Search Results (108)

Background/Objectives: This study aimed to evaluate sociodemographic factors, features of the acute infection, and post-infection health status in survivors of COVID-19, assessing their association with post-acute COVID-19 syndrome (PACS). Methods: A multidisciplinary public clinic in Brazil assessed COVID-19 survivors between June 2020 and February 2022. Patients were classified as having PACS or subacute infection (SI). Data on the history of the acute infection, current symptoms, physical examination, and laboratory findings were collected and analyzed using multivariate models with PACS as the outcome. Results: Among the 113 participants, 63.71% were diagnosed with PACS at a median of 130 days (IQR: 53–196) following acute symptom onset. Admission to the intensive care unit was more frequent among individuals with PACS than those with SI (83.3% vs. 65.0% respectively; p = 0.037). Symptoms significantly more prevalent in the PACS group when compared to the SI cohort included hair loss (44.4% vs. 17.1% respectively; p = 0.004), lower limb paresthesia (34.7% vs. 9.8% respectively; p = 0.003), and slow thinking speed (28.2% vs. 0.0% respectively; p < 0.001). Logistic regression revealed that only the time interval between the onset of acute symptoms and the clinical evaluation was independently associated with a PACS diagnosis (β = 0.057; 95% CI: 1.03–1.08; p < 0.001). Conclusions: Patients with PACS had a higher frequency of intensive care unit admission compared to those with subacute infection. However, in the multivariate analysis, the severity of the acute infection did not predict the final diagnosis of PACS, which was associated only with the time elapsed since symptom onset. Full article

Background/Objectives: Sudden cardiac arrest (SCA) is a major global health concern with high mortality despite advances in resuscitation techniques. Achieving return of spontaneous circulation (ROSC) represents merely the initial step in the extensive rehabilitation journey. This review highlights the critical role of structured, multidisciplinary rehabilitation following ROSC, emphasizing the necessity of integrated physiotherapy, neurocognitive therapy, and psychosocial support to enhance quality of life and societal reintegration in survivors. Methods: This narrative review analyzed peer-reviewed literature from 2020–2025, sourced from databases such as PubMed, Scopus, Web of Science, and Google Scholar. Emphasis was on clinical trials, expert guidelines (e.g., European Resuscitation Council 2021, American Heart Association 2020), and high-impact journals, with systematic thematic analysis across rehabilitation phases. Results: The review confirms rehabilitation as essential in addressing Intensive Care Unit–acquired weakness, cognitive impairment, and post-intensive care syndrome. Early rehabilitation (0–7 days post-ROSC), focusing on parameter-guided mobilization and cognitive stimulation, significantly improves functional outcomes. Structured interdisciplinary interventions encompassing cardiopulmonary, neuromuscular, and cognitive domains effectively mitigate long-term disability, facilitating return to daily activities and employment. However, access disparities and insufficient randomized controlled trials limit evidence-based standardization. Discussion: Optimal recovery after SCA necessitates early and continuous interdisciplinary engagement, tailored to individual physiological and cognitive profiles. Persistent cognitive fatigue, executive dysfunction, and emotional instability remain significant barriers, underscoring the need for holistic and sustained rehabilitative approaches. Conclusions: Comprehensive, individualized rehabilitation following cardiac arrest is not supplementary but fundamental to meaningful recovery. Emphasizing early mobilization, neurocognitive therapy, family involvement, and structured social reintegration pathways is crucial. Addressing healthcare disparities and investing in rigorous randomized trials are imperative to achieving standardized, equitable, and outcome-oriented rehabilitation services globally. Full article

Survivors of intensive care unit (ICU) hospitalization often face persistent health challenges after discharge, collectively referred to as post-intensive care syndrome (PICS). This condition affects physical, cognitive, and mental health, significantly impacting patients’ quality of life and increasing their healthcare utilization. Additionally, caregivers may develop PICS-F (PICS family), experiencing stress-related health burdens. Despite the growing awareness of these issues, structured post-ICU follow-up remains inconsistent, leaving a gap in care that general practitioners (GPs) must often fill. This review examines the role of GPs in managing post-ICU patients, outlining common complications, screening tools, rehabilitation strategies, and potential areas for improved collaboration between primary care and ICU teams. Emphasizing a multidisciplinary and proactive approach, we propose practical interventions that GPs can adopt to enhance long-term recovery outcomes for ICU survivors. Full article

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Background: Post-intensive care syndrome (PICS) affects over half of intensive care unit (ICU) survivors, impairing their long-term health and quality of life. Although the Post-Intensive Care Syndrome Questionnaire (PICSQ) was developed to measure PICS, validated cutoff values for screening are lacking. This study aimed to determine optimal cutoff values for each domain of the PICSQ. Methods: A total of 475 ICU survivors completed the PICSQ three months after discharge. Receiver operating characteristic (ROC) curve analyses were conducted to determine optimal cutoff values for each domain. The criterion tools included the Hospital Anxiety and Depression Scale, the Posttraumatic Diagnostic Scale, the Activities of Daily Living scale, and the Montreal Cognitive Assessment. Health-related quality of life and hospital readmission rates were compared between groups classified by the determined cutoffs. Results: The optimal cutoff values were ≥3 for mental, ≥7 for physical, and ≥2 for cognitive domains, with area under the curve (AUC) values of 0.83, 0.84, and 0.80, respectively. The participants scoring above these cutoffs had significantly lower quality of life and higher readmission rates. Conclusions: The determined cutoff values may support early screening of PICS in ICU survivors, enabling timely interventions to improve long-term outcomes. Further research is needed to validate these values in diverse populations. Full article

Background/Objectives: The present study aimed to analyze changes in symptom intensity during the recovery period of COVID-19 survivors and patients with post-COVID syndrome. Methods: Initially, we described a new remote patient monitoring system to track the intensity of specific symptoms in individuals’ home environments. Remote patient monitoring (RPM) was implemented over 15 days in a cohort of 133 individuals aged 20 to 78 years, divided into four groups: mild (MG, n = 40), Hospital Discharge Without Invasive Mechanical Ventilation (WIMV, n = 40), Hospital Discharge With Invasive Mechanical Ventilation (IMV, n = 13), and reinfected (RG, n = 40). Results: The most prevalent symptoms reported across all groups, based on average intensity, were shortness of breath, fatigue, cough, headache, and body pain. The WIMV group exhibited the highest average intensities in six symptoms (p < 0.01), while the IMV group reported the highest averages in four symptoms (p < 0.05). Fatigue was the symptom with the highest overall intensity, followed by memory lapses. The hospitalized groups demonstrated the highest intensities and most persistent symptoms (p < 0.05). Blood pressure was significantly higher in the MG group compared to the RG group (p < 0.0001), although all values remained within the normal range. Conclusions: These results provide novel insights, revealing distinct differences in the symptom profiles among the studied groups. These findings hold significant implications for developing more personalized care strategies and informing future pandemic preparedness and response efforts. Full article

Background: Post-intensive care syndrome encompasses physical, cognitive, and psychological impairments that persist in patients after discharge from an intensive care unit. There is considerable variation in the tools used for assessment. This systematic review aimed to summarize the consensus-based recommendations for assessing post-intensive care syndrome. Methods: A comprehensive literature search identified four consensus-based guidelines. A quality assessment carried out using the Appraisal of Guidelines for Research and Evaluation II tool demonstrated high methodological standards across all the included papers. Results: The guidelines consistently emphasize assessing cognition, mental health, and physical function as the core domains. However, there are notable differences in the specific tools recommended. Major et al. focused on physical examinations, while Mikkelsen et al. proposed a fundamental package of five tools covering the key domains. Spies et al. aimed for a pragmatic set of freely available instruments administrable within 30 min. Nakanishi et al. provided a detailed ranking of instruments for each domain. The availability of validated translations varied considerably across languages. Some tools developed specifically for post-intensive care syndrome were not considered by any consensus conference. Conclusions: Further work is needed to establish a universally accepted standard for assessing post-intensive care syndrome that considers practical implementation across diverse settings and languages. Full article

Background: Patients suffering from severe COVID-19 often develop acute respiratory distress syndrome (ARDS), necessitating intensive care unit (ICU) and extracorporeal membrane oxygenation (ECMO). Survivors frequently experience negative impacts on their health-related quality of life. These individuals may experience a range of symptoms and may require extended hospitalization and rehabilitation. The objective of this prospective cohort study was to assess the long-term health-related quality of life in intensive care survivors of COVID-19-related ARDS who received ECMO therapy, >18 months after their ICU discharge. Methods: The health-related quality of life of COVID-19 survivors who had received extracorporeal membrane oxygenation was evaluated using an augmented version of the Short-Form Health Survey-36, >18 months after their ICU discharge. The outcomes were compared to preexisting data from a meta-analysis analyzing patients with non-COVID-19 ARDS and ECMO therapy. Results: Of the 43 eligible patients (mean age 52 ± 9.5 years), 18 patients (46.2%) responded to the written invitation and were included in this study. The four subscales of the Short-Form Health Survey-36 survey, performed via telephone interview, that showed the most severe limitations (points) were role limitation due to physical problems (37.5), emotional problems (47.9), social functioning (38.1), and general health (49.2). The general health, energy/fatigue (vitality), and physical functioning significantly correlated with higher age (p = 0.004, p = 0.003, and p = 0.05, respectively). A longer duration of extracorporeal membrane oxygenation was positively associated with an improved energy/fatigue ratio (vitality) and emotional well-being (p = 0.04 and p = 0.02, respectively). Compared to survivors of non-COVID-19 ARDS treated with ECMO, the survivors in our cohort scored significantly lower on social functioning, physical functioning, and general health (p < 0.01, p = 0.02, p < 0.01). Conclusions: Patients who have recovered from intensive care treatment for COVID-19-related ARDS and have received ECMO therapy continue to experience more severe impairments in their physical, mental, and cognitive health-related quality of life. A longer ECMO duration may improve outcomes in this selected patient population. Full article

Background: Post Intensive Care Syndrome (PICS) is a set of physical, cognitive, and mental health symptoms that arise following intensive care (ICU) hospitalization. Regarding physical changes, muscle weakness is highlighted, potentially leading to functional impairments during and after hospitalization. Multidisciplinary guidelines recommend early mobilization, a rehabilitation intervention, as a strategy to prevent ICU-acquired muscle weakness and reduce functionality impairments. Objective: This study aims to evaluate the effectiveness of early mobilization and positioning interventions to prevent or minimize ICU-acquired weakness in critically ill patients under invasive mechanical ventilation (IMV). Methods: A systematic review of effectiveness will be conducted following Cochrane recommendations. Searches will be made in MEDLINE (via PubMed), CINAHL, Scopus, and Web of Science. Eligible studies will include randomized controlled trials on the functional management of muscle weakness, muscle strength, and ICU-acquired muscle weakness in adults (≥18 years) who have undergone IMV. Eligible interventions (and comparators) include any manual mobilization and positioning strategy or the use of medical devices. Two reviewers will independently select studies, extract data using a piloted tool and assess bias with the RoB 2 tool. If appropriate, a meta-analysis will be conducted, pooling standardized mean differences using a random-effects model. Results: This review included primary experimental studies manipulating at least one variable, control group studies, or randomized trials comparing early intervention protocols, programs, or plans with standard care or existing approaches in the ICU. Conclusions: This review will provide meaningful comparisons of different mobilization and positioning strategies, evaluating their impact on muscle strength and functionality in critically ill patients. Systematic Review Registration: PROSPERO CRD4202348091. Full article

Background/Objectives: This study investigated the prevalence of functional impairments and the effects of long COVID on long-term functional impairments in patients with severe COVID-19. Methods: We conducted a nationwide multicenter cohort study in collaboration with nine hospitals, collecting data using self-administered questionnaires from participants aged 20 years or older who were diagnosed with COVID-19, admitted to the intensive care unit (ICU) between April 2021 and September 2021, and discharged alive. Questionnaires regarding daily life, sequela, and functional impairments were mailed to patients in August 2022. The effects of long COVID on functional impairments were examined using a multivariate logistic regression analysis. Results: The survey was completed by 220 patients, with a mean of 416 days after discharge. Among respondents, 20.5% had physical impairments (n = 45), 35.0% had mental disorders (n = 77), and 42.7% had either (n = 94). Furthermore, 77.7% had long COVID (171/220), and the most common symptom was dyspnea (40.0%). The multivariate analysis showed that fatigue/malaise, upper respiratory tract symptoms, myalgia, muscle weakness, decreased concentration, sleep disorder, brain fog, and dizziness were risk factors for functional impairments at one year. Conclusions: Many patients with severe COVID-19 admitted to the ICU still suffered from post-intensive care syndrome even after one year, which manifested in combination with direct symptoms of the original disease, such as long COVID. Full article

Background: Cardiac arrest (CA) is a leading cause of mortality and morbidity, with survivors often developing post-cardiac arrest syndrome (PCAS), characterized by systemic inflammation, ischemia–reperfusion injury (IRI), and multiorgan dysfunction. Acute kidney injury (AKI), a frequent complication, is associated with increased mortality and prolonged intensive care unit (ICU) stays. This study evaluates AKI incidence and progression in cardiac arrest patients managed with different temperature protocols and explores urinary biomarkers’ predictive value for AKI risk. Methods: A prospective, single-center observational study was conducted, including patients with Return of Spontaneous Circulation (ROSC) post-cardiac arrest. Patients were stratified into three groups: therapeutic hypothermia (TH) at 33 °C, Targeted Temperature Management (TTM) at 35 °C, and no temperature management (No TTM). AKI was defined using KDIGO criteria, with serum creatinine and urinary biomarkers (TIMP-2 and IGFBP7) measured at regular intervals during ICU stay. Results: AKI incidence at 72 h was 31%, varying across protocols. It was higher in the No TTM group at 24 h and in the TH and TTM groups during rewarming. Persistent serum creatinine elevation and fluid imbalance were notable in the TH group. Biomarkers indicated moderate tubular stress in the TTM and No TTM groups. Conclusions: AKI is a frequent complication post-cardiac arrest, with the rewarming phase identified as critical for renal vulnerability. Tailored renal monitoring, biomarker-guided risk assessment, and precise temperature protocols are essential to improve outcomes. Full article

Background/Objectives: Ventilator-associated pneumonia (VAP) is the main nosocomial infection in intensive care units (ICUs) that causes the highest morbidity and mortality. The aim of our study is to investigate variations in crude ICU mortality among patients with VAP over the past decade. We also wish to identify associated risk factors, evaluate changes in the etiology, and assess the incidence and impact of inappropriate empirical antibiotic treatment (IEAT). Methods: We conducted a retrospective, observational, single-center study over a 10-year period (2014–2024), including critically ill patients who developed VAP. The population was divided into three periods: (P1) from 2014 to 2018 (pre-COVID-19); (P2) from 2019 to 2021 (COVID-19); and (P3) from 2022 to 2024 (post-COVID-19). Binary logistic regression was used to identify which variables were independently associated with ICU mortality. Results: A total of 220 patients were included in the study (P1 = 47, P2 = 96, and P3 = 77 patients). The most prevalent microorganisms identified were P. aeruginosa, Klebsiella spp., and S. aureus. Significant variations in etiology were not observed over the years. The incidence of IEAT was 4.5%, with no observed differences between the study periods. Crude ICU mortality was 33.6%, with higher rates observed in IEAT (40% vs. 33.3%, p = 0.73). In patients with appropriate empiric antibiotic treatment (AEAT), there was a significant decrease in crude mortality over the years from 42.2% in P1 to 22.2% in P3 (p < 0.001). Age (OR = 1.04; 95% CI = 1.01–1.08) and P2 (OR = 2.8; 95% CI = 1.1–7.4) were found to be independently associated with an increased risk of mortality. Conversely, a lower risk of death was associated with mean arterial pressure (OR = 0.94; 95% CI = 0.69–0.99) and the use of syndromic respiratory panel (OR = 0.23; 95% CI = 0.07–0.68). Conclusions: A reduction in crude VAP mortality over the years was observed, with no change in the etiology or rate of IEAT. The implementation of protocols using respiratory syndromic panels could be a measure to implement to reduce VAP mortality. Full article

Deep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers. Thanks to its high accuracy, ease of use, and safety profile, duplex ultrasound (DUS), particularly compression ultrasound (CUS), has emerged as the first-line imaging modality for DVT diagnosis. The evaluation of suspected DVT needs a multifaceted approach, and in this context, CUS rapidly became a key diagnostic tool owing to its many unique advantages. Its central role in the diagnostic algorithm of suspected DVT is clearly established in the latest clinical practice guidelines from the European Society for Vascular Surgery and the American Society of Haematology. Indeed, DUS effectively visualizes blood flow and identifies abnormalities like clot formation with high sensitivity (typically exceeding 90% for proximal DVT) and specificity (often approaching 100% for proximal DVT). Additionally, CUS is non-invasive, readily available at the bedside, and avoids radiation exposure, resulting in an ideal method for various clinical settings. CUS has been shown to have a substantial role not only in the diagnosis of an acute DVT but also in the follow-up of its management. Moreover, this method can provide a prognostic assessment, mostly in terms of risk stratification for recurrent thrombosis and/or for potential complications, such as post-thrombotic syndrome. In summary, given its established benefits, CUS is a technique that many physicians should be familiar with, especially those working in emergency departments, intensive care units, or general wards. When needed, healthcare operators with more advanced US skills (such as radiologists, angiologists, or vascular surgeons) may be called upon to provide a second look in case of uncertainty and/or need for additional information. Full article

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to <37 weeks (moderate to late preterm) (36.1%). The maternal severity of COVID-19 was reported to be severe in three cases only (8.3%); however, SARS-CoV-2 infection in neonates with PPHN was either severe (44.4%) or critical (22.2%). Most of these neonates experienced acute respiratory distress syndrome (ARDS) (58.3%). Early and late multisystem inflammatory syndrome in neonates (MIS-N) were reported in 50% and 11.1%, respectively. A high proportion of neonates were admitted to the intensive care unit (ICU) (58.3%) or needed mechanical ventilation (MV) (47.2%). Neonates with concurrent PPHN and SARS-CoV-2 infection who died had worse severity of COVID-19 [i.e., severity of COVID-19 was critical in 10% (neonates with PPHN who survived group) vs. 83.3% (neonates with PPHN who died group); p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary. Full article

Millions of critically ill patients are discharged from intensive care units (ICUs) every year. These ICU survivors may suffer from a condition known as post-intensive care syndrome (PICS) which includes a wide range of cognitive, psychological, and physical impairments. This article will provide an extensive review of PICS. ICU survivors may experience cognitive deficits in memory and attention, with a slow-down of mental processing and problem-solving. From psychological perspectives, depression, anxiety, and post-traumatic stress disorder are the most common issues suffered after ICU discharge. These psycho-cognitive impairments might be coupled with ICU-acquired weakness (polyneuropathy and/or myopathy), further reducing the quality of life, the ability to return to work, and other daily activities. The burden of ICU survivors extends to families too, leading to the so-called PICS-family (or PICS-F), which entails the psychological impairments suffered by the family and, in particular, by the caregiver of the ICU survivor. The development of PICS (and PICS-F) is likely multifactorial, and both patient- and ICU-related factors may influence it. Whilst the prevention of PICS is complex, it is important to identify the patients at higher risk of PICS, and clinicians should be aware of the tools available for diagnosis. Stakeholders should implement strategies to achieve PICS prevention and to support its effective treatment during the recovery phase with dedicated pathways and supporting care. Full article