Chronic Critical Illness and the Long Term Sequela of Critical Care

2014 ◽  
pp. 47-56
Author(s):  
Paul Ellis Marik
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Chronic Critical Illness

Maternal critical care

2020 ◽  
pp. 2701-2705
Author(s):  
Rupert Gauntlett
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Death Rate ◽  
Critical Care Unit ◽  
Post Partum ◽  
The United Kingdom ◽  
The World ◽  
Resource Poor ◽  
Acute Fatty Liver

Critical illness during pregnancy or after giving birth is rare: in the United Kingdom 0.29% of maternities involve admission to a critical care unit, and the maternal death rate is 0.01%. Over 80% of obstetric admissions to critical care occur in the post-partum phase, mainly due to complications relating to massive haemorrhage. Other pregnancy specific conditions that may require critical care support include pre-eclampsia (typically when diagnosis and treatment have been delayed), amniotic fluid embolism, peri-partum cardiomyopathy, and acute fatty liver of pregnancy. Puerperal sepsis remains a major problem in resource-poor parts of the world. Pregnant women who survive critical illness may be particularly prone to long-term psychological morbidity. It is vital that, once physiological stability has been achieved, no time is wasted before a mother is reunited with her baby.

scholarly journals The Development of Chronic Critical Illness Determines Physical Function, Quality of Life, and Long-Term Survival Among Early Survivors of Sepsis in Surgical ICUs*

2019 ◽  
Vol 47 (4) ◽  
pp. 566-573 ◽  
Author(s):  
Anna K. Gardner ◽  
Gabriela L. Ghita ◽  
Zhongkai Wang ◽  
Tezcan Ozrazgat-Baslanti ◽  
Steven L. Raymond ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Critical Illness ◽  
Physical Function ◽  
Term Survival ◽  
Long Term Survival ◽  
Chronic Critical Illness ◽  
Surgical Icus

Chronic Critical Illness

2010 ◽  
Vol 21 (1) ◽  
pp. 44-61 ◽  
Author(s):  
Clareen Wiencek ◽  
Chris Winkelman
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Critical Illness ◽  
Critically Ill Patient ◽  
Essential Information ◽  
Chronic Critical Illness ◽  
Financial Burdens ◽  
Chronically Critically Ill ◽  
Proactive Care

The syndrome of chronic critical illness has well-documented emotional, social, and financial burdens for individuals, caregivers, and the health care system. The purpose of this article is to provide experienced acute and critical care clinicians with essential information about the prevalence and profile of the chronically critically ill patient needed for comprehensive care. In addition, pathophysiology contributing to chronic critical illness is addressed, though the exact mechanism underlying the conversion of acute critical illness to chronic critical illness is unknown. Clinicians can use this information to identify at-risk intensive care unit patients and to institute proactive care to minimize burden and distress experienced by patients and their caregivers.

Hormone therapies in critical illness

2016 ◽  
Author(s):  
Mark S. Cooper
Keyword(s):  
Vitamin D ◽  
Critical Care ◽  
Critical Illness ◽  
Thyroid Storm ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Pituitary Dysfunction ◽  
Hormonal Manipulation ◽  
Patient Groups

A range of hormonal manipulations have been proposed as adjunctive therapy during critical care. These therapies might be used to treat a pre-existing or acquired hormonal disorder. Additionally, hormonal manipulation has been suggested to alter the long-term outcome of critical illness, even in patients without structural abnormalities of endocrine glands. Currently, the effectiveness of these anabolic therapies has not been established and they might be harmful in some patient groups. Recently, it has been recognized that many critically-ill patients have low levels of vitamin D and this is associated with an adverse outcome. It is still unclear whether replacement of vitamin D will be effective in improving outcome. This chapter will also highlight the importance of recognizing and addressing hormonal deficiency in patients with known pituitary disease and with traumatic brain injury (TBI). TBI is associated with a high prevalence of acute and long-term pituitary dysfunction. The management of the rare, but important thyroid disorders requiring critical care, thyroid storm, and myxoedema coma, will also be discussed.

Critical Illness and Long-Term Outcomes Worldwide

2014 ◽  
Author(s):  
Neill KJ Adhikari
Keyword(s):  
Critical Care ◽  
Critical Illness ◽  
Administrative Data ◽  
Population Based ◽  
Post Discharge ◽  
Discharge Care ◽  
Modelling Techniques ◽  
Global Estimates ◽  
The Cost

Interest in the global burden of critical illness and its sequelae are growing, but comprehensive data to describe the burden of acute and post-acute illness and the resources available to provide care are lacking. Challenges to obtaining population-based global estimates of critical illness include the syndrome-based definitions of critical illness, incorrect equating of ‘critical illness’ with ‘admission to an intensive care unit’, lack of reliable case ascertainment in administrative data, and short prodrome and high mortality of critical illness, limiting the number of prevalent cases. Estimates of the burden of post-critical illness morbidity are even less reliable, owing to the limited number of observational studies, inaccurate coding in administrative data, and the unclear attributable risk of these morbidities to critical illness. Modelling techniques will be required to estimate the burden of critical illness and disparities in access to critical care using existing data sources. Demands for critical care and post-discharge care for survivors are likely to increase because of urbanization, an ageing demographic, and ongoing wars, disasters, and pandemics, while the ability to assume the cost of increased critical care may be limited due to economic factors. Major public health questions remain unanswered regarding the worldwide burden of critical illness and its sequelae, variation in resources available for treatment, and strategies that are broadly effective and feasible to prevent and treat critical illness and its consequences.

scholarly journals Sources of Distress for Residents With Chronic Critical Illness and Ventilator Dependence in Long-Term Care

2020 ◽  
pp. 104973232097637
Author(s):  
A. Fuchsia Howard ◽  
Sarah Crowe ◽  
Laura Choroszewski ◽  
Joe Kovatch ◽  
Adrianne J. Haynes ◽  
...  
Keyword(s):  
Critical Illness ◽  
Medical Care ◽  
Quality Care ◽  
Unmet Need ◽  
Physical Symptoms ◽  
Term Care ◽  
Ventilator Dependence ◽  
Chronic Critical Illness ◽  
Sense Of Home

Limited understanding of the psychological challenges experienced by individuals with chronic critical illness hampers efforts to deliver quality care. We used an interpretive description approach to explore sources of distress for individuals with chronic critical illness in residential care, wherein we interviewed six residents, 11 family members, and 21 staff. Rather than discuss physical symptoms, sources of distress for residents were connected to feeling as though they were a patient receiving medical care as opposed to an individual living in their home. The tension between medical care and the unmet need for a sense of home was related to care beyond the physical being overlooked, being dependent on others but feeling neglected, frustration with limited choice and participation in decision making, and feeling sad and alone. Efforts to refine health care for individuals with chronic critical illness must foster a sense of home while ensuring individuals feel safe and supported to make decisions.

scholarly journals Enhanced Recovery after Intensive Care (ERIC): study protocol for a German stepped wedge cluster randomised controlled trial to evaluate the effectiveness of a critical care telehealth program on process quality and functional outcomes

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036096 ◽  
Author(s):  
Christine Adrion ◽  
Bjoern Weiss ◽  
Nicolas Paul ◽  
Elke Berger ◽  
Reinhard Busse ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critical Illness ◽  
Stepped Wedge ◽  
Link Type ◽  
Cluster Randomised ◽  
Icu Discharge ◽  
Randomised Controlled ◽  
The Impact

IntroductionSurvival after critical illness has noticeably improved over the last decades due to advances in critical care medicine. Besides, there is an increasing number of elderly patients with chronic diseases being treated in the intensive care unit (ICU). More than half of the survivors of critical illness suffer from medium-term or long-term cognitive, psychological and/or physical impairments after ICU discharge, which is recognised as post-intensive care syndrome (PICS). There are evidence-based and consensus-based quality indicators (QIs) in intensive care medicine, which have a positive influence on patients’ long-term outcomes if adhered to.Methods and analysisThe protocol of a multicentre, pragmatic, stepped wedge cluster randomised controlled, quality improvement trial is presented. During 3 predefined steps, 12 academic hospitals in Berlin and Brandenburg, Germany, are randomly selected to move in a one-way crossover from the control to the intervention condition. After a multifactorial training programme on QIs and clinical outcomes for site personnel, ICUs will receive an adapted, interprofessional protocol for a complex telehealth intervention comprising of daily telemedical rounds at ICU. The targeted sample size is 1431 patients. The primary objective of this trial is to evaluate the effectiveness of the intervention on the adherence to eight QIs daily measured during the patient’s ICU stay, compared with standard of care. Furthermore, the impact on long-term recovery such as PICS-related, patient-centred outcomes including health-related quality of life, mental health, clinical assessments of cognition and physical function, all-cause mortality and cost-effectiveness 3 and 6 months after ICU discharge will be evaluated.Ethics and disseminationThis protocol was approved by the ethics committee of the Charité—Universitätsmedizin, Berlin, Germany (EA1/006/18). The results will be published in a peer-reviewed scientific journal and presented at international conferences. Study findings will also be disseminated via the website (www.eric-projekt.net).Trial registration numberClinicalTrials.gov Registry (NCT03671447).

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