RT Book, Section
A1 Jolley, Sarah
A1 Douglas, Ivor S.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201799126
T1 Long-Term Outcomes after Critical Illness
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accessmedicine.mhmedical.com/content.aspx?aid=1201799126
RD 2024/09/12
AB Survivors  of  critical  illness  experience  important  functional  decrements  and  decreased  health-related  quality  of  life  due  to  ICU-acquired  weakness  and  a  spectrum  of  other  physical  disabilities,  and  neurocognitive  and  neuropsychological  dysfunction.These  morbidities  may  not  be  wholly  reversible,  and  the  decrement  in  function  is  more  marked  in  older  patients,  those  with  a  greater  burden  of  comorbid  illness  or  longer  ICU  length  of  stay.Poor  neurocognitive  outcomes  have  been  linked  to  delirium,  hypoxia  and  sedative-hypnotic  use,  hypoglycemia,  and  possibly  conservative  fluid  management;  dysfunction  is  similar  to  that  of  moderate  traumatic  brain  injury  and  mild  dementia.Approximately  one-third  to  one-half  of  survivors  of  critical  illness  will  develop  long-term  neurocognitive  impairments.Early  mobility  during  critical  illness  is  safe  and  feasible.  However,  efficacy  as  measured  by  functional  outcomes  and  independence  remains  questionable.ICU  multidisciplinary  early  mobility  rehabilitation  programs  designed  for  patients  who  had  good  premorbid  functional  status  improve  functional  outcomes  at  ICU  and  hospital  discharge.  The  role  and  durability  of  early  rehabilitations  intervention  on  longer-term  outcomes  in  less  functional  patients  at  ICU  admission  are  less  clear.ICU  diaries  have  been  shown  to  improve  psychological  outcomes  and  improve  health-related  quality  of  life,  but  not  posttraumatic  stress  disorder  among  ICU  survivors  and  may  result  in  less  posttraumatic  stress  disorder  among  relatives  of  ICU  patients.Neurocognitive  rehabilitation  has  shown  some  early  benefit  on  the  outcome  and  requires  further  study.Family  caregivers  also  experience  psychological  morbidity  and  are  important  modifiers  of  patient  outcomes  over  time.