Rubenfeld Gordon D
Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Crit Care. 2007 Oct;13(5):476-81. doi: 10.1097/MCC.0b013e3282efdea5.
The aim of this article is to review the literature specifically on interventions that are targeted at improving health related quality of life in survivors of critical illness. Although there is a growing literature describing the impairment in quality of life of survivors of critical illness, there are a considerably smaller number of studies describing effective interventions at treating or preventing these complications. The topic is complex because critical illness spans a number of diseases including spinal cord injury and myocardial infarction that have an extensive rehabilitation literature.
To date there are limited studies to guide clinicians in treatments to prevent or treat the sequelae of critical illness. Standard therapies such as daily interruption of sedation and lung protective ventilation do not appear to worsen long-term outcomes. Insulin therapy and stress dose corticosteroids may be beneficial in preventing neuromuscular complications and posttraumatic stress disorder, respectively. A self-help manual for survivors appears to improve physical functioning.
Research interest in developing interventions to improve long-term outcome after critical illness is in its infancy and it is too early to make strong clinical recommendations. Multiple potential treatment areas exist both within the ICU and after patients leave the hospital for intensivists to target.
本文旨在回顾专门针对改善危重症幸存者健康相关生活质量的干预措施的文献。尽管描述危重症幸存者生活质量受损的文献越来越多，但描述治疗或预防这些并发症的有效干预措施的研究数量要少得多。该主题很复杂，因为危重症涵盖多种疾病，包括脊髓损伤和心肌梗死，针对这些疾病已有大量康复文献。
迄今为止，指导临床医生预防或治疗危重症后遗症的研究有限。诸如每日中断镇静和肺保护性通气等标准疗法似乎不会使长期预后恶化。胰岛素治疗和应激剂量的皮质类固醇可能分别有助于预防神经肌肉并发症和创伤后应激障碍。一本面向幸存者的自助手册似乎能改善身体机能。
开发改善危重症后长期预后的干预措施的研究兴趣尚处于起步阶段，现在做出强有力的临床推荐还为时过早。重症监护病房内以及患者出院后，对重症监护医生而言，存在多个潜在的治疗领域可供关注。
