Experience from multidisciplinary follow-up on critically ill patients treated in an intensive care unit (original) (raw)
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Post-ICU symptoms, consequences, and follow-up: an integrative review
Nursing in Critical Care, 2015
Aim: To determine the symptoms seen in patients after discharge from an intensive care unit (ICU) and the follow-up programmes offered to help patients deal with the problems that arise after an ICU stay. Background: An increasing number of people are discharged from an ICU to continued treatment, care and rehabilitation in general hospital wards, rehabilitation facilities and at home. A prolonged stay in an ICU is associated with stressful memories that have long-term physical, mental and social consequences for health-related quality of life. We therefore conducted a data search to identify the programmes that have attempted to cope with these consequences. Data sources: Searches of six online databases were conducted in December 2013. Review methods: Qualitative or quantitative, original, empirical studies on symptoms and consequences associated with ICU stay and the follow-up programmes offered were reviewed. Excluded were studies in ICU patients younger than 18 years published in languages other than Scandinavian or English. We analysed original empirical studies according to symptoms, consequences and follow-up programmes and added a category 'new ideas'. This was done to identify any possible evolution in the programmes offered to patients after ICU care. The review of the literature and the critical analysis were summarized in a figure in order to join the different parts together into a logical, coherent whole. Conclusions: Patients discharged from an ICU are heterogeneous, with a wide array of physical, mental and social problems. They and their close relatives can benefit from returning together to the ICU or participating in follow-up programmes. Little is known about the specific effects of the different types of follow-up. Relevance to clinical practice: ICU staff as well as other professionals should prepare patients and relatives for the fact that they may need various types of help for many months after discharge from the ICU, and an overview of national and local opportunities for help should be offered. Key words: follow-up • intensive care • post intensive care syndrome • diary • memories BACKGROUND The number of patients admitted to an intensive care unit (ICU) is increasing, and improved medical technology helps more patients to survive critical illness (Espersen et al., 2007). Consequently, millions of people are discharged from an ICU to continued treatment, care and rehabilitation in general hospital
Acta Anaesthesiologica Scandinavica, 2017
Background: Rehabilitation efforts after treatment in the intensive care unit (ICU) are termed intensive care aftercare. It includes both early in-hospital follow-up after ICU-discharge and late follow-up after hospital discharge. This study aims to investigate the current ICU-aftercare activities in Denmark. Methods: We conducted an electronic questionnaire survey, which was distributed by e-mail to the heads of all 31 general ICUs in Denmark. Specialized ICUs were not included. The questionnaire was divided into the following sections: early ICU-aftercare, late ICU-aftercare, future development and demographics. Results: Thirty-one ICUs were invited to participate. The response rate was 100%. Overall, 26 of 31 ICUs (84%) offered ICU-aftercare, with the following distribution: early ICU-aftercare (58%), late ICU-aftercare (57%) and both (29%). There were no significant associations between hospital size and provision of ICU-aftercare. For early ICU-aftercare, the most common eligibility criteria were based on ICU length of stay (LOS) (44%) and a decision based upon doctors' discretion (22%). Incidence of guidelines for early ICU-aftercare (44%) and checklists at patient contact (35%) were sparse. The most common early ICU-aftercare items were as follows: respiratory care (82%), tracheostomy care (59%) and nutritional care (59%). For late ICU-aftercare, the most common eligibility criterion was LOS (41%). Guidelines (71%), but not checklist at patient contact (35%), were more common. Most frequent late ICU-aftercare interventions were review of ICU-diaries (59%) and patient charts (53%). Conclusion: Eighty-four per cent of Danish ICUs offered ICUaftercare to their patients. There was an abundant heterogeneity of eligibility criteria and ICU-aftercare interventions. Editorial Comment Follow-up after ICU stay is now standard of care in Scandinavian countries. A national survey in Denmark confirms the international front line position of Scandinavia in this respect. It is now important to define the future targets of ICU-aftercare, beyond being an extremely valuable feedback to the ICU professionals. At Danish intensive care units (ICU), more than 30,000 patients are admitted for treatment of critical illness every year. 1 The overall 30-day standardized survival rate after critical illness and treatment is above 70%. 2 A variety of short-and long-term impairments after ICU treatment have,
Clinics
OBJECTIVES: To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country. METHODS: Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil. RESULTS: A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government. CONCLUSIONS: A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.
Follow-up after intensive care
… in Anaesthesia, Critical Care & Pain, 2004
Until recently, an intensive care unit (ICU) stay was deemed successful if a patient survived to go to the ward. Practitioners in neonatal medicine have always been concerned with the functional outcome of their infants. However, practitioners in adult intensive care have historically paid little attention to the long term outcomes of their patients. Also, little consideration was taken of the patient dying on the ward or soon after leaving hospital or indeed if the patient went home with an appalling quality of life.
Implementation of a Follow-Up Program for Intensive Care Unit Survivors
International Journal of Environmental Research and Public Health, 2021
In Intensive Care Unit (ICU) survivors, critical illness has an impact on an individual’s long-term health status and quality of life. Adults who have recovered from intensive care management could develop muscle weakness, neurocognitive impairment, difficulties in managing activities of daily living and to returning to work, and psychological problems such as depression and anxiety. A prospective, observational study was designed. Data were collected from January to December 2018 from a structured follow-up program, at 3 time points after ICU discharge: at seven days, a visit in the general ward, a phone interview at three months and an ambulatory visit at six months. A total of 95 patients were enrolled, 36% female, with a median age of 65 (55–73) years and a median ICU length of stay of 13 (8–20) days. At the seven days follow-up, patients who had a positive Hospital Anxiety and Depression Scale showed a significantly longer time of intubation (p = 0.048) and length of ICU stay (...
Health status of ICU survivors: a pilot study
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 2002
This paper reports on a pilot study that focused on the feasibility of conducting longitudinal research on the health status of intensive care unit (ICU) survivors. Twenty patients completed a short ICU specific health status survey while in ICU and then were invited to complete the same survey--with the addition of the Medical Outcome Study Short Form-36 (SF-36) health status survey--at 6 and 12 months after their hospital discharge. While the patients were in the ICU, 20 family members completed the same survey on the patients' behalf as proxy respondents. Most patients were willing to be in the study for its duration. There was a wide variation in patients' responses to the ICU specific instrument at all data collection points. Patient and proxy responses were very similar for almost all of the physical items but there was a lack of agreement for the more subjective psychosocial items. The SF-36 was found to be more reliable and easier to score and analyse in this small s...
PLOS ONE
Post-intensive care unit (ICU) sequelae, including physical and mental health problems, are relatively unexplored. Characteristics commonly used to predict outcome lack prognostic value when it comes to long-term physical recovery. Therefore, the objective of this study was to assess the incidence of non-recovery in long-stay ICU-patients. In this single-centre study, retrospective data of adults with an ICU stay >48 hours who visited the specialized post-ICU clinic, and completed the Dutch RAND 36-item Short Form questionnaire at 3 and 12 months post-ICU, were retrieved from electronic patient records. In cases where physical functioning scores at 12 months were below reference values, patients were allocated to the physical non-recovery (NR) group. Significantly different baseline and (post-)ICU-characteristics were assessed for correlations with physical recovery at 12 months post-ICU. Of 250 patients, 110 (44%) fulfilled the criteria for the NR-group. Neither the severity of ...
Critical Care Follow-up Clinics
Clinical Nurse Specialist, 2016
Objective-The purpose of this scoping review was to identify evidence describing benefits of interventions provided in ICU-survivor follow-up clinics. Background-Advances in intensive care unit (ICU) treatments have increased the number of survivors who require specialized care for ICU-related sequelae. ICU survivor follow-up clinics exist yet little is known about the nature and impact of interventions provided in such clinics. A scoping review of publications about in-person post-ICU follow-up care was undertaken. Method-Ten databases were searched yielding one-hundred eleven relevant unique publication titles and abstracts. Sample heterogeneity supported using a scoping review method. After excluding non-related publications, 33 reports were fully reviewed. Twenty international publications were included that described ICU follow-up clinic interventions and/or outcomes. Results-Authors discussed very diverse interventions in 15 publications, and 9 reported some level of intervention effectiveness. Evidence was strongest that supported the use of prospective diaries as an intervention to prevent or improve psychological symptoms whereas evidence to support implementation of other interventions was weak. Correspondence to: Sue Lasiter. All authors had substantial contributions to the conception, acquisition, analysis, and interpretation of data. All authors were actively involved in writing important intellectual content and revising it critically for final approval of the version to be published. Authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work could be appropriately investigated and resolved.