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Hatakeyama J, Nakamura K, Sumita H, Kawakami D, Nakanishi N, Kashiwagi S, Liu K, Kondo Y. Intensive care unit follow-up clinic activities: a scoping review. J Anesth 2024; 38:542-555. [PMID: 38652320 DOI: 10.1007/s00540-024-03326-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/12/2024] [Indexed: 04/25/2024]
Abstract
The importance of ongoing post-discharge follow-up to prevent functional impairment in patients discharged from intensive care units (ICUs) is being increasingly recognized. Therefore, we conducted a scoping review, which included existing ICU follow-up clinic methodologies using the CENTRAL, MEDLINE, and CINAHL databases from their inception to December 2022. Data were examined for country or region, outpatient name, location, opening days, lead profession, eligible patients, timing of the follow-up, and assessment tools. Twelve studies were included in our review. The results obtained revealed that the methods employed by ICU follow-up clinics varied among countries and regions. The names of outpatient follow-up clinics also varied; however, all were located within the facility. These clinics were mainly physician or nurse led; however, pharmacists, physical therapists, neuropsychologists, and social workers were also involved. Some clinics were limited to critically ill patients with sepsis or those requiring ventilation. Ten studies reported the first outpatient visit 1-3 months after discharge. All studies assessed physical function, cognitive function, mental health, and the health-related quality of life. This scoping review revealed that an optimal operating format for ICU follow-up clinics needs to be established according to the categories of critically ill patients.
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Affiliation(s)
- Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hidenori Sumita
- Clinic Sumita, 305-12, Minamiyamashinden, Ina-cho, Toyokawa, Aichi, 441-0105, Japan
| | - Daisuke Kawakami
- Department of Intensive Care Medicine, Iizuka Hospital, 3-83, Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki, Chuo-ward, Kobe, 650-0017, Japan
| | - Shizuka Kashiwagi
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road CHERMSIDE QLD 4032, Brisbane, Australia
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Bianquis C, Leiva Agüero S, Cantero C, Golfe Bonmatí A, González J, Hu X, Lacoste-Palasset T, Livesey A, Guillamat Prats R, Salai G, Sykes DL, Toland S, van Zeller C, Viegas P, Vieira AL, Zaneli S, Karagiannidis C, Fisser C. ERS International Congress 2023: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2024; 10:00886-2023. [PMID: 38651090 PMCID: PMC11033729 DOI: 10.1183/23120541.00886-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 04/25/2024] Open
Abstract
Early career members of Assembly 2 (Respiratory Intensive Care) attended the 2023 European Respiratory Society International Congress in Milan, Italy. The conference covered acute and chronic respiratory failure. Sessions of interest to our assembly members and to those interested in respiratory critical care are summarised in this article and include the latest updates in respiratory intensive care, in particular acute respiratory distress syndrome and mechanical ventilation.
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Affiliation(s)
- Clara Bianquis
- Sorbonne Université, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sebastian Leiva Agüero
- Academic unit of the University Institute of Health Science H.A. Barceló Foundation, La Rioja, Argentina
| | - Chloé Cantero
- APHP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Pneumologie, Paris, France
| | | | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Xinxin Hu
- St Vincent's Health Network Sydney, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Thomas Lacoste-Palasset
- Assistance Publique Hôpitaux de Paris, Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence de l'Hypertension Pulmonaire, Hôpital Bicêtre, Le Kremlin Bicêtre, France
- Université Paris–Saclay, Faculté de Médecine, Le Kremlin Bicêtre, France
| | - Alana Livesey
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Grgur Salai
- Department of Pulmonology, University Hospital Dubrava, Zagreb, Croatia
| | | | - Sile Toland
- Department of Medicine, Letterkenny University Hospital, Donegal, Ireland
| | - Cristiano van Zeller
- Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Pedro Viegas
- Departamento de Pneumonologia, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal
| | | | - Stavroula Zaneli
- 1st Respiratory Department, Medical School, National and Kapodistrian University of Athens, “Sotiria” Chest Hospital, Athens, Greece
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, ARDS and ECMO Centre, Cologne-Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University Hospital, Cologne, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
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Gerhardy B, Orde S, Morgan L. Outcomes of right heart dysfunction in the acutely and severely unwell: protocol for a prospective, longitudinal observational study using multimodal assessment. BMJ Open 2023; 13:e074571. [PMID: 37848309 PMCID: PMC10582947 DOI: 10.1136/bmjopen-2023-074571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
INTRODUCTION The relationship of acute right heart dysfunction (RHD) with long-term cardiopulmonary dysfunction and its' associated morbidity has not been clearly elucidated. We propose a prospective, observational study to assess the natural history of acute RHD using a combination of imaging, functional and qualitative assessment methods, including the recently described combination of simultaneous maximal effort cardiopulmonary exercise testing and stress echocardiography. METHODS AND ANALYSIS We propose a single-centre study of patients ≥18 years admitted to either the intensive care or respiratory close observation units with RHD on transthoracic echocardiography (TTE). Participants will undergo a repeat TTE ~72 hours after the initial study, with a final TTE performed prior to discharge in patients who have a prolonged (>1 week) stay. Inpatient clinical, biochemical and therapeutic indices will be collected contemporaneously. At ~6 months postdischarge, participants will undergo evaluation with validated symptom assessment tools (Dyspnoea-12 and PAH-SYMPACT Questionnaires) and a combined maximal effort cardiopulmonary exercise test and stress echocardiogram. This study is an observational, hypothesis-generating study with a recruitment target of 100 patients established based on typical admission rates of the relevant hospital departments. Measures of central tendency and dispersion will be used to describe the cohort. Inferential statistics will be used to compare the two a priori defined groups of those whose RHD had resolved prior to hospital discharge and those whose dysfunction persisted at time of discharge. ETHICS AND DISSEMINATION This study has received ethics approval from the local ethics committee (Nepean and Blue Mountains Local Health District approval, project 2021/ETH12111). Written informed consent will be sought from all patients prior to recruitment. The results will be submitted for publication in a relevant peer-reviewed journal and presented at an appropriate national/international conference. STUDY REGISTRATION Australian New Zealand Clinical Trials Registry, ANZCTR12623000309684.
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Affiliation(s)
- Benjamin Gerhardy
- Nepean Hospital ICU, Kingswood, New South Wales, Australia
- Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
| | - Sam Orde
- Nepean Hospital ICU, Kingswood, New South Wales, Australia
- Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
| | - Lucy Morgan
- Sydney Medical School Nepean, The University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Pardo E, Lescot T, Preiser JC, Massanet P, Pons A, Jaber S, Fraipont V, Levesque E, Ichai C, Petit L, Tamion F, Taverny G, Boizeau P, Alberti C, Constantin JM, Bonnet MP. Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study. Crit Care 2023; 27:7. [PMID: 36611211 PMCID: PMC9826592 DOI: 10.1186/s13054-022-04298-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. METHODS The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. RESULTS During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11). CONCLUSIONS In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.
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Affiliation(s)
- Emmanuel Pardo
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Thomas Lescot
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Saint-Antoine, Assistance publique-hôpitaux de Paris, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Jean-Charles Preiser
- Service des Soins intensifs, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Pablo Massanet
- Département Anesthésie-Réanimation, Centre Hospitalier Universitaire Nîmes, 30000, Nîmes, France
| | - Antoine Pons
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier. PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier Cedex 5, France
| | - Vincent Fraipont
- Service de Soins Intensifs, Centre Hospitalier Régional de Liège, 4000, Liège, Citadelle, Belgium
| | - Eric Levesque
- Service d'anesthésie-réanimation chirurgicale, GHU Henri-Mondor, 94000, Créteil, France
| | - Carole Ichai
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Département Anesthésie-Réanimation, Nice, France
| | - Laurent Petit
- Service de réanimation chirurgicale et traumatologique Pellegrin place Amélie Raba-Léon, 33000, Bordeaux, France
| | - Fabienne Tamion
- Service de Médecine Intensive Réanimation, CHU Rouen, Université de Normandie, UNIROUEN, INSERM U1096, 76000, Rouen, France
| | - Garry Taverny
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Priscilla Boizeau
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Corinne Alberti
- AP-HP, Hôpital Robert-Debré, Unité d'Epidémiologie Clinique, 48 bd Serurier, 75019, Paris, France
| | - Jean-Michel Constantin
- Sorbonne Université, GRC 29, AP-HP, DMU DREAM, Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 75013, Paris, France
| | - Marie-Pierre Bonnet
- Sorbonne Université, Département Anesthésie-Réanimation, Hôpital Armand Trousseau, DMU DREAM, GRC 29, AP-HP, Paris, France
- Université Paris Cité, INSERM, INRA, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Maternité Port Royal, 53 avenue de l'Observatoire, 75014, Paris, France
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Heraud SO, Shah V, Perez-Gutierez V, Al-Khateeb M, Fraga SG, Afzal A, Rubin M, Edding S, Nino J, Horoub A, Paracha N, Gujral M, Cemalovic N, Menon V. Post-Intensive Care Syndrome Among Survivors in a Safety Net Hospital in South Bronx: A Comparison of Patients With and Without Coronavirus Disease 2019. Open Forum Infect Dis 2022; 10:ofac606. [PMID: 36628057 PMCID: PMC9825262 DOI: 10.1093/ofid/ofac606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 11/22/2022] Open
Abstract
Comparison of post-intensive care syndrome between critically ill survivors with or without coronavirus disease 2019 (CovP and CovN, respectively) showed that fewer CovP were able to return to work full time at >1 year and none at <1 year after discharge and that the majority of CovP survivors were able to work part time during both evaluation periods compared to CovN.
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Affiliation(s)
| | | | - Victor Perez-Gutierez
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Mohannad Al-Khateeb
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | | | - Afsheen Afzal
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Mayer Rubin
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Sherida Edding
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Jessica Nino
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Ali Horoub
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Nushra Paracha
- Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Manmeet Gujral
- Department of Critical Care, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Nail Cemalovic
- Department of Critical Care, New York City Health + Hospitals/Lincoln Medical Center, Bronx, New York, USA
| | - Vidya Menon
- Correspondence: Vidya Menon, MD, Department of Medicine, New York City Health + Hospitals/Lincoln Medical Center, 234 E 149th St, Bronx, NY 10451 ()
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Pandian V, Hopkins BS, Yang CJ, Ward E, Sperry ED, Khalil O, Gregson P, Bonakdar L, Messer J, Messer S, Chessels G, Bosworth B, Randall DM, Freeman-Sanderson A, McGrath BA, Brenner MJ. Amplifying patient voices amid pandemic: Perspectives on tracheostomy care, communication, and connection. Am J Otolaryngol 2022; 43:103525. [PMID: 35717856 PMCID: PMC9172276 DOI: 10.1016/j.amjoto.2022.103525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate perspectives of patients, family members, caregivers (PFC), and healthcare professionals (HCP) on tracheostomy care during the COVID-19 pandemic. METHODS The cross-sectional survey investigating barriers and facilitators to tracheostomy care was collaboratively developed by patients, family members, nurses, speech-language pathologists, respiratory care practitioners, physicians, and surgeons. The survey was distributed to the Global Tracheostomy Collaborative's learning community, and responses were analyzed. RESULTS Survey respondents (n = 191) from 17 countries included individuals with a tracheostomy (85 [45 %]), families/caregivers (43 [22 %]), and diverse HCP (63 [33.0 %]). Overall, 94 % of respondents reported concern that patients with tracheostomy were at increased risk of critical illness from SARS-CoV-2 infection and COVID-19; 93 % reported fear or anxiety. With respect to prioritization of care, 38 % of PFC versus 16 % of HCP reported concern that patients with tracheostomies might not be valued or prioritized (p = 0.002). Respondents also differed in fear of contracting COVID-19 (69 % PFC vs. 49 % HCP group, p = 0.009); concern for hospitalization (55.5 % PFC vs. 27 % HCP, p < 0.001); access to medical personnel (34 % PFC vs. 14 % HCP, p = 0.005); and concern about canceled appointments (62 % PFC vs. 41 % HCP, p = 0.01). Respondents from both groups reported severe stress and fatigue, sleep deprivation, lack of breaks, and lack of support (70 % PFC vs. 65 % HCP, p = 0.54). Virtual telecare seldom met perceived needs. CONCLUSION PFC with a tracheostomy perceived most risks more acutely than HCP in this global sample. Broad stakeholder engagement is necessary to achieve creative, patient-driven solutions to maintain connection, communication, and access for patients with a tracheostomy.
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Affiliation(s)
- Vinciya Pandian
- Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, United States of America; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States of America.
| | - Brandon S Hopkins
- Department of Otolaryngology, Head and Neck Surgery, The Cleveland Clinic, Cleveland, OH, United States of America.
| | - Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein School of Medicine/Montefiore Medical Center, Bronx, New York, NY, United States of America.
| | - Erin Ward
- Global Tracheostomy Collaborative, Raleigh, NC, United States of America; Family Liaison, Multidisciplinary Tracheostomy Team, Boston Children's Hospital, Boston, MA, United States of America; MTM-CNM Family Connection, Inc., Methuen, MA, United States of America(1)
| | - Ethan D Sperry
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Ovais Khalil
- Johns Hopkins University School of Nursing, Baltimore, MD, United States of America.
| | - Prue Gregson
- Tracheostomy Review and Management Services, Austin Health, Melbourne, VIC, Australia.
| | - Lucy Bonakdar
- Tracheostomy Review and Management Services, Austin Health, Melbourne, VIC, Australia.
| | - Jenny Messer
- Austin Health Tracheostomy Patient & Family Forum
| | - Sally Messer
- Austin Health Tracheostomy Patient & Family Forum
| | - Gabby Chessels
- Austin Health Tracheostomy Patient & Family Forum, Tracheostomy Review and Management Services, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC, Australia.
| | | | - Diane M Randall
- Memorial Regional Health System, Fort Lauderdale, FL, United States of America.
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
| | - Brendan A McGrath
- Anaesthesia & Intensive Care Medicine, Manchester University Hospital NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical Center, Ann Arbor, MI, United States of America; Global Tracheostomy Collaborative, Raleigh, NC, United States of America.
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Owen A, Patel JM, Parekh D, Bangash MN. Mechanisms of Post-critical Illness Cardiovascular Disease. Front Cardiovasc Med 2022; 9:854421. [PMID: 35911546 PMCID: PMC9334745 DOI: 10.3389/fcvm.2022.854421] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Prolonged critical care stays commonly follow trauma, severe burn injury, sepsis, ARDS, and complications of major surgery. Although patients leave critical care following homeostatic recovery, significant additional diseases affect these patients during and beyond the convalescent phase. New cardiovascular and renal disease is commonly seen and roughly one third of all deaths in the year following discharge from critical care may come from this cluster of diseases. During prolonged critical care stays, the immunometabolic, inflammatory and neurohumoral response to severe illness in conjunction with resuscitative treatments primes the immune system and parenchymal tissues to develop a long-lived pro-inflammatory and immunosenescent state. This state is perpetuated by persistent Toll-like receptor signaling, free radical mediated isolevuglandin protein adduct formation and presentation by antigen presenting cells, abnormal circulating HDL and LDL isoforms, redox and metabolite mediated epigenetic reprogramming of the innate immune arm (trained immunity), and the development of immunosenescence through T-cell exhaustion/anergy through epigenetic modification of the T-cell genome. Under this state, tissue remodeling in the vascular, cardiac, and renal parenchymal beds occurs through the activation of pro-fibrotic cellular signaling pathways, causing vascular dysfunction and atherosclerosis, adverse cardiac remodeling and dysfunction, and proteinuria and accelerated chronic kidney disease.
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Affiliation(s)
- Andrew Owen
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Jaimin M. Patel
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dhruv Parekh
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Mansoor N. Bangash
- Department of Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Mansoor N. Bangash
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Estrup S, Kjer CKW, Vilhelmsen F, Ahmed N, Poulsen LM, Gøgenur I, Mathiesen O. Health-related quality of life, anxiety and depression and physical recovery after critical illness - A prospective cohort study. Acta Anaesthesiol Scand 2022; 66:85-93. [PMID: 34425002 DOI: 10.1111/aas.13976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 05/23/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Critical illness is often followed by mental and physical impairments. We aimed to assess the health-related quality of life (HRQoL), symptoms of anxiety and depression, and physical function in critically ill patients after discharge from the intensive care unit. METHODS For this prospective cohort study we included all available adult patients admitted to the ICU for >24 h during a 12-month period. Home visits took place at 3 and 12 months after discharge from the hospital and included Short-Form Health Survey (SF-36), Hospital Anxiety and Depression Scale, and Chelsea Critical Care Assessment Too (CPAx). RESULTS We visited 79 patients at 3 and 53 at 12 months. In patients with data from both visits the mental components SF-36 scores (median (IQR)) were 55 (43-63) at 3, and 58.5 (49.5-64) at 12 months; physical component SF-36 scores were 35 (28-45) at 3, and 36 (28-42) at 12 months. SF-36 subdomains of mental health, social functioning, and role emotional were close to normal. Vitality, bodily pain, general health, physical functioning, and role physical were severely affected. Incidences of anxiety and depression symptoms were 16%/8% at 3 and 13%/8% at 12 months) and physical function (CPAx) was 47 at both time points). CONCLUSION We found no change in HRQoL, anxiety, and depression, or physical function from 3 months to 1 year. Physical health-related quality of life was impaired at both time points. Subdomain scores for physical health-related quality of life were affected more than mental domains at both time points.
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Affiliation(s)
- Stine Estrup
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Cilia K. W. Kjer
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Frederik Vilhelmsen
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Nadia Ahmed
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Lone M. Poulsen
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
| | - Ismail Gøgenur
- Department of Gastrointestinal Surgery Center for Surgical Science Zealand University Hospital Køge Denmark
| | - Ole Mathiesen
- Department of Anesthesiology Centre of Anaesthesiological Research Zealand University Hospital Køge Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen, Køge Denmark
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9
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Drake TM, Riad AM, Fairfield CJ, Egan C, Knight SR, Pius R, Hardwick HE, Norman L, Shaw CA, McLean KA, Thompson AAR, Ho A, Swann OV, Sullivan M, Soares F, Holden KA, Merson L, Plotkin D, Sigfrid L, de Silva TI, Girvan M, Jackson C, Russell CD, Dunning J, Solomon T, Carson G, Olliaro P, Nguyen-Van-Tam JS, Turtle L, Docherty AB, Openshaw PJ, Baillie JK, Harrison EM, Semple MG. Characterisation of in-hospital complications associated with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol UK: a prospective, multicentre cohort study. Lancet 2021; 398:223-237. [PMID: 34274064 PMCID: PMC8285118 DOI: 10.1016/s0140-6736(21)00799-6] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/22/2021] [Accepted: 03/29/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND COVID-19 is a multisystem disease and patients who survive might have in-hospital complications. These complications are likely to have important short-term and long-term consequences for patients, health-care utilisation, health-care system preparedness, and society amidst the ongoing COVID-19 pandemic. Our aim was to characterise the extent and effect of COVID-19 complications, particularly in those who survive, using the International Severe Acute Respiratory and Emerging Infections Consortium WHO Clinical Characterisation Protocol UK. METHODS We did a prospective, multicentre cohort study in 302 UK health-care facilities. Adult patients aged 19 years or older, with confirmed or highly suspected SARS-CoV-2 infection leading to COVID-19 were included in the study. The primary outcome of this study was the incidence of in-hospital complications, defined as organ-specific diagnoses occurring alone or in addition to any hallmarks of COVID-19 illness. We used multilevel logistic regression and survival models to explore associations between these outcomes and in-hospital complications, age, and pre-existing comorbidities. FINDINGS Between Jan 17 and Aug 4, 2020, 80 388 patients were included in the study. Of the patients admitted to hospital for management of COVID-19, 49·7% (36 367 of 73 197) had at least one complication. The mean age of our cohort was 71·1 years (SD 18·7), with 56·0% (41 025 of 73 197) being male and 81·0% (59 289 of 73 197) having at least one comorbidity. Males and those aged older than 60 years were most likely to have a complication (aged ≥60 years: 54·5% [16 579 of 30 416] in males and 48·2% [11 707 of 24 288] in females; aged <60 years: 48·8% [5179 of 10 609] in males and 36·6% [2814 of 7689] in females). Renal (24·3%, 17 752 of 73 197), complex respiratory (18·4%, 13 486 of 73 197), and systemic (16·3%, 11 895 of 73 197) complications were the most frequent. Cardiovascular (12·3%, 8973 of 73 197), neurological (4·3%, 3115 of 73 197), and gastrointestinal or liver (0·8%, 7901 of 73 197) complications were also reported. INTERPRETATION Complications and worse functional outcomes in patients admitted to hospital with COVID-19 are high, even in young, previously healthy individuals. Acute complications are associated with reduced ability to self-care at discharge, with neurological complications being associated with the worst functional outcomes. COVID-19 complications are likely to cause a substantial strain on health and social care in the coming years. These data will help in the design and provision of services aimed at the post-hospitalisation care of patients with COVID-19. FUNDING National Institute for Health Research and the UK Medical Research Council.
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Affiliation(s)
- Thomas M Drake
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aya M Riad
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Cameron J Fairfield
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Conor Egan
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Riinu Pius
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Hayley E Hardwick
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Lisa Norman
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Catherine A Shaw
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kenneth A McLean
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Antonia Ho
- Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, UK
| | - Olivia V Swann
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK
| | - Michael Sullivan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Felipe Soares
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Karl A Holden
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Department of Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Laura Merson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel Plotkin
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Louise Sigfrid
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thushan I de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Michelle Girvan
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Clare Jackson
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Clark D Russell
- Roslin Institute, University of Edinburgh, Edinburgh, UK; Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Jake Dunning
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, London, UK
| | - Tom Solomon
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK; Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Gail Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jonathan S Nguyen-Van-Tam
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; United Kingdom Department of Health and Social Care, London, UK
| | - Lance Turtle
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Annemarie B Docherty
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Peter Jm Openshaw
- National Heart and Lung Institute, Imperial College London, London, UK
| | - J Kenneth Baillie
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
| | - Malcolm G Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK; Paediatric Infectious Diseases, Royal Hospital for Sick Children, Edinburgh, UK
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11
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Slim MAM, Lala HM, Barnes N, Martynoga RA. Māori health outcomes in an intensive care unit in Aotearoa New Zealand. Anaesth Intensive Care 2021; 49:292-300. [PMID: 34154375 DOI: 10.1177/0310057x21989715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Māori are the indigenous people of New Zealand, and suffer disparate health outcomes compared to non-Māori. Waikato District Health Board provides level III intensive care unit services to New Zealand's Midland region. In 2016, our institution formalised a corporate strategy to eliminate health inequities for Māori. Our study aimed to describe Māori health outcomes in our intensive care unit and identify inequities. We performed a retrospective audit of prospectively entered data in the Australian and New Zealand Intensive Care Society database for all general intensive care unit admissions over 15 years of age to Waikato Hospital from 2014 to 2018 (n = 3009). Primary outcomes were in-intensive care unit and in-hospital mortality. The secondary outcome was one-year mortality. In our study, Māori were over-represented relative to the general population. Compared to non-Māori, Māori patients were younger (51 versus 61 years, P < 0.001), and were more likely to reside outside of the Waikato region (37.2% versus 28.0%, P < 0.001) and in areas of higher deprivation (P < 0.001). Māori had higher admission rates for trauma and sepsis (P < 0.001 overall) and required more renal replacement therapy (P < 0.001). There was no difference in crude and adjusted mortality in-intensive care unit (16.8% versus 16.5%, P = 0.853; adjusted odds ratio 0.98 (95% confidence interval 0.68 to 1.40)) or in-hospital (23.7% versus 25.7%, P = 0.269; adjusted odds ratio 0.84 (95% confidence interval 0.60 to 1.18)). One-year mortality was similar (26.1% versus 27.1%, P=0.6823). Our study found significant ethnic inequity in the intensive care unit for Māori, who require more renal replacement therapy and are over-represented in admissions, especially for trauma and sepsis. These findings suggest upstream factors increasing Māori risk for critical illness. There was no difference in mortality outcomes.
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Affiliation(s)
- M Atif Mohd Slim
- Department of Critical Care, Waikato Hospital, Hamilton, New Zealand
| | - Hamish M Lala
- Department of Critical Care, Waikato Hospital, Hamilton, New Zealand
| | - Nicholas Barnes
- Department of Critical Care, Waikato Hospital, Hamilton, New Zealand
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13
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Halpin DMG, Criner GJ, Papi A, Singh D, Anzueto A, Martinez FJ, Agusti AA. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2021; 203:24-36. [PMID: 33146552 PMCID: PMC7781116 DOI: 10.1164/rccm.202009-3533so] [Citation(s) in RCA: 390] [Impact Index Per Article: 130.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.
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Affiliation(s)
- David M. G. Halpin
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Gerard J. Criner
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Alberto Papi
- Department of Medical Sciences, Cardiorespiratory and Internal Medicine Unit, University of Ferrara, Ferrara, Italy
| | - Dave Singh
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Antonio Anzueto
- Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health, University of Texas, San Antonio, Texas
| | - Fernando J. Martinez
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
| | - Alvar A. Agusti
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain; and
| | - on behalf of the GOLD Science Committee
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
- Department of Medical Sciences, Cardiorespiratory and Internal Medicine Unit, University of Ferrara, Ferrara, Italy
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
- Division of Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System, University of Texas Health, University of Texas, San Antonio, Texas
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, New York
- Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain; and
- Department of Medicine, Pulmonary, and Critical Care Medicine, the German Center for Lung Research, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
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Merino-Osorio C, Velásquez M, Reveco R, Marmolejo JI, Fu C. 24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country. Value Health Reg Issues 2020; 23:99-104. [PMID: 33171360 DOI: 10.1016/j.vhri.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. METHODS Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. RESULTS Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. CONCLUSIONS A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a cost-benefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.
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Affiliation(s)
- Catalina Merino-Osorio
- School of Physical Therapy, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
| | - Mónica Velásquez
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile; Department of Medical Specialties Faculty of Medicine Universidad de La Frontera, Temuco, Chile
| | - Roberto Reveco
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile; Department of Administration and Economy, Universidad de La Frontera, Temuco, Chile
| | - José Ignacio Marmolejo
- School of Physical Therapy, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Instituto Nacional del Tórax, Santiago, Chile
| | - Carolina Fu
- Department of Physical Therapy, Speech, and Occupational Therapy, Universidade São Paulo, São Paulo, Brazil
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15
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Chen CP, Chen YW, Chang KH, Huang SW, Wu CH, Escorpizo R, Stucki G, Liou TH. Clustering of functioning and disability profile based on the WHO disability assessment schedule 2.0 - a nationwide databank study. Disabil Rehabil 2020; 44:353-362. [PMID: 32525411 DOI: 10.1080/09638288.2020.1767703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To compare and cluster the health status and disability restrictions associated with eight major physiological functions of body systems, using functioning domains of WHO Disability Assessment Schedule 2.0.Design: Retrospective analyses of a nation-wide disability database.Setting: Population-based study.Participants: Records from patients >18 years of age with disability were obtained from the Taiwan Data Bank of Persons with Disability (July 2012-November 2017). Disability functioning profile of the following diagnosis were analyzed: stroke, schizophrenia, hearing loss, liver cirrhosis, chronic kidney disease, congestive heart failure, burn, head and neck cancer.Interventions: Not applicable.Main Outcome Measures: Demographic data, severity of impairment, and Disability Assessment Scale scores were obtained and analyzed. Radar charts were constructed using the WHO Disability Assessment Schedule 2.0. functioning domain score. Degree of similarity between any two given diagnosis was assessed by cluster analysis, comparing the Euclidean distances between radar chart data points among the six domains.Results: Based on cluster analysis of similarities between functioning domain profiles, the eight diagnoses were grouped into different disability clusters. Four clusters of disability were named according to the type restriction patterns: global-impact cluster (stroke); interaction-restriction cluster (schizophrenia, hearing loss); physical-limitation cluster, (liver cirrhosis, CKD, and congestive heart failure); and specific-impact cluster (burn, head and neck cancer). The rates of institutionalization and unemployment differed between the four clusters.Conclusion: We converted WHO Disability Assessment Schedule 2.0. functioning domain scores into six-dimensioned radar chart, and demonstrate disability restrictions can be further categorized into clusters according to similarity of functioning impairment. Understanding of disease-related disabilities provides an important basis for designing rehabilitation programs and policies on social welfare and health that reflect the daily-living needs of people according to diagnosis.Implication for RehabilitationThe use of radar charts provided a direct visualization of the scope and severity of disabilities associated with specific diagnoses.Diagnosis-related disabilities can be organized into clusters based on similarities in WHODAS 2.0 disability domain profiles.Knowledge of the characteristics of disability clusters is important to understand disease-related disabilities and provide a basis for designing rehabilitation.
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Affiliation(s)
- Chao-Pen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kwang-Hwa Chang
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.,Graduate institute of sports science, National Taiwan Sports University, Taoyuan, Taiwan
| | - Chien-Hua Wu
- Department of Applied Mathematics, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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16
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Saxena H, Ward KR, Krishnan C, Epureanu BI. Effect of Multi-Frequency Whole-Body Vibration on Muscle Activation, Metabolic Cost and Regional Tissue Oxygenation. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:140445-140455. [PMID: 34036017 PMCID: PMC8143035 DOI: 10.1109/access.2020.3011691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Prolonged immobilization from a critical illness can result in significant muscle atrophy. Whole-body vibration (WBV) could potentially attenuate the issue of muscle atrophy; however, there exists no device that could potentially provide WBV in supine position that is suitable for critically ill patients. Hence, the purpose of this study was to develop a new wearable suit, called therapeutic vibration device (TVD), that can provide WBV in supine position and test its effects on physiologic markers of physical activity including muscle activation, oxygen consumption (VO2), and regional hemoglobin oxygen saturation (rSO2). The prototype TVD delivered multi-frequency WBV axially to 19 healthy participants in supine position for 10 minutes simultaneously at 25 Hz/4.2 grms on the feet and 15 Hz/0.7 grms on the shoulders. Muscle activation was recorded by electromyography (EMG), VO2 was measured by indirect calorimetry and rSO2 was recorded by near-infrared spectroscopy. Recordings were collected from each participant from multiple body locations, on three separate days, at baseline and during the intervention. Acceleration was also recorded to gain insight into transmissibility and coherence. Repeated-measures ANOVA using Bonferroni correction revealed that the muscle activity significantly increased by 4% - 62% (p < 0.05), VO2 improved by 22.3% (p < 0.05) and rSO2 increased by 1.4% - 4.5% (p < 0.05) compared to baseline. WBV provided by the TVD is capable of producing physiologic responses consistent with mild physical activity. Such effects could potentially be valuable as an adjunct to physical therapy for early mobilization to prevent atrophy occurring from prolonged immobilization.
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Affiliation(s)
- Himanshu Saxena
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin R Ward
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chandramouli Krishnan
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Bogdan I Epureanu
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI 48109, USA
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17
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Wittholz K, Fetterplace K, Clode M, George ES, MacIsaac CM, Judson R, Presneill JJ, Deane AM. Measuring nutrition-related outcomes in a cohort of multi-trauma patients following intensive care unit discharge. J Hum Nutr Diet 2019; 33:414-422. [PMID: 31788891 DOI: 10.1111/jhn.12719] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Functional recovery is an important outcome for those who survive critical illness. The present study aimed to assess nutrition provision and nutrition-related outcomes in a multi-trauma cohort following intensive care unit (ICU) discharge. METHODS The present study investigated a prospective cohort of patients discharged from an ICU, who had been admitted because of major trauma and required mechanical ventilation for at least 48 h. Nutrition-related outcomes, including body weight, quadriceps muscle layer thickness (QMLT), handgrip strength and subjective global assessment, were recorded on ICU discharge, days 5-7 post-ICU discharge and then weekly until hospital discharge. Nutrition intake was recorded for 5 days post-ICU discharge. Unless otherwise stated, data are presented as the mean (SD). RESULTS Twenty-eight patients [75% males, 55 (22.5) years] were included. Intake met 64% (28%) of estimated energy and 72% (32%) of protein requirements over the 5 days post-ICU discharge, which was similar to over the ICU admission. From ICU admission to hospital discharge, the mean reduction in weight was 4.2 kg (95% confidence interval = 2.2-6.3, P < 0.001) and after ICU discharge, the mean reduction in weight and QMLT was 2.6 kg (95% confidence interval = 1.0-4.2, P = 0.004) and 0.23 cm (95% confidence interval = 0.06-0.4, P = 0.01), respectively. CONCLUSIONS Patients received less energy and protein than estimated requirements after ICU discharge. Weight loss and reduction in QMLT also occurred during this period.
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Affiliation(s)
- K Wittholz
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - K Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia
| | - M Clode
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - E S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - C M MacIsaac
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia.,Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - R Judson
- Department of Trauma, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - J J Presneill
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia.,Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - A M Deane
- Department of Medicine and Radiology, Royal Melbourne Hospital, The University of Melbourne, Melbourne Medical School, Parkville, VIC, Australia.,Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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Knudson KA, Gustafson CM, Sadler LS, Whittemore R, Redeker NS, Andrews LK, Mangi A, Funk M. Long-term health-related quality of life of adult patients treated with extracorporeal membrane oxygenation (ECMO): An integrative review. Heart Lung 2019; 48:538-552. [DOI: 10.1016/j.hrtlng.2019.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
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19
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Rai S, Anthony L, Needham DM, Georgousopoulou EN, Sudheer B, Brown R, Mitchell I, van Haren F. Barriers to rehabilitation after critical illness: a survey of multidisciplinary healthcare professionals caring for ICU survivors in an acute care hospital. Aust Crit Care 2019; 33:264-271. [PMID: 31402265 DOI: 10.1016/j.aucc.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/04/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There is scant literature on the barriers to rehabilitation for patients discharged from the intensive care unit (ICU) to acute care wards. OBJECTIVES The objective of this study was to assess ward-based rehabilitation practices and barriers and assess knowledge and perceptions of ward clinicians regarding health concerns of ICU survivors. METHODS, DESIGN, SETTING, AND PARTICIPANTS This was a single-centre survey of multidisciplinary healthcare professionals caring for ICU survivors in an Australian tertiary teaching hospital. MAIN OUTCOME MEASURES The main outcome measures were knowledge of post-intensive care syndrome (PICS) amongst ward clinicians, perceptions of ongoing health concerns with current rehabilitation practices, and barriers to inpatient rehabilitation for ICU survivors. RESULTS The overall survey response rate was 35% (198/573 potential staff). Most respondents (66%, 126/190) were unfamiliar with the term PICS. A majority of the respondents perceived new-onset physical weakness, sleep disturbances, and delirium as common health concerns amongst ICU survivors on acute care wards. There were multifaceted barriers to patient mobilisation, with inadequate multidisciplinary staffing, lack of medical order for mobilisation, and inadequate physical space near the bed as common institutional barriers and patient frailty and cardiovascular instability as the commonly perceived patient-related barriers. A majority of the surveyed ward clinicians (66%, 115/173) would value education on health concerns of ICU survivors to provide better patient care. CONCLUSION There are multiple potentially modifiable barriers to the ongoing rehabilitation of ICU survivors in an acute care hospital. Addressing these barriers may have benefits for the ongoing care of ICU survivors.
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Affiliation(s)
- Sumeet Rai
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia.
| | - Lakmali Anthony
- Australian National University Medical School, Canberra, Australia
| | - Dale M Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA; John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | | | - Bindu Sudheer
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian Catholic University, Watson, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia
| | - Frank van Haren
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; University of Canberra, Bruce, Canberra, Australia
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Huang CY, Daniels R, Lembo A, Hartog C, O'Brien J, Heymann T, Reinhart K, Nguyen HB. Life after sepsis: an international survey of survivors to understand the post-sepsis syndrome. Int J Qual Health Care 2019; 31:191-198. [PMID: 29924325 DOI: 10.1093/intqhc/mzy137] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/30/2018] [Accepted: 06/02/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE In this study, we aim to describe the post-sepsis syndrome from the perspective of the sepsis survivors. DESIGN AND SETTING The study is a prospective, observational online international survey. PARTICIPANTS Sepsis survivors enrolled via social media from 13 September 2014 to 13 September 2016. INTERVENTIONS None. MAIN OUTCOME MEASURES Physiologic, physical and psychological function post-sepsis; and patient satisfaction with sepsis-centered care. RESULTS 1731 completed surveys from 41 countries were analyzed, with 79.9% female respondents, age 47.6 ± 14.4 years. The majority of respondents (47.8%) had sepsis within the last year. Survivors reported an increase in sensory, integumentary, digestive, breathing, chest pain, kidney and musculoskeletal problems after sepsis (all P-value <0.0001). Physical functions such as daily chores, running errands, spelling, reading and reduced libido posed increased difficulty (all P-value <0.0001). Within 7 days prior to completing the survey, the survivors reported varying degrees of anxiety, depression, fatigue and sleep disturbance. Sepsis survivors reported dissatisfaction with a number of hospital support services, with up to 29.3% of respondents stating no social services support was provided for their condition. CONCLUSIONS Sepsis survivors suffer from a myriad of physiologic, physical and psychological challenges. Survivors overall reveal dissatisfaction with sepsis-related care, suggesting areas for improvement both in-hospital and post-discharge.
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Affiliation(s)
- Cynthia Y Huang
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Department of Medicine, Loma Linda University, Loma Linda, California, USA
| | - Ron Daniels
- The UK Sepsis Trust, Birmingham B2 5SN, UK; and Department of Critical Care, Heart of England NHS Foundation Trust, Sutton Coldfield, UK
| | - Angie Lembo
- Sepsis Survivor, Sepsis Survivors Inc., Corona, California, USA
| | - Christiane Hartog
- Center for Sepsis Control and Care, University Hospital of Jena, 07747 Jena; and Patient- and Family-Centered Care, Klinik Bavaria Kreischa, Kreischa, Germany
| | | | | | - Konrad Reinhart
- Center for Sepsis Control and Care, University Hospital of Jena, 07747 Jena; and Patient- and Family-Centered Care, Klinik Bavaria Kreischa, Kreischa, Germany.,Global Sepsis Alliance, Jena, Germany
| | - H Bryant Nguyen
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Department of Medicine, Loma Linda University, Loma Linda, California, USA
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21
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Schofield‐Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev 2018; 11:CD012701. [PMID: 30388297 PMCID: PMC6517170 DOI: 10.1002/14651858.cd012701.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The intensive care unit (ICU) stay has been linked with a number of physical and psychological sequelae, known collectively as post-intensive care syndrome (PICS). Specific ICU follow-up services are relatively recent developments in health systems, and may have the potential to address PICS through targeting unmet health needs arising from the experience of the ICU stay. There is currently no single accepted model of follow-up service and current aftercare programmes encompass a variety of interventions and materials. There is uncertain evidence about whether follow-up services effectively address PICS, and this review assesses this. OBJECTIVES Our main objective was to assess the effectiveness of follow-up services for ICU survivors that aim to identify and address unmet health needs related to the ICU period. We aimed to assess effectiveness in relation to health-related quality of life (HRQoL), mortality, depression and anxiety, post-traumatic stress disorder (PTSD), physical function, cognitive function, ability to return to work or education and adverse effects.Our secondary objectives were to examine different models of follow-up services. We aimed to explore: the effectiveness of service organisation (physician- versus nurse-led, face-to-face versus remote, timing of follow-up service); differences related to country (high-income versus low- and middle-income countries); and effect of delirium, which can subsequently affect cognitive function, and the effect of follow-up services may differ for these participants. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and CINAHL on 7 November 2017. We searched clinical trials registers for ongoing studies, and conducted backward and forward citation searching of relevant articles. SELECTION CRITERIA We included randomised and non-randomised studies with adult participants, who had been discharged from hospital following an ICU stay. We included studies that compared an ICU follow-up service using a structured programme and co-ordinated by a healthcare professional versus no follow-up service or standard care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included five studies (four randomised studies; one non-randomised study), for a total of 1707 participants who were ICU survivors with a range of illness severities and conditions. Follow-up services were led by nurses in four studies or a multidisciplinary team in one study. They included face-to-face consultations at home or in a clinic, or telephone consultations or both. Each study included at least one consultation (weekly, monthly, or six-monthly), and two studies had up to eight consultations. Although the design of follow-up service consultations differed in each study, we noted that each service included assessment of participants' needs with referrals to specialist support if required.It was not feasible to blind healthcare professionals or participants to the intervention and we did not know whether this may have introduced performance bias. We noted baseline differences (two studies), and services included additional resources (two studies), which may have influenced results, and one non-randomised study had high risk of selection bias.We did not combine data from randomised studies with data from one non-randomised study. Follow-up services for improving long-term outcomes in ICU survivors may make little or no difference to HRQoL at 12 months (standardised mean difference (SMD) -0.0, 95% confidence interval (CI) -0.1 to 0.1; 1 study; 286 participants; low-certainty evidence). We found moderate-certainty evidence from five studies that they probably also make little or no difference to all-cause mortality up to 12 months after ICU discharge (RR 0.96, 95% CI 0.76 to 1.22; 4 studies; 1289 participants; and in one non-randomised study 79/259 deaths in the intervention group, and 46/151 in the control group) and low-certainty evidence from four studies that they may make little or no difference to PTSD (SMD -0.05, 95% CI -0.19 to 0.10, 703 participants, 3 studies; and one non-randomised study reported less chance of PTSD when a follow-up service was used).It is uncertain whether using a follow-up service reduces depression and anxiety (3 studies; 843 participants), physical function (4 studies; 1297 participants), cognitive function (4 studies; 1297 participants), or increases the ability to return to work or education (1 study; 386 participants), because the certainty of this evidence is very low. No studies measured adverse effects.We could not assess our secondary objectives because we found insufficient studies to justify subgroup analysis. AUTHORS' CONCLUSIONS We found insufficient evidence, from a limited number of studies, to determine whether ICU follow-up services are effective in identifying and addressing the unmet health needs of ICU survivors. We found five ongoing studies which are not included in this review; these ongoing studies may increase our certainty in the effect in future updates. Because of limited data, we were unable to explore whether one design of follow-up service is preferable to another, or whether a service is more effective for some people than others, and we anticipate that future studies may also vary in design. We propose that future studies are designed with robust methods (for example randomised studies are preferable) and consider only one variable (the follow-up service) compared to standard care; this would increase confidence that the effect is due to the follow-up service rather than concomitant therapies.
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Affiliation(s)
- Oliver J Schofield‐Robinson
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Sharon R Lewis
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
| | - Joanne McPeake
- NHS Greater Glasgow and Clyde/University of GlasgowGlasgow Royal Infirmary (North Sector)GlasgowUK
| | - Phil Alderson
- National Institute for Health and Care ExcellenceLevel 1A, City Tower,Piccadilly PlazaManchesterUKM1 4BD
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22
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Jovanović G, Jakovljević DK, Lukić-Šarkanović M. Enhanced Recovery in Surgical Intensive Care: A Review. Front Med (Lausanne) 2018; 5:256. [PMID: 30338259 PMCID: PMC6180254 DOI: 10.3389/fmed.2018.00256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Patients are admitted to the surgical intensive care (SICU) unit after emergency and elective surgery. After elective surgery, for further support, or to manage coexisting comorbidities. The implementation of the ERAS (Enhanced recovery after surgery) protocols in surgery should decrease the need for ICU beds, but there will always be unpredicted complications after surgery. These will require individual management. What we can do for our surgical patients in ICU to further enhance their recovery? To promote early enhanced recovery in surgical intensive care—SICU, three areas need to be addressed, sedation, analgesia, and delirium. Tools for measurement and protocols for management in these three areas should be developed to ensure best practice in each SICU. The fourth important area is Nutrition. Preoperative screening and post-operative measurement of the state of nutrition also need to be developed in the SICU. The fifth important area is early mobilization. ERAS protocols encourage early mobilization of the critically ill patients, even if on mechanical ventilation. Early mobilization is possible and should be implemented by special multidisciplinary ICU team. All team members must be familiar with protocols to be able to implement them in their field of expertise. Personal and professional attitudes are critical for implementation. In the core of all our efforts should be the patient and his well-being.
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Affiliation(s)
- Gordana Jovanović
- University of Novi Sad, Faculty of Medicine, Department of Anesthesia and Perioperative Medicine, Novi Sad, Serbia.,Clinic for Anesthesia and Intensive Care Therapy, Clinical Center of Vojvodina, Novi Sad, Serbia.,University of Novi Sad, Faculty of Medicine, Department of Physiology and Sports Medicine, Novi Sad, Serbia
| | - Dea Karaba Jakovljević
- University of Novi Sad, Faculty of Medicine, Department of Physiology and Sports Medicine, Novi Sad, Serbia
| | - Mirka Lukić-Šarkanović
- Clinic for Anesthesia and Intensive Care Therapy, Clinical Center of Vojvodina, Novi Sad, Serbia
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23
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Denehy L, Granger CL, El-Ansary D, Parry SM. Advances in cardiorespiratory physiotherapy and their clinical impact. Expert Rev Respir Med 2018; 12:203-215. [PMID: 29376440 DOI: 10.1080/17476348.2018.1433034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Cardiorespiratory physiotherapy is an evidence-based practice that has evolved alongside changes in medical and surgical management, analgesia, the ageing society and increasing comorbidities of our patient populations. Continued research provides the profession with the ability to adapt to meet the changing patient and community needs. Areas covered: This review focuses on surgical, respiratory and critical care settings discussing the most significant changes over the past decade with an increased focus on rehabilitation across the care continuum and a shift away from providing predominately airway clearance in established disease populations but also providing this in emerging groups. Further important changes are identification and emphases on patient self-management including changing their behaviour to more positively embrace wellness, particularly increasing physical activity levels. This paper outlines these changes and offers speculation on factors that may impact the profession in the future. Expert commentary: The increasing focus on new technologies, physical activity levels, changes to the health systems in different countries and an increasingly comorbid and ageing society will shape the next steps in the evolution of cardiorespiratory physiotherapy. Continued research is vital to keep pace with these changes so that physiotherapists can provide the most effective treatments to improve patient outcomes.
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Affiliation(s)
- Linda Denehy
- a Department of Physiotherapy, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Victoria , Australia
| | - Catherine L Granger
- a Department of Physiotherapy, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Victoria , Australia
| | - Doa El-Ansary
- b Department of Cardiothoracic Surgery , Royal Melbourne Hospital, Royal Parade , Parkville , Australia
| | - Selina M Parry
- a Department of Physiotherapy, Melbourne School of Health Sciences , The University of Melbourne , Melbourne , Victoria , Australia
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24
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Wischmeyer PE. Tailoring nutrition therapy to illness and recovery. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:316. [PMID: 29297385 PMCID: PMC5751603 DOI: 10.1186/s13054-017-1906-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Without doubt, in medicine as in life, one size does not fit all. We do not administer the same drug or dose to every patient at all times, so why then would we live under the illusion that we should give the same nutrition at all times in the continuum of critical illness? We have long lived under the assumption that critical illness and trauma lead to a consistent early increase in metabolic/caloric need, the so-called “hypermetabolism” of critical illness. What if this is incorrect? Recent data indicate that early underfeeding of calories (trophic feeding) may have benefits and may require consideration in well-nourished patients. However, we must confront the reality that currently ICU nutrition delivery worldwide is actually leading to “starvation” of our patients and is likely a major contributor to poor long-term quality of life outcomes. To begin to ascertain the actual calorie and protein delivery required for optimal ICU recovery, an understanding of “starvation” and recovery from starvation and lean body mass (LBM) loss is needed. To begin to answer this question, we must look to the landmark Minnesota Starvation Study from 1945. This trial defines much of the world’s knowledge about starvation, and most importantly what is required for recovery from starvation and massive LBM loss as occurs in the ICU. Recent and historic data indicate that critical illness is characterized by early massive catabolism, LBM loss, and escalating hypermetabolism that can persist for months or years. Early enteral nutrition during the acute phase should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein, and moderate nonprotein calories in well-nourished patients, as in the acute phase they are capable of generating significant endogenous energy. Post resuscitation, increasing protein (1.5–2.0 g/kg/day) and calories are needed to attenuate LBM loss and promote recovery. Malnutrition screening is essential and parenteral nutrition can be safely added following resuscitation when enteral nutrition is failing based on pre-illness malnutrition and LBM status. Following the ICU stay, significant protein/calorie delivery for months or years is required to facilitate functional and LBM recovery, with high-protein oral supplements being essential to achieve adequate nutrition.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology and Surgery, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
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25
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Johnson AM, Henning AN, Morris PE, Tezanos AGV, Dupont-Versteegden EE. Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU. Sci Rep 2017; 7:17591. [PMID: 29242519 PMCID: PMC5730602 DOI: 10.1038/s41598-017-17624-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/15/2017] [Indexed: 01/06/2023] Open
Abstract
Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and for length of stay were found. The regression model determined that time to first physical therapy evaluation, Charlson Comorbidity Index score, mean days of physical therapy treatment and mechanical ventilation were associated with increased hospital length of stay. Time to first physical therapy evaluation in the intensive care unit and the hospital, and mean days of physical therapy treatment associated with hospital length of stay. Further prospective study is required to determine whether shortening time to physical therapy evaluation and treatment in a cardiothoracic intensive care unit could influence length of stay.
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Affiliation(s)
- Audrey M Johnson
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America.
| | - Angela N Henning
- Rehabilitation Department, UK HealthCare, Lexington, Kentucky, United States of America
| | - Peter E Morris
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Lexington, Kentucky, United States of America
| | - Alejandro G Villasante Tezanos
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, United States of America
| | - Esther E Dupont-Versteegden
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America
- Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America
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26
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Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise. Curr Opin Crit Care 2017; 23:269-278. [PMID: 28661414 DOI: 10.1097/mcc.0000000000000431] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW We have significantly improved hospital mortality from sepsis and critical illness in last 10 years; however, over this same period we have tripled the number of 'ICU survivors' going to rehabilitation. Furthermore, as up to half the deaths in the first year following ICU admission occur post-ICU discharge, it is unclear how many of these patients ever returned home or a meaningful quality of life. For those who do survive, recent data reveals many 'ICU survivors' will suffer significant functional impairment or post-ICU syndrome (PICS). Thus, new innovative metabolic and exercise interventions to address PICS are urgently needed. These should focus on optimal nutrition and lean body mass (LBM) assessment, targeted nutrition delivery, anabolic/anticatabolic strategies, and utilization of personalized exercise intervention techniques, such as utilized by elite athletes to optimize preparation and recovery from critical care. RECENT FINDINGS New data for novel LBM analysis technique such as computerized tomography scan and ultrasound analysis of LBM are available showing objective measures of LBM now becoming more practical for predicting metabolic reserve and effectiveness of nutrition/exercise interventions. 13C-Breath testing is a novel technique under study to predict infection earlier and predict over-feeding and under-feeding to target nutrition delivery. New technologies utilized routinely by athletes such as muscle glycogen ultrasound also show promise. Finally, the role of personalized cardiopulmonary exercise testing to target preoperative exercise optimization and post-ICU recovery are becoming reality. SUMMARY New innovative techniques are demonstrating promise to target recovery from PICS utilizing a combination of objective LBM and metabolic assessment, targeted nutrition interventions, personalized exercise interventions for prehabilitation and post-ICU recovery. These interventions should provide hope that we will soon begin to create more 'survivors' and fewer victim's post-ICU care.
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Abstract
Sepsis is characterized by early massive catabolism, lean body mass (LBM) loss, and escalating hypermetabolism persisting for months to years. Early enteral nutrition should attempt to correct micronutrient/vitamin deficiencies, deliver adequate protein and moderated nonprotein calories, as well-nourished patients can generate reasonable endogenous energy. After resuscitation, increasing protein/calories are needed to attenuate LBM loss and promote recovery. Malnutrition screening is essential, and parenteral nutrition can be safely added when enteral nutrition is failing based on preillness malnutrition. Following discharge from intensive care unit, significantly increased protein/calorie delivery is required for months to years to facilitate functional and LBM recovery.
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28
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Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness? Am J Phys Med Rehabil 2017; 96:607-615. [DOI: 10.1097/phm.0000000000000718] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Oliver J Schofield-Robinson
- Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, NHS; Research and Development; Lancaster UK LA1 4RP
| | - Sharon R Lewis
- Royal Lancaster Infirmary; Patient Safety Research Department; Pointer Court 1, Ashton Road Lancaster UK LA1 4RP
| | - Andrew F Smith
- Royal Lancaster Infirmary; Department of Anaesthesia; Ashton Road Lancaster Lancashire UK LA1 4RP
| | - Joanne McPeake
- NHS Greater Glasgow and Clyde/University of Glasgow; Glasgow Royal Infirmary (North Sector); Glasgow UK
| | - Phil Alderson
- National Institute for Health and Care Excellence; Level 1A, City Tower, Piccadilly Plaza Manchester UK M1 4BD
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30
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Wischmeyer PE, Hasselmann M, Kummerlen C, Kozar R, Kutsogiannis DJ, Karvellas CJ, Besecker B, Evans DK, Preiser JC, Gramlich L, Jeejeebhoy K, Dhaliwal R, Jiang X, Day AG, Heyland DK. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:142. [PMID: 28599676 PMCID: PMC5466764 DOI: 10.1186/s13054-017-1736-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/23/2017] [Indexed: 12/19/2022]
Abstract
Background Nutrition guidelines recommendations differ on the use of parenteral nutrition (PN), and existing clinical trial data are inconclusive. Our recent observational data show that amounts of energy/protein received early in the intensive care unit (ICU) affect patient mortality, particularly for inadequate nutrition intake in patients with body mass indices (BMIs) of <25 or >35. Thus, we hypothesized increased nutrition delivery via supplemental PN (SPN) + enteral nutrition (EN) to underweight and obese ICU patients would improve 60-day survival and quality of life (QoL) versus usual care (EN alone). Methods In this multicenter, randomized, controlled pilot trial completed in 11 centers across four countries, adult ICU patients with acute respiratory failure expected to require mechanical ventilation for >72 hours and with a BMI of <25 or ≥35 were randomized to receive EN alone or SPN + EN to reach 100% of their prescribed nutrition goal for 7 days after randomization. The primary aim of this pilot trial was to achieve a 30% improvement in nutrition delivery. Results In total, 125 patients were enrolled. Over the first 7 post-randomization ICU days, patients in the SPN + EN arm had a 26% increase in delivered calories and protein, whereas patients in the EN-alone arm had a 22% increase (both p < 0.001). Surgical ICU patients received poorer EN nutrition delivery and had a significantly greater increase in calorie and protein delivery when receiving SPN versus medical ICU patients. SPN proved feasible to deliver with our prescribed protocol. In this pilot trial, no significant outcome differences were observed between groups, including no difference in infection risk. Potential, although statistically insignificant, trends of reduced hospital mortality and improved discharge functional outcomes and QoL outcomes in the SPN + EN group versus the EN-alone group were observed. Conclusions Provision of SPN + EN significantly increased calorie/protein delivery over the first week of ICU residence versus EN alone. This was achieved with no increased infection risk. Given feasibility and consistent encouraging trends in hospital mortality, QoL, and functional endpoints, a full-scale trial of SPN powered to assess these clinical outcome endpoints in high-nutritional-risk ICU patients is indicated—potentially focusing on the more poorly EN-fed surgical ICU setting. Trial registration NCT01206166 Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1736-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul E Wischmeyer
- Department of Anesthesiology and Surgery and Duke Clinical Research Institute, Duke University School of Medicine, DUMC, Box 3094, Mail # 41, 2301 Erwin Road, 5692 HAFS, Durham, NC, 27710, USA.
| | - Michel Hasselmann
- Faculté de Médecine de l'Université de Strasbourg, Centre Hospitalier Universitaire de Strasbourg Nouvel Hȏpital Civil, Strasbourg Cedex, France
| | - Christine Kummerlen
- Faculté de Médecine de l'Université de Strasbourg, Centre Hospitalier Universitaire de Strasbourg Nouvel Hȏpital Civil, Strasbourg Cedex, France
| | - Rosemary Kozar
- Shock Trauma Center, University of Maryland Medical Center, University of Maryland, Baltimore, MD, USA
| | - Demetrios James Kutsogiannis
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Constantine J Karvellas
- Divisions of Gastroenterology and Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Beth Besecker
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Ohio State University Medical Center, Ohio State University, Columbus, OH, USA
| | - David K Evans
- Department of Surgery, The Ohio State University Medical Center, Ohio State University, Columbus, OH, USA
| | - Jean-Charles Preiser
- Department of Intensive Care, Universite Libre de Bruxelles, Erasme University Hospital, Brussels, Belgium
| | - Leah Gramlich
- Department of Medicine, Division of Gastroenterology, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | | | - Rupinder Dhaliwal
- Clinical Evaluation Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Xuran Jiang
- Clinical Evaluation Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Queen's University, Kingston, ON, Canada.,Department of Critical Care Medicine, Kingston General Hospital, Queen's University, Kingston, ON, Canada.,Department of Community Health and Epidemiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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31
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Abstract
This paper discusses critical illness as a biographical disruption in intensive care and beyond. When people talk about critical illness, they often associate it with intensive care units (ICU). However, critical illness disrupts one’s existential being both in the immediacy of ICU hospitalisation and during the long-term recovery phase. In ICU the patient experiences biographical disruption by being attached to technology and being unconscious. During the period of unconsciousness the patient undergoes severance from the world. This period is then followed by the discovery of oneself confined to the strange ICU environment and restricted by lifesaving technology upon regaining consciousness. These phases highlight the nature of critical illness as a biographical disruption. Chronic illness and illness in general as a biographical disruption have been discussed previously. However there is little literature about critical illness as a biographical disruption per se.
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Affiliation(s)
- Agness C Tembo
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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Choi J, Donahoe MP, Hoffman LA. Psychological and Physical Health in Family Caregivers of Intensive Care Unit Survivors: Current Knowledge and Future Research Strategies. J Korean Acad Nurs 2017; 46:159-67. [PMID: 27182013 DOI: 10.4040/jkan.2016.46.2.159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/31/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE This article provides an overview of current knowledge on the impact of caregiving on the psychological and physical health of family caregivers of intensive care unit (ICU) survivors and suggestions for future research. METHODS Review of selected papers published in English between January 2000 and October 2015 reporting psychological and physical health outcomes in family caregivers of ICU survivors. RESULTS In family caregivers of ICU survivors followed up to five years after patients' discharge from an ICU, psychological symptoms, manifested as depression, anxiety and post-traumatic stress disorder, were highly prevalent. Poor self-care, sleep disturbances and fatigue were identified as common physical health problems in family caregivers. Studies to date are mainly descriptive; few interventions have targeted family caregivers. Further, studies that elicit unique needs of families from diverse cultures are lacking. CONCLUSION Studies to date have described the impact of caregiving on the psychological and physical health in family caregivers of ICU survivors. Few studies have tested interventions to support unique needs in this population. Therefore, evidence for best strategies is lacking. Future research is needed to identify ICU caregivers at greatest risk for distress, time points to target interventions with maximal efficacy, needs of those from diverse cultures and test interventions to mitigate family caregivers' burden.
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Affiliation(s)
- Jiyeon Choi
- Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
| | - Michael P Donahoe
- Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Leslie A Hoffman
- Department of Acute & Tertiary Care, School of Nursing & Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Effect of neuromuscular stimulation and individualized rehabilitation on muscle strength in Intensive Care Unit survivors: A randomized trial. J Crit Care 2017; 40:76-82. [PMID: 28364678 DOI: 10.1016/j.jcrc.2017.03.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 02/20/2017] [Accepted: 03/19/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE Intensive Care Unit (ICU) survivors experience muscle weakness leading to restrictions in functional ability. Neuromuscular electrical stimulation (NMES) has been an alternative to exercise in critically ill patients. The aim of our study was to investigate its effects along with individualized rehabilitation on muscle strength of ICU survivors. MATERIAL AND METHODS Following ICU discharge, 128 patients (age: 53±16years) were randomly assigned to daily NMES sessions and individualized rehabilitation (NMES group) or to control group. Muscle strength was assessed by the Medical Research Council (MRC) score and hand grip at hospital discharge. Secondary outcomes were functional ability and hospital length of stay. RESULTS MRC, handgrip, functional status and hospital length of stay did not differ at hospital discharge between groups (p>0.05). ΔMRC% one and two weeks after ICU discharge tended to be higher in NMES group, while it was significant higher in NMES group of patients with ICU-acquired weakness at two weeks (p=0.05). CONCLUSIONS NMES and personalized physiotherapy in ICU survivors did not result in greater improvement of muscle strength and functional status at hospital discharge. However, in patients with ICU-aw NMES may be effective. The potential benefits of rehabilitation strategies should be explored in larger number of patients in future studies. CLINICAL TRIAL REGISTRATION www.Clinicaltrials.gov: NCT01717833.
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Kean S, Salisbury LG, Rattray J, Walsh TS, Huby G, Ramsay P. ‘Intensive care unit survivorship’ - a constructivist grounded theory of surviving critical illness. J Clin Nurs 2017; 26:3111-3124. [DOI: 10.1111/jocn.13659] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Susanne Kean
- School of Health in Social Science; Nursing Studies; The University of Edinburgh; Edinburgh UK
| | - Lisa G Salisbury
- School of Health in Social Science; Nursing Studies; The University of Edinburgh; Edinburgh UK
| | - Janice Rattray
- School of Nursing & Midwifery; University of Dundee; Dundee UK
| | - Timothy S Walsh
- School of Clinical Science; Queens Medical Research Institute; The University of Edinburgh; Edinburgh UK
| | - Guro Huby
- Faculty of Health and Social Studies; Østfold University College; Halden Norway
| | - Pamela Ramsay
- School of Nursing; Midwifery & Social Care; Edinburgh Napier University; Edinburgh UK
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Zhang TT, Huang YQ, Liu ZR, Chen HG. Distribution and Risk Factors of Disability Attributed to Personality Disorders: A National Cross-sectional Survey in China. Chin Med J (Engl) 2017; 129:1765-71. [PMID: 27453222 PMCID: PMC4976561 DOI: 10.4103/0366-6999.186649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Personality disorders can lead to some disability. However, little is known about the disability prevalence and function impairments. This study aimed to describe the disability prevalence attributed to personality disorders, its distribution, impairments of daily activities and social functions, and risk factors in China. Methods: Using a descriptive and analytic epidemiological method, data from the Second China National Sample Survey on Disability in 2006 were analyzed. The disability prevalence attributed to personality disorders, its distribution in different people and regions, and risk factors were statistically calculated. Results: Respondents included 1,909,205 adults. The disability prevalence rate attributed to personality disorders in China was 5.9/100,000. The disability rate attributed to personality disorders of males was higher than that of females (P = 0.012), while the rate of the unemployed was higher than that of the employed (P < 0.001). Furthermore, the rates of unmarried/divorced/widowed people and the illiterate population were higher than those of married and educated people (P < 0.001). Regarding the severity of disability attributable to personality disorders, mild disability accounted for a majority or 60% of the respondents. The data showed that disability mainly impaired respondents’ ability to engage in daily activities, get along with people, and participate in social situations. According to the case-control study, marriage, employment, and higher education were protective factors of disability. Conclusions: The prevalence of disability attributed to personality disorders is low in China and always leads to mild disability. The distribution of disability attributed to personality disorders also varies in the Chinese population.
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Affiliation(s)
- Ting-Ting Zhang
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Yue-Qin Huang
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Zhao-Rui Liu
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Hong-Guang Chen
- Department of Social Psychiatry and Behavioral Medicine, Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders and Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
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[Delirium, analgesia, and sedation in intensive care medicine : Development of a protocol-based management approach]. Med Klin Intensivmed Notfmed 2017; 112:65-74. [PMID: 28074297 DOI: 10.1007/s00063-016-0251-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/01/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental. Here, a treatment target is defined and continuously re-evaluated by validated monitoring methods. Evidence clearly supports a paradigm shift towards patients that are awake, attentive, and able to participate in their therapy. Individualized analgesia and (non)sedation approaches allow a Richmond Agitation-Sedation Scale (RASS) target value of 0/-1 for the majority of patients. Should sedation indeed be necessary, there must be a focus on avoiding oversedation, especially an early deep sedation.
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37
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Paratz JD, Boots RJ. Dealing with the critical care aftermath: where to from here? J Thorac Dis 2016; 8:2400-2402. [PMID: 27746987 DOI: 10.21037/jtd.2016.08.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer D Paratz
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia;; Griffith University, Southport, Queensland, Australia
| | - Robert J Boots
- Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia;; Department of Thoracic Medicine, Royal Brisbane & Women's Hospital, Brisbane, Australia
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38
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Describing and measuring recovery and rehabilitation after critical illness. Curr Opin Crit Care 2016; 21:445-52. [PMID: 26348422 DOI: 10.1097/mcc.0000000000000233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation is the cornerstone of management of postcritical illness morbidity. Selection of appropriate tools to measure response to rehabilitation therapy is vital to accurately document trajectory of change across the recovery continuum. In the context of physical-based strategies to redress critical illness associated muscle wasting and dysfunction, this review will discuss a framework to guide assessment of physical recovery in the critical illness population, clinimetric measurement properties for instruments and evidence for their implementation, and recent interventional trial data. RECENT FINDINGS The International Classification of Functioning, Disability and Health (ICF) model is a useful framework to guide selection of outcome measures representing physical function at the level of impairment, activity limitation and participation restriction. Clinimetric data are emerging to support a number of physical function outcome measures in the ICU, albeit further research is required to corroborate tools used beyond ICU discharge. Factors associated with outcome measure selection have contributed to interpreting findings from recent interventional trials of physical rehabilitation. SUMMARY Determining the future design, conduct and impact of physical therapy interventions for critically ill patients will rely on further development of clinimetrically robust metrics to capture individual patient response spanning the recovery pathway. This approach should be similarly applied to rehabilitation interventions addressing other postintensive care syndrome domains.
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39
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Depressive symptoms and anxiety in intensive care unit (ICU) survivors after ICU discharge. Heart Lung 2016; 45:140-6. [PMID: 26791248 PMCID: PMC4878700 DOI: 10.1016/j.hrtlng.2015.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 11/10/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The association between intensive care unit (ICU) survivors' psychological sequelae, individual care needs, and discharge disposition has not been evaluated. OBJECTIVE To describe depressive symptoms and anxiety in ICU survivors and explore these symptoms based on individual care needs and discharge disposition for 4 months post-ICU discharge. METHODS We analyzed data from 39 ICU survivors who self-reported measures of depressive symptoms (Center for Epidemiologic Studies-Depression 10 items [CESD-10]) and anxiety (Shortened Profile of Mood States-Anxiety subscale [POMS-A]). RESULTS A majority of patients reported CESD-10 scores above the cut off (≥ 8) indicating risk for clinical depression. POMS-A scores were highest within 2 weeks post-ICU discharge and decreased subsequently. Data trends suggest worse depressive symptoms and anxiety when patients had moderate to high care needs and/or were unable to return home. CONCLUSION ICU survivors who need caregiver assistance and extended institutional care reported trends of worse depressive symptoms and anxiety.
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40
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Huang SW, Chang KH, Escorpizo R, Chi WC, Yen CF, Liao HF, Chang FH, Chiu WT, Lin JW, Liou TH. Functioning and disability analysis by using WHO Disability Assessment Schedule 2.0 in older adults Taiwanese patients with dementia. Disabil Rehabil 2015; 38:1652-63. [DOI: 10.3109/09638288.2015.1107636] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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41
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Huang SW, Chang KH, Escorpizo R, Hu CJ, Chi WC, Yen CF, Liao HF, Chiu WT, Liou TH. Using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Predicting Institutionalization of Patients With Dementia in Taiwan. Medicine (Baltimore) 2015; 94:e2155. [PMID: 26632747 PMCID: PMC5059016 DOI: 10.1097/md.0000000000002155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is an assessment tool and it has been applied for disability status assessment of Taiwanese dementia patients since July 2012. The aim of this study was to investigate the predicting accuracy of WHODAS 2.0 for institutionalization of dementia patients.Of these patients, 13,774 resided in a community and 4406 in a long-term care facility. Demographic data and WHODAS 2.0 standardized scores were analyzed using the Chi-square test and independent t test to compare patients with dementia in an institution with those in a community. The receiver operating characteristic (ROC) curve was applied to investigate accuracy in predicting institutionalization, and the optimal cutoff point was determined using the Youden index. Binary logistic regression was used to analyze variables to determine risk factors for the institutionalization of patients with dementia.WHODAS 2.0 scores in all domains were higher in patients with dementia in a long-term care facility than in those in a community (P < 0.01). The ROC curve showed moderate accuracy for all domains of WHODAS 2.0 (area under curve 0.6~0.8). Binary logistic regression revealed that the male gender, severity of disease, and standardized WHODAS 2.0 scores surpassing the cutoff values were risk factors for the institutionalization of patients with dementia.Although the accuracy of WHODAS 2.0 in predicting institutionalization is not considerably high for patients with dementia, our study found that the WHODAS 2.0 scores, the male gender, education status, urbanization level, and severity of disease were risk factors for institutionalization in long-term care facilities.
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Affiliation(s)
- Shih-Wei Huang
- From the Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital (S-WH, W-CC, T-HL); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine (S-WH, T-HL); Graduate Institute of Injury Prevention and Control (K-HC, W-TC, T-HL); Department of Physical Medicine and Rehabilitation, Wan Fang Hospital (K-HC); Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA (RE); Swiss Paraplegic Research, Nottwil, Switzerland (RE); Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City (C-JH); Department of Public Health, Tzu Chi University, Hualien (C-FY); Chinese Association of Early Intervention Profession for Children with Developmental Delays, Hualien City (H-FL); School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan (H-FL)
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42
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Abstract
Medical care of the geriatric patient is an important area of focus as the population ages and life expectancy increases. In particular, critical care of the geriatric patient will be especially affected, because geriatric patients will consume most critical care beds in the future and subsequently require increased use of resources. This review focuses on the physiologic effects of aging on all body systems. Focus on frailty and its effect on recovery from critical illness and its potential to modify the course of patient care will be important areas of research in the future.
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Affiliation(s)
- Maurice F Joyce
- Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - John Adam Reich
- Department of Anesthesiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
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Cohen J, Vincent JL, Adhikari NKJ, Machado FR, Angus DC, Calandra T, Jaton K, Giulieri S, Delaloye J, Opal S, Tracey K, van der Poll T, Pelfrene E. Sepsis: a roadmap for future research. THE LANCET. INFECTIOUS DISEASES 2015; 15:581-614. [DOI: 10.1016/s1473-3099(15)70112-x] [Citation(s) in RCA: 658] [Impact Index Per Article: 73.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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44
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Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med 2015; 41:763-75. [DOI: 10.1007/s00134-015-3689-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
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45
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Karnatovskaia LV, Johnson MM, Benzo RP, Gajic O. The spectrum of psychocognitive morbidity in the critically ill: A review of the literature and call for improvement. J Crit Care 2015; 30:130-7. [DOI: 10.1016/j.jcrc.2014.09.024] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/07/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
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Parry SM, Puthucheary ZA. The impact of extended bed rest on the musculoskeletal system in the critical care environment. EXTREME PHYSIOLOGY & MEDICINE 2015; 4:16. [PMID: 26457181 PMCID: PMC4600281 DOI: 10.1186/s13728-015-0036-7] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/30/2015] [Indexed: 04/14/2023]
Abstract
Prolonged immobility is harmful with rapid reductions in muscle mass, bone mineral density and impairment in other body systems evident within the first week of bed rest which is further exacerbated in individuals with critical illness. Our understanding of the aetiology and secondary consequences of prolonged immobilization in the critically ill is improving with recent and ongoing research to establish the cause, effect, and best treatment options. This review aims to describe the current literature on bed rest models for examining immobilization-induced changes in the musculoskeletal system and pathophysiology of immobilisation in critical illness including examination of intracellular signalling processes involved. Finally, the review examines the current barriers to early activity and mobilization and potential rehabilitation strategies, which are being, investigated which may reverse the effects of prolonged bed rest. Addressing the deleterious effects of immobilization is a major step in treatment and prevention of the public health issue, that is, critical illness survivorship.
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Affiliation(s)
- Selina M. Parry
- />Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC 3010 Australia
| | - Zudin A. Puthucheary
- />Division of Respiratory and Critical Care Medicine, National University Health System, Singapore, Singapore
- />Institute of Health and Human Performance, University College London, London, UK
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47
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Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, Hopkins RO, Hough CL, Kress JP, Latronico N, Moss M, Needham DM, Rich MM, Stevens RD, Wilson KC, Winkelman C, Zochodne DW, Ali NA. An Official American Thoracic Society Clinical Practice Guideline: The Diagnosis of Intensive Care Unit–acquired Weakness in Adults. Am J Respir Crit Care Med 2014; 190:1437-46. [DOI: 10.1164/rccm.201411-2011st] [Citation(s) in RCA: 248] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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48
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Tembo AC, Higgins I, Parker V. The experience of communication difficulties in critically ill patients in and beyond intensive care: Findings from a larger phenomenological study. Intensive Crit Care Nurs 2014; 31:171-8. [PMID: 25486970 DOI: 10.1016/j.iccn.2014.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/09/2014] [Accepted: 10/20/2014] [Indexed: 11/19/2022]
Abstract
Communication difficulties in intensive care units (ICU) with critically ill patients have been well documented for more than three decades. However, there is only a paucity of literature that has explored communication difficulties beyond the ICU environment. This paper discusses the experience of communication difficulties in critically ill patients in ICU and beyond as part of findings from a larger study that explored the lived experiences of critically ill patients in ICU in the context of daily sedation interruption (DSI). The aim of the study was to describe the lived experience of people who experienced critical illness in ICU using a hermeneutic phenomenological approach in the DSI context. Twelve participants aged between 20 and 76 years with an ICU stay ranging from 3 to 36 days were recruited from a 16 bed ICU in a large regional referral hospital in New South Wales (NSW), Australia. Participants were intubated, mechanically ventilated and subjected to (DSI) during their critical illness in ICU. In-depth face to face interviews with participants were conducted at two weeks after discharge from ICU and at six to eleven months later. Interviews were audio taped and transcribed. Thematic analysis using van Manen's (1990) method was completed. The overarching theme; 'Being in limbo' and subthemes 'Being disrupted'; 'Being imprisoned' and 'Being trapped' depict the main elements of the experience. This paper discusses communication difficulties in critically ill patients as one of the main findings relating to the theme 'Being trapped'. Participants' reports of communication difficulties in ICU are similar to those reported by patients in other studies where DSI was not used. However, not many studies have reported ongoing communication difficulties after ICU hospitalisation. Recommendations are made for new models of care and support to mitigate critically ill patients' communication concerns in ICU and for further research into the causes and treatment to benefit this group of patients. Most importantly, extra care is recommended not to damage vocal cords during intubation and cuff inflation in the course of mechanical ventilation.
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Affiliation(s)
- Agness C Tembo
- University of Newcastle, School of Nursing and Midwifery, Faculty of Health and Medicine, Callaghan Campus, Newcastle, NSW 2308, Australia; Newcastle Private Hospital, Look Out Road, New Lambton, NSW 2305, Australia
| | - Isabel Higgins
- Professor of Nursing University of Newcastle, School of Nursing and Midwifery, Faculty of Health and Medicine, Callaghan Campus, Newcastle, NSW 2308, Australia
| | - Vicki Parker
- Professor of Nursing University of New England, Armidale, NSW 2351, Australia
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Denehy L, Nordon-Craft A, Edbrooke L, Malone D, Berney S, Schenkman M, Moss M. Outcome measures report different aspects of patient function three months following critical care. Intensive Care Med 2014; 40:1862-9. [DOI: 10.1007/s00134-014-3513-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/28/2014] [Indexed: 10/24/2022]
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50
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Ewens BA, Hendricks JM, Sundin D. Never ending stories: visual diarizing to recreate autobiographical memory of intensive care unit survivors. Nurs Crit Care 2014; 22:8-18. [PMID: 25294316 DOI: 10.1111/nicc.12093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/22/2014] [Accepted: 02/25/2014] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to explore the potential use of visual diarizing to enable intensive care unit (ICU) survivors to create their story of recovery. BACKGROUND An ICU experience can have deleterious psychological and physical effects on survivors leading to reductions in quality of life which for some may be of significant duration. Although there has been exploration of many interventions to support recovery in this group, service provision for survivors remains inconsistent and inadequate. DESIGN AND PARTICIPANTS A qualitative interpretive biographical exploration of the ICU experience and recovery phase of ICU survivors using visual diarizing as method. This paper is a component of a larger study and presents an analyses of one participant's visual diary in detail. METHODS Data collection was twofold. The participant was supplied with visual diary materials at 2 months post-hospital discharge and depicted his story in words and pictures for a 3-month period, after which he was interviewed. The interview enabled the participant and researcher to interpret the visual diary and create a biographical account of his ICU stay and recovery journey. FINDINGS The analysis of one participant's visual diary yielded a wealth of information about his recovery trajectory articulated through the images he chose to symbolize his story. The participant confirmed feelings of persecution whilst in ICU and was unprepared for the physical and psychological disability which ensued following his discharge from hospital. However, his story was one of hope for the future and a determination that good would come out of his experience. He considered using the visual diary enhanced his recovery. CONCLUSIONS The participant perceived that visual diarizing enhanced his recovery trajectory by enabling him to recreate his story using visual imagery in a prospective diary. RELEVANCE TO CLINICAL PRACTICE Prospective visual diarizing with ICU survivors may have potential as an aid to recovery.
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Affiliation(s)
- Beverley A Ewens
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Joyce M Hendricks
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Deb Sundin
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
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