Patients' Priorities and Goals of Care During Intensive Care Unit Recovery: A Multicenter Cohort Study.

Background: Patients can experience physical, emotional, social, and cognitive challenges following discharge from critical care. Data regarding goals of care for intensive care unit recovery from a patient's perspective are limited.

Objectives: To use data from a multicenter intensive care unit recovery program to explore patients' goals during recovery from critical illness and to understand optimal models of care for future research design and care delivery.

Understanding Bayesian analysis of clinical trials: an overview for clinicians.

Bayesian analysis is being used with increasing frequency in critical care research and brings advantages and disadvantages compared to traditional Frequentist techniques. This study overviews this methodology and explains the terminology encountered when appraising this literature. Setting different priors can impact the interpretation of new results, and we describe an approach to understanding this.

Changes in frailty status and discharge destination post emergency laparotomy.

Background: Pre-operative frailty adversely affects morbidity and mortality after emergency laparotomy (EmLap), especially in older adults (65 years and above). Little is known about frailty after EmLap. We explored the change in frailty status from pre- to post-EmLap and any influence on discharge destination.

Stoma reversal after emergency stoma formation-the importance of timing: a multi-centre retrospective cohort study.

Background: Restoration of intestinal continuity is a key consideration for patients having a stoma created under emergency conditions. There is contrasting evidence about the outcomes of stoma reversal for these patients. This research aims to describe the post-operative outcomes of stoma reversal after emergency formation, and whether these are affected by the timing of reversal.

Patient and family member experience of hospital readmission following critical illness.

Background: Hospital readmission following critical illness is common. There is limited data which examines the patient and family perspective of hospital readmission. Understanding the impact of readmissions from a patient perspective can potentially help design meaningful clinical pathways to support improvements in care.

Mechanisms underlying neurocognitive dysfunction following critical illness: a systematic review.

Introduction: Cognitive impairment is a significant healthcare problem globally and its prevalence is projected to affect over 150 million people worldwide. Survivors of critical illness are impacted frequently by long-term neurocognitive dysfunction regardless of presenting illness, but the mechanisms are poorly understood. The goal of this review was to synthesise the existing evidence regarding potential mechanisms underlying neurocognitive dysfunction following critical illness in order to guide potential avenues for future research.

Long term mortality in burn injury survivors: A matched cohort study.

Background: Survivors of burn injuries may be at risk of early death. This study describes the mortality of burn survivors in comparison with two matched cohorts.

Methods: This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched cohorts; one from the general population and one with a diagnosis of acute pancreatitis.

Anxiety and depression following critical illness: A comparison of the recovery trajectories of patients and caregivers.

Background: Following critical illness, family members are often required to adopt caregiving responsibilities. Anxiety and depression are common long term problems for both patients and caregivers. However, at present, it is not known how the trajectories of these symptoms compare between patients and caregivers.

Characterizing Cardiac Function in ICU Survivors of Sepsis: A Pilot Study Protocol.

Background: Sepsis is one of the most common reasons for ICU admission and a leading cause of mortality worldwide. More than one-half of survivors experience significant physical, psychological, or cognitive impairments, often termed post-intensive care syndrome (PICS). Sepsis is recognized increasingly as being associated with a risk of adverse cardiovascular events that is comparable with other major cardiovascular risk factors.

Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery - a multicentre retrospective study.

Aim: Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse.

Could an integrated model of health and social care after critical illness reduce socioeconomic disparities in outcomes? A Bayesian analysis.

Background: There is limited evidence to understand what impact, if any, recovery services might have for patients across the socioeconomic spectrum after critical illness. We analysed data from a multicentre critical care recovery programme to understand the impact of this programme across the socioeconomic spectrum.

Methods: The setting for this pre-planned secondary analysis was a critical care rehabilitation programme-Intensive Care Syndrome: Promoting Independence and Return to Employment.

Long term opioid use after burn injury: a retrospective cohort study.

Background: Patients who have survive a burn injury might be at risk of opioid dependence after discharge. This study examined the use of opioids in patients who suffer burn injury and explored factors associated with persistent opioid use after hospital discharge.

Methods: This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched comparison cohorts from the general population and adults with a diagnosis of acute pancreatitis.

Factors Associated With New Analgesic Requirements Following Critical Illness.

Background: Chronic opioid use represents a significant burden to global healthcare with adverse long-term outcomes. Elevated patient reported pain levels and analgesic prescriptions have been reported following discharge from critical care. We describe analgesic requirements following discharge from hospital and identify if a critical care admission is a significant factor for stronger analgesic prescriptions.

Patient-reported impact of emergency laparotomy on employment and health status 1 year after surgery.

Background: Whilst there has been significant improvement in mortality outcomes after emergency laparotomy, there is little information on longer term outcomes in the year after discharge. The main aim of the study was to assess the impact that an emergency laparotomy has on patients' and employment and health status 1 year after surgery.

Methods: This study was a questionnaire study conducted in a single centre district general hospital of patients who had undergone an emergency laparotomy between October 2015 and December 2016.

Investigation of frailty markers including a novel biomarker panel in emergency laparotomy: protocol of a prospective cohort study.

Background: Emergency laparotomy (EmLAP) is one of the commonest emergency operations performed in the United Kingdom (approximately 30, 000 laparotomies annually). These potentially high-risk procedures can be life changing with frail patients and/ or older adults (≥ 65 years) having the poorest outcomes, including mortality. There is no gold standard of frailty assessment and no clinical chemical biomarkers existing in practice.

The relationship between pain, anxiety and depression in patients with post-intensive care syndrome.

Purpose: Survivors of critical illness frequently experience long-term symptoms including physical symptoms such as pain and emotional symptoms such as anxiety and depression. These symptoms frequently co-exist, however, at present there is limited understanding of these relationships. The aim of this study was to quantify the relationship between pain, anxiety and depression across the recovery trajectory.

The impact of intestinal stoma formation on patient quality of life after emergency surgery-A systematic review.

Aim: Elective stoma formation has a negative effect on patient quality of life (QoL), with a potential detrimental impact on body image, confidence and social functioning being shown previously. However, the impact of emergency stoma formation on QoL has been explored less frequently. This systematic review aims to synthesize all available literature exploring QoL via patient-reported outcome measures.

Medication-related problems in critical care survivors: a systematic review.

Objectives: There are numerous, often single centre discussions of assorted medication-related problems after hospital discharge in patients who survive critical illness. However, there has been little synthesis of the incidence of medication-related problems, the classes of medications most often studied, the factors that are associated with greater patient risk of such problems or interventions that can prevent them.

Methods: We undertook a systematic review to understand medication management and medication problems in critical care survivors in the hospital discharge period.

Association Between Socioeconomic Status and Outcomes in Critical Care: A Systematic Review and Meta-Analysis.

Objectives: Socioeconomic status is well established as a key determinant of inequalities in health outcomes. Existing literature examining the impact of socioeconomic status on outcomes in critical care has produced inconsistent findings. Our objective was to synthesize the available evidence on the association between socioeconomic status and outcomes in critical care.

Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation.

Purpose: To guarantee the safety of the public, clinicians and patients during the COVID-19 pandemic, hospital visits were severely restricted internationally. There are limited data on the precise impact of these visiting restrictions on Intensive Care Unit clinicians. Our objectives therefore were to explore the impact of family visitation restrictions on clinicians and care delivery and describe innovation alongside areas for potential improvement.

Evaluating pain in survivors of critical illness: the correlation between the EQ-5D-5L and the Brief Pain Inventory.

Introduction: Pain is a common and debilitating symptom in survivors of critical illness. The 'Core Outcome Set for Survivors of Acute Respiratory Failure' proposes that the pain and discomfort question of the EuroQol 5 Dimension 5 Level (EQ-5D-5L) could be used to assess pain in this group, however, it was recognised that further research is required to evaluate how this single question compares to other more detailed pain tools. This study aims to evaluate the relationship between the pain and discomfort question of the EQ-5D-5L and the Brief Pain Inventory (BPI) in survivors of critical illness.

Patient and Caregiver-Derived Health Service Improvements for Better Critical Care Recovery.

Objectives: To engage critical care end-users (survivors and caregivers) to describe their emotions and experiences across their recovery trajectory, and elicit their ideas and solutions for health service improvements to improve the ICU recovery experience.

Design: End-user engagement as part of a qualitative design using the Framework Analysis method.

Setting: The Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups).

Modification of social determinants of health by critical illness and consequences of that modification for recovery: an international qualitative study.

Objectives: Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness.

Design: In-depth semistructured interviews following hospital discharge.