Rehabilitation Interventions for Postintensive Care Syndrome

Mehlhorn, Juliane; Freytag, Antje; Schmidt, Konrad; Brunkhorst, Frank M.; J, Graf; Troitzsch, Ute; Schlattmann, Peter; Wensing, Michel; Gensichen, Jochen

doi:10.1097/ccm.0000000000000148

Cited by 202 publications

(121 citation statements)

References 68 publications

Supporting

Mentioning

110

Contrasting

Unclassified

Order By: Relevance

“…[29][30] (3) Creating post-ICU clinics to provide follow-up counseling and support to the patients and family. [31] Clinicians should also provide proper education about resources that assist in promoting rehabilitation. (4) Maintaining good nutritional status and adequate sleep of the patient.…”

Section: Prevention and Management (The Abcde Bundle)mentioning

confidence: 99%

Post-intensive care syndrome: An overview

Rawal

Yadav

Kumar

2017

Journal of Translational Internal Medicine

467

330

View full text Add to dashboard Cite

Survival of critically unwell patients has improved in the last decade due to advances in critical care medicine. Some of these survivors develop cognitive, psychiatric and /or physical disability after treatment in intensive care unit (ICU), which is now recognized as post intensive care syndrome (PICS). Given the limited awareness about PICS in the medical faculty this aspect is often overlooked which may lead to reduced quality of life and cause a lot of suffering of these patients and their families. Efforts should be directed towards preventing PICS by minimizing sedation and early mobilization during ICU.All critical care survivors should be evaluated for PICS and those having signs and symptoms of it should be managed by a multidisciplinary team which includes critical care physician, neuro-psychiatrist, physiotherapist and respiratory therapist,with the use of pharmacological and non-apharmacological interventions. This can be achieved through an organizational change and improvement, knowing the high rate of incidence of PICS and its adverse effects on the survivor's life and daily activities and its effect on the survivor's family.

show abstract

Section: Prevention and Management (The Abcde Bundle)mentioning

confidence: 99%

Post-intensive care syndrome: An overview

Rawal

Yadav

Kumar

2017

Journal of Translational Internal Medicine

467

330

View full text Add to dashboard Cite

show abstract

“…34,35 We also identified factors that are potentially modifiable during and after an ICU stay, including sleep, depression, and stress, as potential targets for interventions to improve the quality of life and reduce the difficulty of recovery for survivors of a critical illness.…”

mentioning

confidence: 99%

Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge

McKinley

Fien

Elliott

et al. 2016

American Journal of Critical Care

View full text Add to dashboard Cite

Background Intensive care unit survivors often have diminished health-related quality of life. Objectives To describe health-related quality of life of former intensive care patients and identify associated factors 6 months after hospital discharge. Methods Six months after discharge, 193 patients from an intensive care unit completed the Short Form-36 Health Survey; measures of sleep; Intensive Care Experience Questionnaire; Depression, Anxiety and Stress Scales; and Posttraumatic Stress Disorder Checklist. Norm-based scores were calculated for the Short Form-36. Bivariate associations with Short Form-36 scores were tested by using the Pearson correlation. Multiple linear regression was used to identify independent associations with health-related quality of life. Results All scores on the Short Form-36 (physical component summary, 41.8; mental component summary, 48.2) were less than population norms. Bivariate associations with health-related quality of life (P < .05) were scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, awareness of surroundings and frightening experiences, depression, anxiety, stress, posttraumatic symptoms, and sleep quality at 2 and 6 months. In linear regression, scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, and sleep quality at 6 months were independently associated with Short Form-36 physical summary scores (P < .001); depression and stress were independently associated with mental summary scores (P < .001). Conclusion Sleep, depression, and stress are potential targets for interventions to improve health-related quality of life and improve recovery.

show abstract

“…69 The authors conclude that more directed interventions and further research are needed before definitive conclusions can be drawn. 53,70 The future Mindfulness meditation is a technique that has been used in other specialities to assist with reducing anxiety, stress and depression, improving coping strategies, reducing mental fatigue, with an overall aim to improve cognitive function and overall quality of life. Similar techniques could be used during and following the ICU admission, with both patients and families.…”

mentioning

confidence: 99%

The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence

Clancy

Edginton

Casarin

et al. 2015

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Mortality rates alone are no longer a sufficient guide to quality of care. Due to medical advances, patients are surviving for longer following critical illness and major surgery; therefore, functional outcomes and long-term quality of life are of increasing consequence. Post-operative cognitive dysfunction has been acknowledged as a complication following anaesthesia for many years, and interest in persistent cognitive dysfunction following a critical illness is growing. Psychological and neurocognitive sequelae following discharge from intensive care are acknowledged to occur with sufficient significance to have recently coined the term 'the post-intensive care syndrome'. Rehabilitation following critical illness has been highlighted as an important goal in recently published national UK guidelines, including the need to focus on both physical and non-physical recovery. Neuropsychological and cognitive consequences following anaesthesia and critical illness are significant. The exact pathophysiological mechanisms linking delirium, cognitive dysfunction and neuropsychological symptoms following critical illness are not fully elucidated but have been studied elsewhere and are outside the scope of this article. There is limited evidence as yet for specific peri-operative preventative strategies, but early management and rehabilitation strategies following intensive care discharge are now emerging. This article aims to summarise the issues and appraise current options for management, including both neuroprotective and neurorehabilitative strategies in intensive care. KeywordsIntensive care, critical illness, rehabilitation, cognitive dysfunction, delirium, post-traumatic stress disorder Over the last decade, there has been an increase in the complexity of patients presenting to intensive care, due in part to the severity of co-morbidities at presentation and an increasingly elderly population. Despite this, mortality rates are improving; the long-term consequences of critical illness are thus becoming ever more relevant. The risk factors and pathogenesis of delirium and post-cognitive dysfunction have been reviewed thoroughly elsewhere. This article summarises the relevant findings in these areas and deliberately focuses on the psychological and neurocognitive sequelae following critical illness including depression, anxiety, post-traumatic stress disorder and cognitive dysfunction; reviewing the evidence for incidence, pathophysiology and management. Psychological and neurocognitive consequences of critical illnessThe neuropsychological sequelae that occur following a critical care admission are numerous and can be highly distressing for patients and their families. Symptoms that occur include intrusive memories, delusions, delirium, panic episodes and nightmares. Conditions such as depression, anxiety, post-traumatic stress disorder (PTSD) and cognitive dysfunction are increasingly recognised among patients who survive an intensive care admission and are described collectively as the 'post-intensive care...

show abstract

Rehabilitation Interventions for Postintensive Care Syndrome

Abstract: Interventions which have substantial effects in post-ICU patients are rare. Positive effects were seen for ICU-diary interventions for posttraumatic stress disorder. More interventions for the growing number of ICU survivors are needed.

Cited by 202 publications

References 68 publications

Post-intensive care syndrome: An overview

Post-intensive care syndrome: An overview

Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge

The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence

Contact Info

Product

Resources

About