New Physical, Mental, and Cognitive Problems 1 Year after ICU Admission: A Prospective Multicenter Study

Geense, Wytske; Zegers, Marieke; Peters, Marco; Ewalds, Esther; Simons, Koen S.; Vermeulen, Hester; Hoeven, Johannes G. van der; Boogaard, Mark van den

doi:10.1164/rccm.202009-3381oc

Cited by 134 publications

(140 citation statements)

References 47 publications

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“…This emphasises both the need for investment in personnel, and the urgency of addressing psychological morbidity in survivors, 23–25 which can influence engagement with other aspects of recovery, and contribute to hospital readmission. 26 Likewise, occupational therapy is another example of a key profession that would benefit from greater prevalence within services compared with the levels seen in the current findings, especially in the context of long-term cognitive impairment in critical illness survivors, 27–29 and the challenges of returning to work in this patient population. 30–33 …”

Section: Discussionmentioning

confidence: 79%

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

et al. 2021

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ObjectiveTo comprehensively update and survey the current provision of recovery, rehabilitation and follow-up services for adult critical care patients across the UK.DesignCross-sectional, self-administered, predominantly closed-question, electronic, online survey.SettingInstitutions providing adult critical care services identified from national databases.ParticipantsMultiprofessional critical care clinicians delivering services at each site.ResultsResponses from 176 UK hospital sites were included (176/242, 72.7%). Inpatient recovery and follow-up services were present at 127/176 (72.2%) sites, adopting multiple formats of delivery and primarily delivered by nurses (n=115/127, 90.6%). Outpatient services ran at 130 sites (73.9%), predominantly as outpatient clinics. Most services (n=108/130, 83.1%) were co-delivered by two or more healthcare professionals, typically nurse/intensive care unit (ICU) physician (n=29/130, 22.3%) or nurse/ICU physician/physiotherapist (n=19/130, 14.6%) teams. Clinical psychology was most frequently lacking from inpatient or outpatient services. Lack of funding was consistently the primary barrier to service provision, with other barriers including logistical and service prioritisation factors indicating that infrastructure and profile for services remain inadequate. Posthospital discharge physical rehabilitation programmes were relatively few (n=31/176, 17.6%), but peer support services were available in nearly half of responding institutions (n=85/176, 48.3%). The effects of the COVID-19 pandemic resulted in either increasing, decreasing or reformatting service provision. Future plans for long-term service transformation focus on expansion of current, and establishment of new, outpatient services.ConclusionOverall, these data demonstrate a proliferation of recovery, follow-up and rehabilitation services for critically ill adults in the past decade across the UK, although service gaps remain suggesting further work is required for guideline implementation. Findings can be used to enhance survivorship for critically ill adults, inform policymakers and commissioners, and provide comparative data and experiential insights for clinicians designing models of care in international healthcare jurisdictions.

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Section: Discussionmentioning

confidence: 79%

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

et al. 2021

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“…7 ), and it is well known in the aftermath of a spectrum of infectious diseases [8][9][10][11][12][13] . Before the SARS-CoV-2 pandemic, patient management in intensive care was frequently associated with mental and physical decline, and this could partially explain long COVID in patients with severe illness 14 . However, the burden of long COVID in mild to moderately ill patients is not well defined.…”

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confidence: 99%

Long COVID in a prospective cohort of home-isolated patients

Blomberg

Mohn

Brokstad

et al. 2021

Nat Med

544

513

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Long-term complications after coronavirus disease 2019 (COVID-19) are common in hospitalized patients, but the spectrum of symptoms in milder cases needs further investigation. We conducted a long-term follow-up in a prospective cohort study of 312 patients—247 home-isolated and 65 hospitalized—comprising 82% of total cases in Bergen during the first pandemic wave in Norway. At 6 months, 61% (189/312) of all patients had persistent symptoms, which were independently associated with severity of initial illness, increased convalescent antibody titers and pre-existing chronic lung disease. We found that 52% (32/61) of home-isolated young adults, aged 16–30 years, had symptoms at 6 months, including loss of taste and/or smell (28%, 17/61), fatigue (21%, 13/61), dyspnea (13%, 8/61), impaired concentration (13%, 8/61) and memory problems (11%, 7/61). Our findings that young, home-isolated adults with mild COVID-19 are at risk of long-lasting dyspnea and cognitive symptoms highlight the importance of infection control measures, such as vaccination.

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“…Yet, transitional care interventions as defined by the TCM emphasise streamlined plans of care and continuity of care across settings and between professionals and are not primary focused on patient outcomes. 26 None of the studies had previously selected a risk group for the development of elements of PICS which are important in the development of post-ICU problems, 8,9 which may influence the results. In addition, some studies had a very short ICU admission, and all studies had a relatively short follow-up, which means that possible complaints may not be measurable until later.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…In more detail, male patients reported less frailty and fatigue than female patients, and patients with pre-existent anxiety had a higher chance of suffering from symptoms of depression and PTSD after ICU admission after 1 year. 9 Because of the wide range of variety in PICS problems, a strategy with an individually approach is preferred. To ensure continuity of care, guidelines advice coordination of patients' recovery pathway by healthcare professionals with appropriate competencies and frequently screening on elements of PICS during transitions of care settings across the continuum of critical illness and recovery.…”

Section: Introductionmentioning

confidence: 99%

The effects of intensive care unit-initiated transitional care interventions on elements of post-intensive care syndrome: A systematic review and meta-analysis

Hoog

Bruin

Pelgrim

et al. 2022

Australian Critical Care

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The aim of the study was to assess the effectiveness of intensive care unit (ICU)einitiated transitional care interventions for patients and families on elements of post-intensive care syndrome (PICS) and/or PICS-family (PICSe-F). Review method used: This is a systematic review and meta-analysis Sources: The authors searched in biomedical bibliographic databases including PubMed, Embase (OVID), CINAHL Plus (EBSCO), Web of Science, and the Cochrane Library and included studies written in English conducted up to October 8, 2020. Review methods: We included (non)randomised controlled trials focussing on ICU-initiated transitional care interventions for patients and families. Two authors conducted selection, quality assessment, and data extraction and synthesis independently. Outcomes were described using the three elements of PICS, which were categorised into (i) physical impairments (pulmonary, neuromuscular, and physical function), (ii) cognitive impairments (executive function, memory, attention, visuo-spatial and mental processing speed), and (iii) psychological health (anxiety, depression, acute stress disorder, post-traumatic stress disorder, and depression). Results: From the initially identified 5052 articles, five studies were included (i.e., two randomised controlled trials and three nonrandomised controlled trials) with varied transitional care interventions. Quality among the studies differs from moderate to high risk of bias. Evidence from the studies shows no significant differences in favour of transitional care interventions on physical or psychological aspects of PICS-(F). One study with a nurse-led structured follow-up program showed a significant difference in physical function at 3 months. Conclusions: Our review revealed that there is a paucity of research about the effectiveness of transitional care interventions for ICU patients with PICS. All, except one of the identified studies, failed to

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New Physical, Mental, and Cognitive Problems 1 Year after ICU Admission: A Prospective Multicenter Study

Cited by 134 publications

References 47 publications

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

Recovery, rehabilitation and follow-up services following critical illness: an updated UK national cross-sectional survey and progress report

Long COVID in a prospective cohort of home-isolated patients

The effects of intensive care unit-initiated transitional care interventions on elements of post-intensive care syndrome: A systematic review and meta-analysis

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