Some more #COVIDDeepThoughts after post-ICU clinic this week. All of the patients we saw were #COVID19 survivors in their 40s-60s, previously relatively healthy, had been intubated in the #ICU, some for quite a while. 1st, the good news. All of them were home & many back at work.

We had done a lot of video visits beforehand, which made things go much more smoothly...because of the video visits, many patients had gotten medication adjustments and subspecialist referrals they needed before seeing us in person.

Observations: Everyone experienced delirium in the #ICU, even those w/o OVERT delirium...ppl w/ neg CAM-ICU, RASS 0, interacting seemingly appropriately. Important to ask about this...I took care of almost all of these pts myself in the ICU & wouldn’t have known if I didn’t ask.

Recalling delirium can be disturbing for people. Knowing that you were hallucinating or even just not acting like yourself can be very jarring & depersonalizing...our minds & personalities constitute such a huge part of our identities.

Oh & words matter - “you were experiencing delirium” NOT “you were delirious.” Some patients will benefit from referral to mental health but are hesitant to pursue it. NORMALIZE referral to psych the same way you would normalize a referral to cardiology. It’s just as crucial.

More under the radar observations: arterial lines are not always so benign. We’ve seen hand pain, tingling, and weakness post-discharge. Referral to occupational therapy helps a lot. Also consider placing these on the patient’s non-dominant side whenever possible.

With increased use of #prone positioning (life saving for many), we’ve been looking out for shoulder issues (PT eval & treatment very helpful), ocular symptoms (none so far), & facial wounds (engaged our wound care specialists to help come up w/ better ways to treat & prevent).

Reporting follow-up info to your #ICU staff can potentially help improve care for patients still hospitalized (which is why I’m sharing this here); @CritKristin and I are hoping to formalize this reporting process for our ICU.

It also boosts staff morale to know the folks they took care of are doing well (more on that soon), so following #ICUrecovery is basically awesome for everyone - discharged patients, current patients, and clinicians.