scholarly journals A Combined Early Cognitive and Physical Rehabilitation Program for People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial

2012 ◽  
Vol 92 (12) ◽  
pp. 1580-1592 ◽  
Author(s):  
Nathan E. Brummel ◽  
James C. Jackson ◽  
Timothy D. Girard ◽  
Pratik P. Pandharipande ◽  
Elena Schiro ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Functional Outcomes ◽  
Cognitive Rehabilitation ◽  
Rehabilitation Program ◽  
Physical Rehabilitation ◽  
Surgical Intensive Care

Background In the coming years, the number of survivors of critical illness is expected to increase. These survivors frequently develop newly acquired physical and cognitive impairments. Long-term cognitive impairment is common following critical illness and has dramatic effects on patients' abilities to function autonomously. Neuromuscular weakness affects similar proportions of patients and leads to equally profound life alterations. As knowledge of these short-term and long-term consequences of critical illness has come to light, interventions to prevent and rehabilitate these devastating consequences have been sought. Physical rehabilitation has been shown to improve functional outcomes in people who are critically ill, but subsequent studies of physical rehabilitation after hospital discharge have not. Post-hospital discharge cognitive rehabilitation is feasible in survivors of critical illness and is commonly used in people with other forms of acquired brain injury. The feasibility of early cognitive therapy in people who are critically ill remains unknown. Objective The purpose of this novel protocol trial will be to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units. Design This is a randomized controlled trial. Setting The setting for this trial will be medical and surgical intensive care units of a large tertiary care referral center. Patients The participants will be patients who are critically ill with respiratory failure or shock. Intervention Patients will be randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Twice-daily cognitive rehabilitation sessions will be performed with patients who are noncomatose and will consist of orientation, memory, and attention exercises (eg, forward and reverse digit spans, matrix puzzles, letter-number sequences, pattern recognition). Daily physical rehabilitation sessions will advance patients from passive range of motion exercises through ambulation. Patients with cognitive or physical impairment at discharge will undergo a 12-week, in-home cognitive rehabilitation program. Measurements A battery of neurocognitive and functional outcomes will be measured 3 and 12 months after hospital discharge. Conclusions If feasible, these interventions will lay the groundwork for a larger, multicenter trial to determine their efficacy.

scholarly journals Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

2021 ◽  
Vol 15 ◽  
Author(s):  
Ashley D. Turner ◽  
Travis Sullivan ◽  
Kurt Drury ◽  
Trevor A. Hall ◽  
Cydni N. Williams ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Animal Models ◽  
Critically Ill ◽  
Cognitive Dysfunction ◽  
Functional Outcomes ◽  
Pediatric Intensive Care ◽  
Critically Ill Children ◽  
Post Discharge

In the midst of concerns for potential neurodevelopmental effects after surgical anesthesia, there is a growing awareness that children who require sedation during critical illness are susceptible to neurologic dysfunctions collectively termed pediatric post-intensive care syndrome, or PICS-p. In contrast to healthy children undergoing elective surgery, critically ill children are subject to inordinate neurologic stress or injury and need to be considered separately. Despite recognition of PICS-p, inconsistency in techniques and timing of post-discharge assessments continues to be a significant barrier to understanding the specific role of sedation in later cognitive dysfunction. Nonetheless, available pediatric studies that account for analgesia and sedation consistently identify sedative and opioid analgesic exposures as risk factors for both in-hospital delirium and post-discharge neurologic sequelae. Clinical observations are supported by animal models showing neuroinflammation, increased neuronal death, dysmyelination, and altered synaptic plasticity and neurotransmission. Additionally, intensive care sedation also contributes to sleep disruption, an important and overlooked variable during acute illness and post-discharge recovery. Because analgesia and sedation are potentially modifiable, understanding the underlying mechanisms could transform sedation strategies to improve outcomes. To move the needle on this, prospective clinical studies would benefit from cohesion with regard to datasets and core outcome assessments, including sleep quality. Analyses should also account for the wide range of diagnoses, heterogeneity of this population, and the dynamic nature of neurodevelopment in age cohorts. Much of the related preclinical evidence has been studied in comparatively brief anesthetic exposures in healthy animals during infancy and is not generalizable to critically ill children. Thus, complementary animal models that more accurately “reverse translate” critical illness paradigms and the effect of analgesia and sedation on neuropathology and functional outcomes are needed. This review explores the interactive role of sedatives and the neurologic vulnerability of critically ill children as it pertains to survivorship and functional outcomes, which is the next frontier in pediatric intensive care.

Impact of a Prolonged Surgical Critical Illness on Patients’ Families

2002 ◽  
Vol 11 (5) ◽  
pp. 459-466 ◽  
Author(s):  
Sandra M. Swoboda ◽  
Pamela A. Lipsett
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Functional Outcome ◽  
Substantial Effect ◽  
Surgical Intensive Care Unit ◽  
Long Term Effects ◽  
Surgical Intensive Care ◽  
Prolonged Stay

• Background Long-term effects on patients’ families after a prolonged stay in a surgical intensive care unit are unclear. We hypothesized that illnesses requiring more than 7 days’ stay in the surgical intensive care unit would have significant, long-lasting effects on patients’ families that would be related to patients’ functional outcome. • Methods All patients who stayed in the general surgery intensive care unit 7 days or more between July 1, 1996, and June 30, 1997, were enrolled. A total of 128 patients met the entry criteria, and families of surviving patients were interviewed at baseline and 1, 3, 6, and 12 months later. Maximum dysfunction/impact was compared with patients’ functional outcome. • Results Significant disturbances in the families’ lives occurred throughout the 12 months of this study. Almost 60% of responding families provided a moderate or large amount of caregiving between 1 and 9 months after a prolonged illness, 44.9% had to quit work after 1 month, and more than 36.7% of families had lost savings after 1 year. Some families moved to a less expensive home, delayed educational plans, or delayed medical care for another family member. • Conclusions An acute surgical illness that results in a prolonged stay in an intensive care unit has a substantial effect on patients’ families that is maximal between 1 and 3 months and parallels the patient’s functional outcome. Systems that provide support to both patients and their families should be emphasized in the hospital and after discharge.

Neurocognitive impairment after critical illness

2016 ◽  
Author(s):  
Ramona O. Hopkins ◽  
James C. Jackson
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critical Illness ◽  
Cognitive Rehabilitation ◽  
Acquired Brain Injury ◽  
Neurocognitive Impairment ◽  
Daily Functioning ◽  
Cognitive Domains ◽  
Over Time

More than 5 million individuals are admitted to intensive care units (ICUs) in North America annually. Due to improvements in treatment, increasing numbers of these individuals survive and go on to develop long-term neurocognitive impairment in a variety of cognitive domains. As evidence from over two dozen studies demonstrates, neurocognitive impairment occurs in up to two-thirds of individuals. While it may be particularly common in those with pre-existing vulnerabilities, even patients who are young with robust health prior to critical illness are at risk of post-ICU neurocognitive impairment. While neurocognitive impairment may improve over time and even dissipate in a subset of ICU survivors, neurocognitive impairment is often permanent and, in some cases may be progressive. As commonly occurs in the context of acquired brain injury, the neurocognitive impairment observed after critical illness is typically diffuse, although domains including memory, attention, and executive functioning are often particularly impaired. This impairment is sufficiently severe to negatively impact daily functioning. Although the risk factors and mechanisms undergirding neurocognitive impairment have yet to be fully elucidated, potential contributors include inflammation, hypoxia, and delirium. While one way to impact on the prevalence and incidence of cognitive impairment after critical illness is to attempt to modify key ‘in-hospital’ risk factors, another approach involves the use of post-ICU cognitive rehabilitation, which is increasingly being successfully employed with other impaired medical populations.

scholarly journals Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Johanna Helmersson-Karlqvist ◽  
Miklos Lipcsey ◽  
Johan Ärnlöv ◽  
Max Bell ◽  
Bo Ravn ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Risk Prediction ◽  
Cystatin C ◽  
Mortality Risk ◽  
Critically Ill Patients ◽  
Cox Regression ◽  
Sample Tube ◽  
Long Term Mortality

AbstractDecreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.

ICU admissions: Consequences after discharge

2020 ◽  
Vol 13 (9) ◽  
pp. 550-556
Author(s):  
Minal Karavadra ◽  
Ricky Bell
Keyword(s):  
Intensive Care ◽  
Cognitive Decline ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Psychiatric Disturbance ◽  
Intensive Care Department ◽  
Previous Level ◽  
The Uk

The intensive care department may seem a long way from the GP's consulting room, but every year tens of thousands of critically ill patients are admitted to intensive care units (ICUs) across the UK. Patients are often left with long term sequelae that may require GP input. Physical weakness, psychiatric disturbance and cognitive decline are not uncommon after an illness that requires a stay in an ICU. These hinder a patient’s return to their previous level of function and impact caregivers after discharge. This article aims to highlight the chronic symptoms patients can acquire during ICU admission that may come to the attention of GPs for their advice and treatment.

Implementing Volume-Based Feeding to Optimize Delivery of Enteral Nutrition

2021 ◽  
Vol 41 (2) ◽  
pp. 16-26
Author(s):  
Angela Bonomo ◽  
Diane Lynn Blume ◽  
Katie Davis ◽  
Hee Jun Kim
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Educational Approach ◽  
Lecture Demonstration

Background At least 80% of ordered enteral nutrition should be delivered to improve outcomes in critical care patients. However, these patients typically receive 60% to 70% of ordered enteral nutrition volume. In a practice review within a 28-bed medical-surgical adult intensive care unit, patients received a median of 67.5% of ordered enteral nutrition with standard rate-based feeding. Volume-based feeding is recommended to deliver adequate enteral nutrition to critically ill patients. Objective To use a quality improvement project to increase the volume of enteral nutrition delivered in the medical-surgical intensive care unit. Methods Percentages of target volume achieved were monitored in 73 patients. Comparisons between the rate-based and volume-based feeding groups used nonparametric quality of medians test or the χ2 test. A customized volume-based feeding protocol and order set were created according to published protocols and then implemented. Standardized education included lecture, demonstration, written material, and active personal involvement, followed by a scenario-based test to apply learning. Results Immediately after implementation of this practice change, delivered enteral nutrition volume increased, resulting in a median delivery of 99.8% of ordered volume (P = .003). Delivery of a mean of 98% ordered volume was sustained over the 15 months following implementation. Conclusions Implementation of volume-based feeding optimized enteral nutrition delivery to critically ill patients in this medical-surgical intensive care unit. This success can be attributed to a comprehensive, individualized, and proactive process design and educational approach. The process can be adapted to quality improvement initiatives with other patient populations and units.

scholarly journals Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients

2021 ◽  
Vol 41 (5) ◽  
pp. e1-e8
Author(s):  
Leigh Chapman ◽  
Lisa Hargett ◽  
Theresa Anderson ◽  
Jacqueline Galluzzo ◽  
Paul Zimand
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Chlorhexidine Gluconate ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Telemetry Unit ◽  
Health Care Associated Infections ◽  
The Impact

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

Sign in / Sign up

Export Citation Format

Share Document