Incomplete Network for Survivors of Catastrophic Illness After Release From ICUs

Vitacca, Michele; Nava, Stefano

doi:10.4187/respcare.02262

Cited by 4 publications

(9 citation statements)

References 12 publications

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“…[2][3][4] Hospitalization and recovery can be very prolonged in this subset of patients. 1 Indeed, this condition may increase risk of early mortality 5,6 and late pulmonary complications, 7 involving increased health costs. 8 Patients needing prolonged mechanical ventilation (PMV) 9 may require transfer to a protected environment such as a chronic ventilator facility, 3,10 which studies have shown can offer some clinical and financial advantages over a prolonged ICU stay.…”

Section: Introductionmentioning

confidence: 99%

“…1 These patients commonly suffer from a wide range of physical disabilities that may be further aggravated by muscle wasting, neuromyopathies, and poor nutritional status. [2][3][4] Hospitalization and recovery can be very prolonged in this subset of patients.…”

Section: Introductionmentioning

confidence: 99%

“…8 Patients needing prolonged mechanical ventilation (PMV) 9 may require transfer to a protected environment such as a chronic ventilator facility, 3,10 which studies have shown can offer some clinical and financial advantages over a prolonged ICU stay. 3,11,12 In particular, patients may receive a prompt and dedicated physiotherapy rehabilitation program in chronic ventilator facilities, 1,3,13 and transfer from an ICU to a chronic ventilator facility substantially improved patients' ambulation and activities of daily life irrespective of the underlying pathophysiology, avoiding unnecessary immobilization 14 . To date, the role of comprehensive rehabilitation in critically ill adults still remains controversial 13 or not fully established 15 : patients who have survived a recent acute respiratory failure (ARF) event can benefit from an individually tailored physiotherapy rehabilitation program that improves clinical indices, respiratory and peripheral muscle strength, activities of daily life, exercise tolerance, and disability scores. 14,[16][17][18][19][20][21][22][23][24] Once the precipitating cause of the ARF episode has been solved, these chronically ill patients still require care due to their huge motor disabilities, clinical dependence (oxygen, mechanical ventilation, nutritional, and communication device needs), and nursing necessities, 3 which the care team (physiotherapist, doctor, and nurse) must measure to better guide the daily care of the patient.…”

Section: Introductionmentioning

confidence: 99%

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Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

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BACKGROUND:The aim of this study was to analyze the effects of a multidisciplinary program carried out in a chronic ventilator facility on disability, autonomy, and nursing needs of patients after a prolonged ICU stay. Secondary outcome measures were survival, weaning rate, chronic ventilator facility stay, and discharge destination. METHODS: Multidisciplinary assessment, clinical stabilization, weaning attempts, and a new Disabled Patients Autonomy Planning tool to assess daily care needs were investigated in 240 subjects in a chronic ventilator facility (52 subjects after cardiovascular surgery, 60 subjects with acute respiratory failure, 71 subjects with COPD, and 57 subjects with neurological disease). RESULTS: At admission, nursing needs, disability, and autonomy differed according to diagnosis (P < .001); weaned subjects had greater nursing needs (P < .001) and disability (P ‫؍‬ .0014) than unweaned subjects. During the stay, 13.8% of the subjects died irrespective of diagnosis (P ‫؍‬ .12); 47% (P < .001) were weaned with significant differences (P <.007) by diagnosis. In the 207 surviving subjects, nursing needs increased as disability increased (r ‫؍‬ 0.59, P < .001) and autonomy decreased (r ‫؍‬ ؊0.66, P < .001); disability and autonomy were interrelated (r ‫؍‬ 0.61, P < .001). Oxygen saturation, hypercapnia, dyspnea, disability, autonomy, and nursing needs significantly improved (all, P < .001). Fifty-nine percent of the subjects were discharged home. Subjects discharged to nursing homes presented mainly neurological diseases, being more disabled and less autonomous, with higher nursing needs (all, P < .04). Mechanical ventilation use and tracheostomy increased the probability of being discharged to a nursing home (odds ratio [OR] of 1.84, P ‫؍‬ .04; OR 2.47, P ‫؍‬ .003, respectively). Mortality was higher in subjects who were ventilated (OR 8.44, P < .001), male (OR 2.64, P ‫؍‬ .01), elderly (P < .001), or malnourished (P ‫؍‬ .01) and in subjects with low autonomy (P < .001), greater nursing needs (P ‫؍‬ .002), and more severe disabilities (P ‫؍‬ .04). CONCLUSIONS: A specialized tailored multidisciplinary program in subjects after an ICU stay contributed to recovery from disability, autonomy, and fewer nursing needs irrespective of diagnosis. Subjects discharged to a nursing home were the most severely disabled.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Vitacca¹,

Paneroni²,

Peroni

et al. 2014

Respir Care

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“…In the last 15 years, availability of beds in intensive care unit (ICU) and new technologies coupled with improved levels of care have highlighted a new category of subjects labeled "ICU survivors" in whom hospitalization and recovery may be abnormally prolonged [1]. Their physical disabilities include mainly peripheral and respiratory muscle wasting, weakness, neuromyopathies and poor nutritional status [2].…”

Section: Introductionmentioning

confidence: 99%

Volitional rehabilitative assessments in patients admitted in a post-intensive care step down unit. A feasibility study

Paneroni

Abrosca

Fokom

et al. 2017

Monaldi Arch Chest Dis

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A high variability in functional tests and activities used during the pulmonary rehabilitation has been observed in post-intensive care unit (ICU) patients, and the best battery of tests to adopt has not been described yet. We tested in patients admitted in a post-ICU Step Down Unit the ability to perform the more frequent functional volitional tests. The relations of each single volitional test with general disability and dyspnea at discharge were also evaluated. At admission, >70% of subjects performed muscle strength test, while <25% performed respiratory and effort tolerance tests. At discharge, feasibility of spirometry, respiratory muscle strength and effort tolerance tests improved (all, p<0.001); 6MWT was the least feasible. At discharge, cardiorespiratory patients were more capable to perform tests compared to neurological ones. All outcome measures, with exception of FEV 1 %, and FVC%, were significantly related to the disability score.Peripheral muscle exercises showed the highest feasibility, spirometry and leg effort tolerance the lowest. Motor disability was explained mainly by the peripheral muscle strength. The study of non-volitional outcome measures and tests linked to a protocol-driven intervention should be performed in this specific population.

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“…1 This group of survivors is a heterogeneous population regarding characteristics such as age, cause of illness, comorbidities, and family situation. 1 Some of these patients experience a pro-longed stay in ICU (Ͼ7 d) and long and difficult time of mechanical ventilation (Ͼ20 d).…”

Section: Introductionmentioning

confidence: 99%

Impact of Clinical and Quality of Life Outcomes of Long-Stay ICU Survivors Recovering From Rehabilitation on Caregivers' Burden

et al. 2016

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BACKGROUND: The objective of this work was to evaluate the time course of clinical and healthrelated quality of life outcomes of long-stay ICU survivors' and caregivers' burden. METHODS: The study included 23 subjects of mixed diagnosis (66 ؎ 11 y, body mass index 26.5 ؎ 5.6 kg/m 2 ) with a recent episode of acute respiratory failure needing in-hospital rehabilitation. Subjects and caregivers were evaluated at hospital discharge (T0, n ‫؍‬ 23) and 6 months later (T6, n ‫؍‬ 16). At T0 and T6, subjects' clinical status (Dependence Nursing Scale), FVC (percent-of-predicted FVC and percent-of-predicted FEV), maximum inspiratory/expiratory pressures, effort tolerance (sitto-stand, Takahashi test, 6-min walking distance), and disability (Barthel index) were evaluated. EuroQol-5D (EQ-5D), McGill Quality of Life, General Perceived Self-Efficacy Scale, and Hospital Anxiety and Depression Scale (HADS-A/HADS-D) were assessed. Caregivers' burden was measured by the Family Strain Questionnaire short form and Caregiver Needs Assessment. Correlation between subjects' clinical status and caregiver assessments was performed at T0. RESULTS: At T0, subjects showed compromised EQ-5D index (0.42 ؎ 0.28); 69% of caregivers had high Family Strain Questionnaire and moderate Caregiver Needs Assessment scores (30 ؎ 13). EQ-5D index was significantly related to Dependence Nursing Scale score (P < .001), percent-of-predicted FVC (P < .02), effort tolerance (all P < .01), disability (P < .001), and caregiver Family Strain Questionnaire score (P < .02). At T6, subjects significantly improved percent-of-predicted FVC (P < .05), maximum expiratory pressure (P < .01), effort tolerance (all P < .05), disability (P < .02), and EQ-5D index (P < .05), whereas caregivers' burden scores were unchanged. However, the percentage of caregivers with strain increased. CONCLUSIONS: In prolonged-ICU-stay survivors, EQ-5D index at hospital discharge is related to clinical status and caregivers' strain. Subjects' clinical status and EQ-5D index improves over time, but caregivers' burden remains high, suggesting the need to monitor/support caregivers.

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Incomplete Network for Survivors of Catastrophic Illness After Release From ICUs

Cited by 4 publications

References 12 publications

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

Volitional rehabilitative assessments in patients admitted in a post-intensive care step down unit. A feasibility study

Impact of Clinical and Quality of Life Outcomes of Long-Stay ICU Survivors Recovering From Rehabilitation on Caregivers' Burden

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