April - 2012
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Cognitive and physical rehabilitation of intensive care unit survivors: Results of the RETURN randomized controlled pilot investigatioJames C. Jackson, E. Wesley Ely, Miriam C. Morey Crit Care Med, 2012, 40:10881097 This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
April |
Previous Comments
| I find this area very interesting. It seems to me that there is some very cost effective "low hanging fruit" to be had in the area of post-discharge follow up. This concept is not new. I would like to hear what is happening across New Zealand and Australia in terms of follow up, structured or otherwise. Back in the mid 90's in London we had a post-ICU clinic which ended up dealing with a lot of interesting problems, some unforeseen, many not requiring ICU physician input, in the surviviors of ICU. A multicomponent rehabilitation program for intensive care unit survivors represents an attractive concept that could bring alot of benefit for our patients. There may be a role for occasional referral to multiple possible medical and paramedical specialties. It could bring a lot of secondary gain too. As an intensivist it is always very pleasing (inspiring even) to see my patients after they have recovered. It would also reinforce the importance of certain fine details of our care as we see these people struggle with the hangover from their stay; a nerve injury, an ulcer or cognitive impairment. The possibility of improved measurement of outcomes in the post ICU course could also be of great interest as we seek to expand the data we use in our research programmes beyond the limited indices of 28 day, 6 and 12 month mortality or length of stay or days on the ventilator. These things are important but there is so much that is not illuminated by that sort of data. Perhaps I am being a little but "fluffy". I am working RFDS at the moment and while we initiate intensive care we also manage these people back in their communities with minimal additional medical/para-medical supports; no OT, physio flies in once a month... We do everything from debriefing to dialysis. The continuity fom pre-hospital care through ICU to post discharge and post-rehabilitation care is something that makes RFDS work really beneficial to me as an ICU trainee. Cognitive impairment is a very big deal. For some of my truly remote patients (indigenous and non-indigenous) it might enforce separation from family and country. The impact of this can be catastrophic. So what programmes exist around ANZ? What do you do at your ICU? Do you have a formal programme? Who runs it, who is involved? Do you or your OT's use tools like the Functional Activities Questionnaire? What would you all like to see being done? | |
| doug lynch-08 Apr, 2012 08:48:47 PM | |
| Agreed Doug, I think this is the next frontier for ICU medicine - the podcasts with Neil Orford and Sue Berney are testament to that. There is much to learn about what happens down the track - they clearly do not do as well as we thought they might, so we need to work out where we can step in. We currently have a fairly standard ICU rehab program - basic chest and dynamic exercises. I'd like to see us move to a more interventional model with time. | |
| Todd Fraser-09 Apr, 2012 12:52:16 PM | |
Comment
Improvements in care has led to an interest in quality of survival following critical illness. Cognitive impairment, particularly related to executive function, is common, as is physical impairment.
Cardiac disease in the setting of heart surgery, and brain injury following...