‘Our patients pay a huge price for surviving critical illness’
ORLANDO — The long-term, often life-altering, physical, cognitive, and mental impairments associated with ICU stays are common following hospitalization for critical illness, especially among patients who undergo mechanical ventilation, an expert said here.
But few patients or family members understand the potential impact of post-ICU syndrome (PICS), Maurene Harvey, RN, MPH, said at a plenary session at the Society of Critical Care Medicine (SCCM) Critical Care Congress. Harvey was SCCM president from 2002 to 2003, and the first registered nurse to hold the position. She is now a critical care educator and consultant.
Reducing patient risk for PICS and raising patient awareness about their long-term risks is a top priority of the SCCM THRIVE initiative, she added.
Three out of four patients who undergo mechanical ventilation continue to have difficulty performing the normal activities of daily life a year later, and as many as 95% of those who develop acquired ICU weakness still have health issues related to their hospital stay 2 to 5 years later, Harvey noted.
“I have begun to think of [PICS] as the cost of living,” she said. “Our patients pay a huge price for surviving critical illness. We currently discharge about 5 million patients from ICUs in the United States each year, and this number is expected to increase. That means the impact of PICS will also increase if we don’t do something about it.”
She said patients and family members understand little about the health challenges they may face following an ICU stay, and this needs to change.
For instance, patients in the ICU need to have access to follow-up care and referral services for a wide range of health issues associated with PICS, including impaired pulmonary function, dyspnea, loss of appetite, difficulty swallowing, joint pain, fatigue, and sexual dysfunction.
“The more they know, the less they fear the unknown, so when some [new impairment] occurs, or they don’t recover as quickly as they think they should, they don’t get scared,” she said.
Harvey outlined several strategies that may reduce patients’ risk for PICS, which she said are already being implemented in the ICU for other reasons. However, she noted that there is, as yet, little research examining the impact of these strategies on PICS.
- Working to reduce the total number of days patients remain on mechanical ventilation and in the ICU
- Reducing heavy sedation times and delirium
- Reducing the incidence of sepsis, acute respiratory distress syndrome, hypo- and hyperglycemia, and hypoxia
- Promoting early mobility during the ICU stay
“We know that early mobility starting right after admission is safe for most of our ICU patients,” Harvey said. “It has been shown to decrease ICU and hospital length of stay, shorten the duration of mechanical ventilation, decrease weakness, delirium depression and anxiety, and improve functional status.”
Following patients after hospital discharge and referring them to follow-up clinics, which is common in Europe, but not the U.S., may also reduce the incidence of PICS, she said.
Providing early psychological intervention may also have an impact on the incidence ofICU-related post traumatic stress disorder (PTSD), she said, noting that interventions such as psychological counseling and teaching stress management and coping skills in the ICU were found to reduce PTSD incidence by half in one study.
Even simple interventions during an ICU stay, such as promoting quality sleep, decreasing noise, adjusting room temperature, and making sure patients have access to glasses and hearing aids, may have an impact on PICS, she said.
“Now that we know PICS exists, we are really ethically, professionally and morally responsible to recognize and address the potential to do something about these ongoing and largely unmet needs,” she said.
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