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Abstract

The majority of intensive care practitioners, until comparatively recently, was content to discharge surviving patients to the care of referring primary specialty colleagues who would undertake subsequent inpatient and outpatient care. With the exception of mortality statistics from clinical studies, the practitioners were thus denied the opportunity of understanding the full impact of critical illness on a patient and their family. The concept of the intensive care follow-up clinic has developed more recently, and is run commonly on multidisciplinary lines. These clinics serve a number of purposes, but importantly have drawn attention to broader patient-centred outcomes after intensive care. Investigators are just beginning to identify, and in some cases quantify, the postdischarge burden on patient and family; additional useful data have also come from follow-up of specific disease states. The purpose of the present review is to highlight some of the important issues that impact on recovery from critical illness towards an acceptable quality of postdischarge life. We have concentrated on the adult literature, and specifically on studies that inform us about the more general effects of critical illness. Head and spinal injury are thus largely ignored, as the effects of the primary injury overwhelm the effects of 'general' critical illness.

The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial

“…More than 140 000 patients are admitted to intensive care units in the United Kingdom each year, of whom more than 50 000 die within a year of admission 12 These patients have an excess long term risk of death compared with the general population matched for age and sex,3 4 and a substantial percentage continue to experience both physical and psychological problems after discharge 56 7 8 9 10 11 Studies assessing health related quality of life after intensive care suggest that it improves over time but that people do not return to the same level of health that they had before they fell ill and their health related quality of life is lower than the general population norms for at least the first year 1…”

Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort*

“…Given large increases in use of critical care during the last decade [1, 2], improving ICU survival rates [3-9], and rapidly growing aged population [10], it is predictable that a large number of critical illness survivors will be attempting to re-enter the workforce while facing new physical, neuropsychological and psychiatric impairments that frequently affects patients after critical illness [11-18]. Since post intensive care syndrome could very well affect patients’ ability to work.…”

“I Can Remember Sort of Vivid People…but to Me They Were Plasticine.” Delusions on the Intensive Care Unit: What Do Patients Think Is Going On?

“…The very specific nature of ICU-acquired delirium and the transient but acute exposure to disrupted cognition could indicate a need for psychological support earlier than is traditionally offered. This could be as simple as working with the patient to cope with their anxieties whilst in the unit through early intervention strategies [ 80 , 81 ], using patient diaries to maintain a detailed narrative of their stay [ 82 ] and offering opportunities for discussion in follow up clinics [ 83 ] although evidence for these is, at present, limited [ 84 , 85 ].…”