Clinical Review ABC of intensive care

Recovery from intensive care

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7207.427 (Published 14 August 1999) Cite this as: BMJ 1999;319:427
  1. Richard D Griffiths,
  2. Christina Jones

    Studies of outcome after intensive care suggest that death rates do not return to normal until 2-4 years after admission. Although some questionnaire studies have reported on morbidity, little published work exists on detailed clinical recovery or longer term residual effects of critical illness. The recovery process may present serious physical, psychological, and social problems for both patients and their families, and these may last for months or years. Although patients who have been in intensive care have often been extremely ill, been at high risk of death, and received care costing tens of thousands of pounds, detailed follow up and targeted support are still rare.

    The 5 year mortality rate in intensive care patients is over 3 times that of the general population. However at 2 year survival rates are parallel. Adapted from Niskanen M et al. Crit Care Med 1996;24:1962-7.

    Discharge to the ward

    Patients on mechanical ventilation are usually discharged from the intensive care unit to the ward when they can breathe unaided. However, several physical problems may still remain. Although these may not be serious enough to keep the patient in intensive care, if left untreated they could lead to readmission. Intensive care staff should therefore follow patients' progress on the ward for a few days to monitor recovery of multisystem disease and assure good continuity of care.

    Examples of physical disorders after intensive care

    • Recovering organ failure (lung, kidney, liver, etc)

    • Severe muscle wasting and weakness including reduced cough power, pharyngeal weakness

    • Joint stiffness

    • Numbness, paraesthesia (peripheral neuropathy)

    • Taste changes resulting in favourite foods being unpalatable

    • Disturbances to sleep rhythm

    • Cardiac and circulatory decompensation:Postural hypotension

    • Reduced pulmonary reserve:Breathlessness on mild exertion

    • Iatrogenic:

      Tracheal stenosis (for example, from repeated intubations) Nerve palsies (needle injuries) Scarring (needle and drain sites)

    The commonest physical problem reported by intensive care patients is severe weakness and fatigue. Patients in intensive care …

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