ImproveLTO

Improving Long-Term Outcomes Research for Acute Respiratory Failure: Johns Hopkins Outcomes After Critical Illness & Surgery(OACIS) project funded by NIH/NHLBI

[Dr. Chacón-Lozsán F .'. @franciscojlk]

🧠 ICU Survival Is Not Enough: Memory Matters

For decades, critical care focused on keeping patients alive.

Today, a different question is emerging:

What kind of life are we returning survivors to?

A thought-provoking 2026 editorial in Intensive Care Medicine reminds us that ICU recovery is not only physica, it is deeply psychological.

The article discusses findings showing that nearly 40% of ICU survivors reported "delusional memories" three months after discharge, and these memories were independently associated with a 3.5–5-fold increase in persistent PTSD symptoms at 12 months.

Interestingly, ICU amnesia itself was not the strongest predictor of long-term distress.

The strongest signal came from vivid, emotionally charged recollections such as:
• hallucinations
• nightmares
• terrifying dreams
• feelings of being abducted, trapped, restrained, or harmed

Experiences that felt completely real to the patient.

The authors challenge the term "delusional memories."

Many of these recollections may not represent psychosis at all.

Instead, they may reflect the brain's attempt to reconstruct fragmented experiences occurring during:
• severe illness
• sedation
• mechanical ventilation
• delirium
• extreme physiological stress

This editorial also provides an important clinical reminder:

Deep sedation is not always a failure of practice.

Sometimes it is lifesaving.

Patients with: • severe ARDS requiring proning
• neuromuscular blockade
• refractory agitation
• complex life-support interventions

may require deep sedation to survive.

The challenge is not eliminating deep sedation.

The challenge is avoiding it when unnecessary and mitigating its psychological consequences when unavoidable.

The authors propose several practical targets for ICU teams:

✅ Analgesia-first strategies

✅ Light sedation whenever feasible

✅ Early communication and reassurance

✅ Early mobilization

✅ ICU diaries documenting the patient's journey

✅ Structured post-ICU follow-up and psychological support

One of the strongest messages of this editorial is simple:

Memory is a vital sign of recovery.

As intensivists, we routinely monitor blood pressure, oxygenation, renal function, and ventilation.

Perhaps we should pay equal attention to the memories we leave behind.

Because surviving critical illness is only the beginning.

Helping patients make sense of what happened may be just as important as helping them survive it.

Reference

Paton M, Bienvenu OJ, Skrobik Y. Memory, sedation, and recovery in the ICU: what should we do better? Intensive Care Medicine. 2026.

#CriticalCare #ICU #Delirium #Sedation #MechanicalVentilation #PICS #PostICUSyndrome #MentalHealth #CriticalCareMedicine #IntensiveCare #ICURecovery #PatientCenteredCare

[Hopkins ICU Rehab @icurehab]

Submit Abstract NOW!

Oral & poster presentations

15th Johns Hopkins #ICURehab
Conference

Details in graphic

Nov 5-6, 2026

Info: https://t.co/ZtjyB7dPss

[Nursing in Critical Care Journal @niccjournal]

🧠 Can We Protect Cognitive Health After ICU Discharge?

This study identified 7 non-pharmacological approaches that may help PICS, including exercise, cognitive training, VR, music therapy, environmental modifications & ICU follow-up care.

🔗 https://t.co/aK88g0LwIG

#PICS

[PHOSP-COVID study @PHOSP_COVID]

Help us again... If you were invited to the PHOSP-COVID 5-year follow-up, your input is vital. We’re checking in on how health and wellbeing have changed since hospitalisation. #PHOSP #COVID19 #LONGCOVID #PatientVoice #BePartOfResearch #COVIDRecovery #HealthResearch

[Critical Care Explorations @CritCareExplore]

🏥 Post-ICU morbidity is common in low-resource settings and highlights the need for feasible follow-up and rehabilitation strategies.

➡️ Read the complete #openaccess article from Critical Care Explorations: https://t.co/Cs9xEPIwD1

#CritCareExplore #SCCM @SCCM

[Alasdair MacLullich @A_MacLullich]

❓ "But they're too drowsy to assess."

I hear this regularly. A patient is lying quietly, eyes closed, not responding to questions. How can we screen for delirium if they won't engage?

✅ 𝐇𝐞𝐫𝐞'𝐬 𝐭𝐡𝐞 𝐜𝐥𝐢𝐧𝐢𝐜𝐚𝐥 𝐩𝐞𝐚𝐫𝐥: 𝐝𝐫𝐨𝐰𝐬𝐢𝐧𝐞𝐬𝐬 𝐈𝐒 𝐭𝐡𝐞 𝐚𝐬𝐬𝐞𝐬𝐬𝐦𝐞𝐧𝐭.

A patient who is drowsy or unrousable has altered consciousness - which is itself a key feature of delirium. You don't need them to answer orientation questions to recognise something is wrong.

The 4AT was designed with this in mind. Item 1 assesses alertness first. A patient who is clearly abnormally sleepy, or agitated, scores 4 points immediately - meeting the threshold for possible delirium before you even ask about the year or the months backwards.

𝑾𝒉𝒂𝒕 𝒕𝒐 𝒅𝒐 𝒘𝒊𝒕𝒉 𝒕𝒉𝒆 𝒅𝒓𝒐𝒘𝒔𝒚 𝒑𝒂𝒕𝒊𝒆𝒏𝒕:

Check their level of arousal. Are they sleepy but rousable? Only rousable to physical stimulus? Unrousable?

Consider this altered consciousness as clinical information. In most cases, the patient will fulfil criteria for delirium when assessed.

➡️ The sleepy patient isn't unsuitable for assessment. The sleepiness is a critical clinical sign.

What's your approach when the patient is too drowsy to complete cognitive testing?

[Hopkins ICU Rehab @icurehab]

Call for abstracts on #ICURehab

Submit to 10th Asia Pacific
#ICURehab Conference

Share research &
quality improvement projects

Oct 3-4, 2026
Taipei, Taiwan

Abstract Deadline: June 1

More info:
https://t.co/bNPsNvwWkT

[APTA Acute Care @AcuteCareAPTA]

Important Deadline for
@ AcuteCareAPTA-sponsored event!

The 15th @HopkinsMedicine
@ICURehab Conference

Abstract deadline:
June 30, 2026

In-Person Conference:
Johns Hopkins Hospital
Nov 5-6, 2026

Info: https://t.co/Gxk0NKWnQy

[Alasdair MacLullich @A_MacLullich]

Why are we building complex AI systems to detect delirium from casenotes when we could just... do a 2-minute bedside test?

The 4AT exists.

It's well-validated (33 studies).

It's free.

Sometimes clinical medicine doesn't need machine learning.

#delirium

[Amy Freeman-Sanderson @DrAmyFS]

Last chance to vote!

If you’ve experienced critical illness, supported someone who has, or work in this area, we want to hear from you

This is your chance to help shape future research priorities.

👉Please vote before 31 May:
https://t.co/MjnrU17NTd

Thanks for sharing

[Hopkins ICU Rehab @icurehab]

“ICU Rehabilitation is
so incredibly important”

“Our patients need it and deserve it”

Hear @DrDaleNeedham discuss
“Why Early #ICURehab Matters”

15th Johns Hopkins #ICURehab Conf

In-Person at Johns Hopkins
Nov 5-6, 2026
Register: https://t.co/B4YFfRLOcl

@APTAcvp, @AOTAInc, @ATSCritCare, @AcuteCareAPTA, @HopkinsAMP

[Hopkins ICU Rehab @icurehab]

Ultrasound assessment of muscle atrophy and its association with functional outcomes in critically ill patients: a systematic review and meta-analysis https://t.co/llvo5PgDMh #icurehab #A2Fbundle

[Hopkins ICU Rehab @icurehab]

Non-pharmacological rehabilitation strategies for pulmonary and physical recovery in ICU survivors after COVID-19: A systematic review https://t.co/z7aEEIck4A #icurehab #A2Fbundle

[Hopkins ICU Rehab @icurehab]

ABSTRACT DEADLINE!
June 30, 2026

15th Johns Hopkins
#ICURehab Conf is
in-Person!

Join us for lively
Abstract Discussion!

Oral & Poster
Abstract Presentations

Details in graphic

Info: https://t.co/ZtjyB7dPss

[Hopkins ICU Rehab @icurehab]

Post-intensive Care Syndrome (PICS): an American Association for the Surgery of Trauma Critical Care Committee Consensus Guideline – Defining, Recognizing, and Managing PICS Associated Physical Impairment, Cognitive Dysfunction, and Thromboinflammatory Dysregulation https://t.co/SJ3sWK4Z1X #icurehab #A2Fbundle

[RESPIRATORY CARE @respcare]

Arora et al contribute a scoping review evaluating telehealth pulmonary rehabilitation programs for individuals with COPD to identify trends, benefits, and gaps in current approaches.
https://t.co/9mfW42H9xV

[NIDUS Delirium Network @NIDUS_Delirium]

The bCAM is this week's #DeliriumMeasure. Find this and other measures on the @NIDUS_Delirium website: https://t.co/kAueEOnNgS
#Delirium

[Hopkins ICU Rehab @icurehab]

Non-Pharmacological Interventions for Cognitive Impairment After Intensive Care: A Scoping Review https://t.co/eqdHT1Kxhd #icurehab #A2Fbundle

[Hopkins ICU Rehab @icurehab]

Hear from @DrDaleNeedham, @DrKatzKatsukawa
and more…

10th Asia Pacific
#ICURehab Conference
Oct 3-4, 2026
Taipei, Taiwan

Abstract Deadline: June 1

Info: https://t.co/bNPsNvwovl

[JAGS @AGSJournal]

Feasibility of a Multicomponent Frailty Intervention During Post-Acute Rehabilitation in Skilled Nursing Facilities. #geriatrics https://t.co/NgtOo55Wx1