Rationale: Patients requiring cardiac surgery are at increased risk for inadequate energy and protein supply, which may negatively affect the postoperative recovery process and mid-to longterm outcomes of concerning patients.This study aimed to evaluate the site performance in medical nutrition therapy (MNT) in critically ill patients after cardiac surgery by measuring the adequacy of energy and protein supply across international intensive care units (ICUs).Methods: An international prospective observational study enrolling mechanically ventilated cardiac surgery patients (age 18 years; length of ICU stay 72 hours) was performed in ICUs worldwide.Data of MNT in routine clinical practice were collected daily from ICU admission to a maximum of 12 days (data shown as n [%] and mean [range], respectively).Results: A total of 13 ICUs (Canada: n¼2, USA: n¼4, Germany: n¼3, Russia: n¼2, Iran: n¼1, Malaysia: n¼1; presence of a dietitian: n¼8 sites), each enrolling approximately n¼20 cardiac surgery patients, were involved in the study.MNT was performed by enteral nutrition (EN; initiated 53 [10-79] hours after ICU admission) and/or (supplemental) parenteral nutrition (PN; hours after ICU admission).Across the sites, the average adequacy of MNT was 47.5% (30.5-78.6%)for energy from all nutritional sources (EN+PN+propofol) and 43.6% (21.7-76.6%)for protein in total (EN+PN).In the case of exclusive EN, the nutritional adequacy was 39.4% (21.9-64.4%)for energy and 39.8% (21.0-67.7%)for protein (more detailed data available). Conclusion:The present study showed that energy and protein adequacy after cardiac surgery was extremely low across international ICUs; nutritional targets were not adequately covered throughout the observation period.These findings illuminate an urgent need to improve the MNT in routine clinical practice to increase nutritional adequacy and, thus, to avoid iatrogenic malnutrition.

Introduction: Critical care survivors sustain a variety of sequelae after intensive care medicine (ICM) admission, and the Coronavirus Disease 2019 (COVID-19) pandemic has added further challenges. Specifically, ICM memories play a significant role, and delusional memories are associated with poor outcomes post-discharge including a delayed return to work and sleep problems. Deep sedation has been associated with a greater risk of perceiving delusional memories, bringing a move toward lighter sedation. However, there are limited reports on post-ICM memories in COVID-19, and influence of deep sedation has not been fully defined. Therefore, we aimed to evaluate ICM-memory recall in COVID-19 survivors and their relation with deep sedation. Materials/Methods: Adult COVID-19 ICM survivors admitted to a Portuguese University Hospital between October 2020 and April 2021 (second/third "waves") were evaluated 1 to 2 months post-discharge using "ICU Memory Tool," to assess real, emotional, and delusional memories. Results: The study included 132 patients (67% male; median age = 62 years, Acute Physiology and Chronic Health Evaluation [APACHE]-II = 15, Simplified Acute Physiology Score [SAPS]-II = 35, ICM stay = 9 days). Approximately 42% received deep sedation (median duration = 19 days). Most participants reported real (87%) and emotional (77%) recalls, with lesser delusional memories (36.4%). Deeply sedated patients reported significantly fewer real memories (78.6% vs 93.4%, P = .012) and increased delusional memories (60.7% vs 18.4%, P < .001), with no difference in emotional memories (75% vs 80.4%, P = .468). In multivariate analysis, deep sedation had a significant, independent association with delusional memories, increasing their likelihood by a factor of approximately 6 (OR = 6.274; 95% confidence interval = 1.165-33.773, P = .032), without influencing real (P = .545) or emotional (P = .133) memories. Conclusions: This study contributes to a better understanding of the potential adverse effects of deep sedation on ICM memories in critical COVID-19 survivors, indicating a significant, independent association with the incidence of delusional recalls. Although further studies are needed to support these findings, they suggest that strategies targeted to minimize sedation should be favored, aiming to improve long-term recovery.

Introduction Evidence suggest that critically ill COVID-19 patients are at higher risk of developing anxiety symptoms, which may be related to or exacerbated by patients concerns regarding their health status and recovery. Objectives To assess anxiety symptoms in critically ill COVID-19 survivors, 1-2 months after hospital discharge and to analyze its association with concerns reported by patients regarding their own health status and recovery. Methods In the framework of MAPA prospective research, this preliminary study included COVID-19 patients admitted in the Intensive Care Medicine Department (ICMD) of a University Hospital. Patients were excluded if they had an ICMD length of stay (LoS) ≤24h, terminal illness, major auditory impairment or inability to communicate at the evaluation time. Participants were assessed at a scheduled telephone follow-up appointment, with Generalized Anxiety Disorder Scale (GAD-7). Additional questions were asked to assess the survivors’ post-discharge concerns regarding discrimination against for COVID-19, infection of a family member, re-infection or sequelae related to COVID-19. Results Eighty-three patients were included (median age=63 years; 63% male) and 24% had anxiety symptoms. Anxiety scores were higher in survivors who reported being afraid of being discriminated against for COVID-19 (30% vs 10%; p=0.034), being re-infected (100% vs 79%; p=0.032) and having sequelae (94% vs 44%; p<0.001). Conclusions These findings revealed that anxiety is common in COVID-19 survivors and is associated with post-discharge patients concerns that may limit patient daily living. This study emphasizes the importance of psychological assessment and follow-up of the COVID-19 survivors, in order to support these patients recovery. Disclosure No significant relationships.

IntroductionSevere COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL).ObjectivesTo identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL.MethodsIn the context of the longitudinal MAPA project, we included adult patients (≥ 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay ≤24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients’ clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge.ResultsOverall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%; p=0.011) and considerably anxiety/depression (83%vs60%; p=0.032).ConclusionsThese findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium long-term impacts.DisclosureNo significant relationships.

Introduction Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on health-related quality of life (HRQoL), commonly used as an indicator of illness and treatment impact. Objectives To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains. Methods This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)≤24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project. Results Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%; p=0.029), pain/discomfort (86%vs49%; p=0.002), and anxiety/depression (96%vs54%; p<0.001). Conclusions These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients. Disclosure No significant relationships.

IntroductionA higher risk of mental health consequences in critical COVID-19 patients is expected due to several reasons, including prolonged mechanical ventilation with exposure to high sedation. In this context, post-discharge depression has been reported in previous COVID-19 studies, with a profound impact on patients’ health-related quality of life (HRQoL).ObjectivesTo identify depressive symptoms in COVID-19 survivors 1-year after hospital discharge and to analyse its association with HRQoL.MethodsAs part of the longitudinal MAPA project, this study enrolled critical COVID-19 patients admitted in the Intensive Care Medicine Department of a University Hospital (March-May 2020). Participants were assessed through telephone by an intensive care nurse and a psychologist, with the Patient Health Questionnaire (PHQ-9) (depressive symptoms), EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS) (global health status patient record).ResultsA sample of 55 survivors (median age=66 years; 69% males) were included, with 20% showing depressive symptoms. Pain/discomfort (67%) and anxiety/depression (67%) were the most EQ-5D-5L domains reported. Survivors scoring for depression had more problems in all HRQoL areas (mobility:91%vs.48%, p=0.015; self-care:64%vs.27%, p=0.035; usual activities:91%vs.50%, p=0.017; pain/discomfort:100%vs.59%, p=0.010; anxiety/depression:100%vs.59%, p=0.010). Moreover, they had a lower EQ-VAS median, corresponding a worse self-perception of health status (50vs.80, p=0.010).ConclusionsEven after 1-year, a significant proportion of survivors presented depressive symptoms with repercussions in all HRQoL dimensions and association with worse self-perception of global quality of life. Taking this in mind, early screening and treatment of depression in COVID-19 survivors will be crucial, minimizing its impact on quality of life.DisclosureNo significant relationships.

Background. According to a meta-analysis, lifetime prevalence of non-suicidal self-injury (NSSI) is between 7.546.5% among adolescents [1] . There are several different theoretical models aimed at conceptualizing this phenomenon. NSSI has different functions along two (interpersonal and intrapersonal) factors [2] . The intrapersonal factor is more often in the background of NSSI [1] , and includes five functions: affect-regulation, anti-dissociation, anti-suicide, self-punishment and marking distress [2] , the first three based on negative reinforcement, while self-punishment is based on positive reinforcement. The Experiential Avoidance Model of NSSI [3] focuses on negative reinforcement, while the Benefits and Barriers Model [4] focuses on experienced pain as a significant aspect of self-harm which has a paradoxical role in NSSI both increasing and decreasing its appearance and is also affected by the functions of NSSI. Aim. The present study aimed to investigate NSSI in a large community adolescent sample focusing on the key aspects of the mentioned models. We specifically aimed to analyze the intrapersonal functions of NSSI among adolescents and its impact on frequency of NSSI, experiential avoidance, and frequency of experienced pain during NSSI. Methods. A non-representative sample of 1015 Hungarian high school students (Mage = 16.81; SDage = 1.42; 14-20 aged) participated in the study. Forty-four percent (41.2%; N = 418) had a history of NSSI. The frequency and functions of NSSI including frequency of experienced pain during self-harm were assessed with the Inventory of Statements About Self-injury (ISAS) [2] , while experiential avoidance was evaluated with the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) [5] . Data were tested using Spearman correlation, bootstrapped linear and logistic regression models, and nonparametric variance analysis. Results. Prevalence of NSSI was the highest among adolescents who experienced pain “sometimes” during NSSI ( χ2(2) = 9.733; p = 0.008). In addition, more frequent NSSI reduced the chance of experiencing pain during NSSI by 1,2% (B = -0.012; SE = 0.006; p = 0.018; CI(95%) = [-0.023 – -0.004]). There was a moderate significant correlation between experiential avoidance and negative reinforcing intrapersonal NSSI functions (NRIF) (rs = 0.298; p < 0.001). NRIF (R2 = 0.031; p = 0.002) and self-punishment function (R2 = 0.02; p = 0.01) had a positive linear relationship with the frequency of NSSI. Furthermore, more frequently experienced pain during NSSI was related to a higher level of all NSSI functions ( χ2(2)NRIF = 22.928; p < 0.001; χ2(2)marking_distress = 13.145; p = 0.001; χ2(2)selfpunishment = 25.934; p < 0.001). Conclusion. We found that NRIF and self-punishment functions of NSSI weakly predict the frequency of NSSI. Besides, more often experienced pain during self-harm correlated with a higher level of all NSSI functions. We also found that experienced pain is not only a barrier but could also be considered as a benefit in NSSI. Self-harm is the most frequent, if there is a detected ""optimum"" of barriers and benefits, which could happen on the level of ""sometimes"" experienced pain during NSSI. Our findings may help to identify key points in the emergence of NSSI in adolescence and thus can help to define targets for early detection and intervention. Conflict of interest Disclosure statement: M. Reinhardt was supported by the National Research, Development and Innovation Office – NKFIH, Budapest, Hungary under grant number PD 128332.

Introduction Survivors of critical illness stay frequently experience long-term mental health morbidity, suggesting that many critically ill patients with COVID-19 may also show a high prevalence of psychiatric conditions. Objectives To describe depression in COVID-19 survivors 4-months post-hospital discharge and to examine its association with health-related quality of life (HRQoL). Methods This pilot study involved COVID-19 adult patients admitted in Intensive Care Medicine Service (ICMS) of a University Hospital. Exclusion criteria were: ICMS length of stay (LoS)≤24h, terminal illness, major sensory loss and inability to communicate at the time of assessment. All participants were evaluated at ICMS scheduled telephone follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EQ-5D-5L (HRQoL). Critical-illness severity was assessed with APACHE-II and SAPS-II. Results Twenty patients were included with a median age of 62(range: 24-77) y.o., the majority male (75%) and married (70%). Median (range) APACHE-II and SAPS-II was 17 (5-34) and 32.5 (7-77), respectively, and LoS was 18 (4-58) days. Overall, 25% patients presented depression symptoms and most reported problems on EQ-5D-5L domains of pain/discomfort (65%), anxiety/depression (55%) and mobility (50%). Depression scores were higher in patients with problems in EQ-5D-5L domains of usual activities (median 4 vs 1.5; p=0.046), pain/discomfort (median 0 vs 4; p=0.004) and anxiety/depression (median 4 vs 0;p<0.001). Conclusions These preliminary findings show that depression is frequent in COVID-19 survivors and it is associated with worse HRQoL. This pilot study highlights the importance of psychological assessment and treatment of COVID-19 survivors, in order to minimize its negative impact on HRQoL, optimizing their recovery.

Purpose: To investigate age-related differences in outcomes of critically ill patients with sepsis around the world. Methods: We performed a secondary analysis of data from the prospective ICON audit, in which all adult ( >16 years ) patients admitted to participating ICUs between May 8 and 18, 2012, were included, except admissions for routine postoperative observation. For this sub-analysis, the 10,012 patients with completed age data were included. They were divided into five age groups - <= 50, 51-60, 61-70, 71-80, >80 years. Sepsis was defined as infection plus at least one organ failure. Results: A total of 2963 patients had sepsis, with similar proportions across the age groups (<= 50 = 25.2%: 51-60 = 30.3%; 61-70 = 32.8%; 71-80 = 30.7%; >80 = 30.9%). Hospital mortality increased with age and in patients >80 years was almost twice that of patients <= 50 years (493% vs 25.2%, p < .05). The maximum rate of increase in mortality was about 0.75% per year, occurring between the ages of 71 and 77 years. In multilevel analysis, age > 70 years was independently associated with increased risk of dying. Conclusions: The odds for death in ICU patients with sepsis increased with age with the maximal rate of increase occurring between the ages of 71 and 77 years. (C) 2019 Elsevier Inc. All rights reserved.