Recovery after prolonged treatment in the intensive care unit

Matteo Parotto; Margaret S. Herridge

doi:10.1503/cmaj.201356

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RE:Recovery after prolonged treatment in the intensive care unit
Laura Istanboulian [PhD (c), MN-NP] and Lindsay Siple

Posted on: 07 December 2020

Posted on: (7 December 2020)

RE:Recovery after prolonged treatment in the intensive care unit
Laura Istanboulian [PhD (c), MN-NP], Nurse Practitioner, Michael Garron Hospital
Other Contributors:
Lindsay Siple, Patient and Family Education Specialist
We were very excited to see that the “5 things” to know about prolonged ICU treatment by Dr. Parotto and Dr. Herridge was published in CMAJ (1). These “5 things” - communicated in simple language - may help patients and families understand the recovery trajectory from prolonged ICU treatment and assist with goal setting. Per the American Thoracic Society shared decision making recommendations, we offer simple language translations of these “5 things” – continuing the conversation with patients and families in mind (2).

Prolonged treatment in the ICU is when a patient has been in a critical care environment and needed life support machines (like a ventilator) for more than1 week.

1. Patients who have prolonged ICU treatment may have new or worse physical, mental, and/or emotional problems. These can last for at least a year after discharge from ICU. This happens for at least 1 out of 4 patients.

2. Patients who have prolonged ICU treatment may have a nerve and muscle injury called "ICU acquired weakness." This can result in feeling tired, joint pain, poor mobility, and needing help to take care of yourself (e.g. feeding, toileting). This happens for up to half of patients.

3. Patients who have prolonged ICU treatment may have difficulty thinking, remembering things, and making decisions. This can last for at least a year after discharge from ICU. This happens for about 1 out of 3 patients.

4. Anxiety and depression occurs in bot...
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We were very excited to see that the “5 things” to know about prolonged ICU treatment by Dr. Parotto and Dr. Herridge was published in CMAJ (1). These “5 things” - communicated in simple language - may help patients and families understand the recovery trajectory from prolonged ICU treatment and assist with goal setting. Per the American Thoracic Society shared decision making recommendations, we offer simple language translations of these “5 things” – continuing the conversation with patients and families in mind (2).

Prolonged treatment in the ICU is when a patient has been in a critical care environment and needed life support machines (like a ventilator) for more than1 week.

1. Patients who have prolonged ICU treatment may have new or worse physical, mental, and/or emotional problems. These can last for at least a year after discharge from ICU. This happens for at least 1 out of 4 patients.

2. Patients who have prolonged ICU treatment may have a nerve and muscle injury called "ICU acquired weakness." This can result in feeling tired, joint pain, poor mobility, and needing help to take care of yourself (e.g. feeding, toileting). This happens for up to half of patients.

3. Patients who have prolonged ICU treatment may have difficulty thinking, remembering things, and making decisions. This can last for at least a year after discharge from ICU. This happens for about 1 out of 3 patients.

4. Anxiety and depression occurs in both patients and their family care givers. This happens for at least 1 out of 3 patients and care givers and up to 7 out of 10 patients and care givers.

5. There may be a longer recovery time for patients, even if they had proper rehabilitation to help their physical, mental, and emotional recovery.

Research about how to care for and treat people with prolonged ICU treatment and their families is a growing field (3, 4). Research how to better manage pain, anxiety, communication problems and other ICU treatment related symptoms may improve outcomes for patients with prolonged ICU and decrease the proportion of people who live with long lasting effects of prolonged ICU treatment. As health care providers who are dedicated to improving the care of patients with prolonged ICU treatment, we are excited to see “5 things” published, and to continue the conversation offering simple language that can help align expectations, goals and decision making with our patients and families.
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Competing Interests: None declared.
References
1. Matteo Parotto, Margaret S. Herridge. Recovery after prolonged treatment in the intensive care unit. CMAJ 2020;192:E1637-E1637.
2. Kon, A. A., Davidson, J.E., Morrison, W., Danis, M., White, D.B. (2016). Shared decision making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement. Critical Care Medicine; 44:1, 188-201.
3. Dale, C.M., Carbone, S., Istanboulian, L., Fraser, I., Cameron, J.I., Herridge, M., and Rose, L. (2020). Support needs and health-related quality of life of family caregivers of patients requiring prolonged mechanical ventilation and admission to a spe
4. Rose, L., Istanboulian, L., Allum, L., Burry, L., Dale, C., Hart, N., Kydonaki, K., Ramsay, P., Pattison, N., Connolly, B. on behalf of the PatiEnt Reported Family Oriented performance Measures (PERFORM) Study Investigators. (2019). Patient and family