The continuum of critical care

Abstract

Until relatively recently, critical illness was considered as a separate entity and the intensive care unit (ICU), often a little cut-off from other areas of the hospital, was in many cases used as a last resort for patients so severely ill that it was no longer possible to care for them on the general ward. However, we are increasingly realizing that critical illness should be seen as just one part of the patient’s disease trajectory and how the patient is managed before and after ICU admission has an important role to play in optimizing outcomes. Identifying critical illness early, before it reaches a stage where it is life-threatening, is a challenge and requires a combination of improved and more frequent or continuous monitoring of at-risk patients, staff training to recognize when a patient is deteriorating, a system to “call for help,” and an effective response to that call. Critical care doctors are now widely available 24 h a day for consultation, and many hospitals have rapid response or medical emergency teams composed of staff trained in intensive care and with resuscitation skills who can attend patients on the ward who have been identified to be deteriorating, assess them to determine the need for ICU admission, and initiate further tests and/or initial therapy. Early intensivist input may also be important for patients undergoing interventions that are likely to result in ICU admission, e.g., transplantation or cardiac surgery. The patient’s continuum after ICU discharge must also be taken into account during their ICU stay, with attempts made to limit the longer-term physical and psychological consequences of critical illness as much as possible. Minimal sedation, good communication, and early mobilization are three factors that can help patients survive their ICU stay with minimal sequelae.

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“…This was about 60% of the PDT type. Patients had tracheostomy for 21-98 days with an average of 37 days, and 37.17 of patients experienced tracheostomy tube replacement during admission, which was the main cause of these replacements, 1 Cerebrovascular accident 2…”

“…[6] Tracheostomy can be performed surgically in the operating room and often for patients with airway anomalies or by dilatation technique in the patient's bedside and intensive units. [1] For decades, the standard method of tracheostomy was open surgical technique (ST). However, over the past 20 years, the use of percutaneous dilatational tracheostomy (PDT) has increased.…”

“…These complications are unusual in tracheostomy with surgery. [1] In 2004, Hassani stated that 40% of the patients he was studying had tracheostomy complications, and none of the 20% deaths that occurred in patients with tracheostomy were related to tracheostomy. Investigator stated underlying diseases such as head trauma, vascular events, and exacerbation of chronic obstructive pulmonary disease (COPD) are related in their deaths.…”

Mobility and clinical outcome of patients admitted to an intensive care unit

“…Studies report that functional impairments and the cognitive status of critical patients are exacerbated by how sedation levels are managed, mechanical ventilation is monitored and patients are mobilized, and given that functional condition and neurological status are affected by disease, they can worsen according to the approach used, whether pharmacological or not [22,31,32].…”

Assignment of pre-event ASA physical status classification by pre-hospital physicians: a prospective inter-rater reliability study

“…Decisions of dose adjusted medication and volume loading before anesthesia are common examples of individualized adaptions in the operating room [4]. Pre-hospital critical care is a continuum, and pre-hospital management is often a part of the patient's course [5,6]. As such, stratification on comorbidity, and individualized treatment, is equally relevant and valid for pre-hospital patients.…”