Critical care clinics
-
Critical care clinics · Oct 2018
ReviewEarly Mobilization in the Intensive Care Unit to Improve Long-Term Recovery.
This article outlines the effect of early mobilization on the long-term recovery of patients following critical illness. It investigates the safety of performing exercise in this environment, the differing types of rehabilitation that can be provided, and the gaps remaining in evidence around this area. It also attempts to assist clinicians in prescription of exercise in this cohort while informing all readers about the impact that mobilization can have for the outcomes of intensive care patients.
-
Critical care clinics · Oct 2018
ReviewPatient and Population-Level Approaches to Persistent Critical Illness and Prolonged Intensive Care Unit Stays.
The differential diagnosis of prolonged intensive care unit (ICU) stays includes intrinsic patient and admitting diagnostic characteristics, occurrences during the course of critical illness, and system failures. Existing data suggest that the most common cause of prolonged ICU stay is the development of new cascading problems, which is now more related to ongoing critical illness than the original reason for ICU admission. Accepting the dynamism inherent in such a clinical course has implications for contemporary clinical care.
-
Critical care clinics · Oct 2018
ReviewFrailty and the Association Between Long-Term Recovery After Intensive Care Unit Admission.
Frailty is common, although infrequently screened for among patients admitted to intensive care. Frailty has been the focus of research in geriatric medicine; however, its epidemiology and interaction with critical illness have only recently been studied. ⋯ Frail survivors of critical illness are high users of health resources. Further research is needed to understand how frailty assessment can inform decision-making before and during an episode of critical illness and during an intensive care course for frail patients.
-
Outcomes after critical illness remain poorly understood. Conceptual models developed by other disciplines can serve as a framework by which to increase knowledge about outcomes after critical illness. This article reviews 3 models to understand the distinct but interrelated content of outcome domains, to review the components of functional status, and to describe how injuries and illnesses relate to disabilities and impairments afterward.
-
Critical illness survivors frequently have substantial psychiatric morbidity, including posttraumatic stress, depression, and anxiety symptoms. Prior psychiatric illness is a potent predictor of postcritical illness psychiatric morbidity. Early emotional distress and memories of frightening psychotic and nightmarish intensive care unit (ICU) experiences are risk factors for longer term psychiatric morbidity. ICU diaries may be effective in decreasing psychiatric morbidity after critical illness, though these and other interventions deserve further study.