A review entitled, “Long-term complications of critical care” published in the February 2011 volume of the journal Critical Care Medicine directs our attention to problems associated with ICU patients — after they are discharged. Until recently, there hasn’t been a huge focus on the health issues and complications faced by critical care survivors. More patients survive the ICU than don’t, no newsflash there, but patient mortality rates are dropping. As the baby boomer population ages, we will likely see more and more ICU survivors. Patients discharged from the ICU suffer from mental health conditions (PTSD, depression, anxiety, for example) and physical health conditions (such as impaired lung function or neuromuscular weakness). These issues may be long-term. Aside from decreased quality of life and a burden on friends and family, these effects of ICU stays translate into overuse of the healthcare system and unnecessary costs. To quote the authors of the review, “the goals of critical care must extend beyond patient survival and include shared, multidisciplinary collaboration to prevent and manage the long-term complications of critical care.”
The review mentioned above discusses important risk factors for certain conditions seen in critical care survivors and suggestions to manage the complications. Age, comorbidity, and severity of ICU illness are among the most significant risk factors.
Below is a diagram from the review that outlines some examples of the pathways leading from certain risk factors to certain adverse effects. Providers need to be cognisant of these, as quality of life often depends on it.
Guidelines from the UK’s Institute for Health and Clinical Excellence were issued in March 2009 in this document, entitled “Rehabilitation after critical illness.” This is a very detailed and comprehensive document, establishing directives to enhance the “optimisation of recovery as a therapeutic objective rather than mere survival.” The guidelines are too extensive to warrant a summary here, so you’ll have to check it out on your own if you’re interested.
Finally I’ll mention another place to go for a little bit of insight on this topic. Here you can find an engaging discussion from the Diane Rehm show on NPR. Transcripts and audio from the piece are there too. It can be dowloaded on iTunes as well.
Healthcare providers need to address ICU patient care with a hollistic approach. There are best practice measures to be taken that will help avoid real, severe problems if the devliery system will make an effort to restore quality of life to patients as opposed to merely restoring survival without the aid of machines.
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