Dale Needham: Post Intensive Care Syndrome

Congrats!  You saved your patient from their critical illness – but do you know what happens to them after they leave your ICU?  Well, if not – you might be shocked to find out.

This week we were lucky enough to have Dr. Dale Needham come and discuss how he takes care of patients not only inside, but also outside the ICU.  He is internationally known for his research with the OACIS (Outcomes After Critical Illness & Surgery) group as well as a huge advocate for preventing post intensive care syndrome.

In this talk, Dr. Needham discusses some incredibly important strategies that can prevent the cognitive & physical impairments many patients struggle with after critical illness.

Post Intensive Care Syndrome

 

PICS Graph

Physical Impairments

  • Muscle wasting as well as severe functional weakness happens not only after prolonged ICU stays, but after just a couple of days!
  • Bedrest is the largest predictor of ICU acquired weakness – get your patients out of bed EVERY DAY if possible.
  • Early PT/OT (<48 hours) is important, don’t wait until their extubated – get them out of bed and moving, tubes and all.

Mental Health

  • Risk factors for clinically significant post-ICU depression.  Risk factors for depression include things we control:
    • ICU sedation
    • Hypoglycemia
    • Traumatic memories in ICU
    • Psychiatric symptoms at discharge
  • Post traumatic stress disorder post-ICU stay COMMON.  Risk factors for PTSD include things we control:
    • Sedation regimen
    • Agitation
    • Restraints
    • Traumatic experience

Cognitive disorders

  • Memory, attention, and executive function are all affected by critical illness
  • Risk factors for significant cognitive dysfunction post-ICU include things we control:
    • Hypoglycemia
    • Hypoxia
    • Hypotension
    • Delirium

Evidence based approach to preventing post-intensive care syndrome

  • Closely monitor and minimize sedation
  • Prevent delirium
  • Avoid high/low blood sugar
  • Encourage early rehabilitation
  • Have patients keep an ICU diary

 

References

  1. Needham DM, Davidson J, Cohen H.  Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference.  Crit Care Med 2012; Feb 40(2):502-9. [PubMed]
  2. Desai SV, Law TJ, Needham DM.  Long-term complications of critical care.  Crit Care Med 2011; Feb 40(2) 371-9. [PubMed]

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Comments

  1. Chris Farmer

    Thanks for uploading this presentation, it is a nice teaching tool!

    1. John Greenwood

      It was an honor having Dr. Needham at our multidisciplinary CC conference. Definitely some important research that we all need to know and share!

      — John

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