ICU. #CHEST2020

@itsradu: Research from @HalliePrescott shows that there are common reasons for readmission in #sepsis. #CHEST2020

@itsradu: Are readmissions preventable? (Maybe??) #CHEST2020

@itsradu: How about in #COVID19? Probably too early to make any conclusions. #CHEST2020

@ICU_Recovery: Some key points in ICU Follow up. #CHEST2020

@ICU_Recovery: Critical Care is a relatively young specialty. Tremendous growth in studies. But not many good studies looking at recovery. #CHEST2020

@ICU_Recovery: But absence of evidence is not evidence of absence. Growing evidence that providing anticipatory guidance to survivors and interventions in the ICU can influence post-ICU outcomes. #CHEST2020

@ICU_Recovery: Most patients in the US do not have access to specialist who can address these post-ICU problems. Although more and more post-ICU clinics. #CHEST2020

@ICU_Recovery: Post-ICU clinics involve multidisciplinary approach. #CHEST2020

@ICU_Recovery: Can we predict who will develop #PICS? #CHEST2020

@ICU_Recovery: We need more than just a one-time look at patients in the post-ICU period. Longitudinal assessment is important. #CHEST2020

@ICU_Recovery: If you are thinking of starting a post-ICU clinic, here are some of the tools that people use to screen. #CHEST2020

@ICU_Recovery: A number of components have found to be important by patients and families. #CHEST2020

@ICU_Recovery: There are significant costs to these clinics, but clinics have been shown to save money over time! #CHEST2020

@ICU_Recovery: #COVID19 has made everything worse in post-ICU care. Graphic by @CAHarrisMD #CHEST2020

@ICU_Recovery: If you're interested in joining a post-ICU collaborative, see below. #CHEST2020