Improving Quality of Life in Patients at Risk for Post–Intensive Care Syndrome

Abstract

ObjectiveTo improve quality of life (QOL) in patients at risk for post–intensive care syndrome (PICS).Patients and MethodsWe conducted a mixed-method, prospective, observational, pre-post interventional study in an adult medical and mixed medical/surgical/transplant intensive care unit (ICU) at a tertiary academic hospital. Preintervention included patients admitted from October 1 through October 31, 2016, and postintervention included patients admitted from January 15 through February 14, 2017. First, a multidisciplinary team of stakeholders identified barriers associated with decreased QOL in patients at risk for PICS. Next, interventions were designed and implemented. The effect of interventions was assessed using a mixed-method analysis. The qualitative analysis used a modified grounded theory approach. The quantitative analysis included assessment of preexisting symptoms and risk factors associated with PICS. The 36-Item Short-Form Health Status Survey (SF-36), which surveys physical and mental composite scores, was used to assess QOL.ResultsBarriers identified were lack of awareness and understanding of PICS. Interventions included educational videos, paper and online education and treatment materials, and online and in-person support groups for education and treatment. After interventions, the qualitative analysis found that patients who participated in the interventions after hospital discharge showed improved QOL, whereas education during hospitalization alone was not effective. The quantitative analysis did not find improvement in QOL, as defined by SF-36 physical or mental composite scores.ConclusionInterventions targeted to patients after hospitalization may offer subjective improvement in QOL for those at risk for PICS.

A atuação do terapeuta ocupacional em Unidade de Terapia Intensiva: uma revisão sistemática

“…Por fim, a quarta limitação se refere à PICS, reconhecida como um conjunto de sinais e sintomas aglutinados em manifestações físicas (fraqueza muscular adquirida da UTI); mentais (ansiedade, depressão); cognitivas (deficit de atenção e de memória); prejuízo ao autocuidado; e redução da qualidade de vida (Held & Moss, 2019;Daniels et al, 2018). Pelos critérios empregados nesta revisão sistemática, intencionalmente, as atuações selecionadas de terapeutas ocupacionais na UTI atendem às demandas físicas, nesse primeiro momento.…”

“…Contudo, entre as publicações não incluídas, há relatos de atuação do terapeuta ocupacional no contexto de UTI sobre outros aspectos da PICS, como: ansiedade (Provancha-Romeo et al, 2019), delírium/confusão mental (Álvarez et al, 2017) e qualidade de vida (Daniels et al, 2018) -que carecem de exploração subsequente. Se fossem incluídos, esses achados aumentariam o leque de práticas do terapeuta ocupacional com pacientes graves na UTI aqui demonstrados.…”

Home and Community-Based Physical Therapist Management of Adults With Post–Intensive Care Syndrome

“…75,78,91 Initiation of services early after hospital discharge is recommended, with planning for timed intervals for follow up from that point forward. 92 Identification of physical, cognitive, and mental health impairments in an interprofessional setting, with providers that include a physical therapist, assists in the establishment of a multifaceted care plan for the unique person. 75…”

Pathophysiology of Volume Administration in Septic Shock and the Role of the Clinical Pharmacist

“…2 More than five million ICU admissions occur per year, almost all with exposure to intravenous (IV) fluids. 3 Recently, the scientific community has reevaluated historical standards of care, demonstrating that compliance with sepsis bundles requiring fluid administration to prespecified goals versus nonprotocolized resuscitation fail to improve mortality. 4,5 Despite ongoing questions surrounding fluid administration and increased understanding of potential harms, no large clinical trials have evaluated the role of current standards of fluid administration versus fluid minimization, and therefore, use remains standard.…”