Recovery after critical illness; when, how and who should be involved?
Editor – The potential for physical and psychological illness following a stay in the intensive care unit (ITU) are well known. National Institute of Health and Care Excellence (NICE) guidelines for recovery following critical illness suggest a rehabilitation pathway to identify and appropriately treat patients following discharge from ITU. Rehabilitation should start ‘as soon as clinically possible’.1 However, we can't help but ask: when, how and who should be involved in the rehabilitation pathway?
When?
Perhaps when a patient is identified as a ‘survivor’? Or should it be as soon as the patient can mobilise? Physical rehabilitation is usually initiated when a patient is deemed ‘stable’, but what does this actually mean and how can we overcome this subjective hurdle?
How?
How should we wake patients with a reduced conscious level? Comfortably, with background analgesia? Slowly, allowing time to become familiar with their surroundings? Once conscious, how should information be given? Should a ‘patient discharge summary’ be part of common practice to aid patients make sense of their experience?2
Who should be involved?
The multidisciplinary team undoubtedly plays an important role in, and following discharge from, ITU. Without standardised care pathways and with limited resources, how well are staff coping? Should family have a role in the rehabilitation pathway? We feel that family involvement in a patient's recovery is often invaluable.
To conclude, recovery from critical illness and an ITU admission is one with many subjective and unclear elements. We suspect with a wide range of clinical practice and without standardised approaches patients may be at risk of further complications. Therefore we urge a need for further data on how, when and who should be involved in the recovery from critical illness.
- © 2014 Royal College of Physicians
References
- 1.↵
- National Institute for Health and Care Excellence
- 2.↵
- White C,
- Bench S,
- Hopkins P
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