CINTESIS - Center for Research in Health Technologies and Health Systems, Faculty of Medicine of Porto, Portugal.
Acta Anaesthesiol Scand. 2012 Oct;56(9):1092-103. doi: 10.1111/j.1399-6576.2012.02686.x. Epub 2012 Apr 4.
Problems survivors face after intensive care unit (ICU) discharge begin while they are still in the ward, where many of their specific problems may run unrecognized, but they assume a heavy weight when they arrive at their homes and face several kind of limitations, from being unable to climb stairs because of weight loss, asthenia, dyspnea or joint stiffness to anxiety, depression or post-traumatic stress disorder. Follow-up consultations have given us a better understanding of these specific problems, and the information gained has been used to improve intensive care itself and promote a quality service for patients and relatives. The aim of this article is to provide an overview on adult ICU outcome studies and discuss how they have influenced and improved the delivery of intensive care. We will explain how we went from real patients to outcome studies and what we have learned concerning the consequences of critical illness and critical care. Development of outcome studies, what we have learned through them and our own experience will be outlined focusing mainly in four topics: mortality, physical disability, neuropsychological disability and health-related quality of life. Interventions to improve outcome on these main topics will be presented, and we will explain how we went from outcome studies to clinical interventions, focusing on the most recent proposals of intervention to improve outcome.
患者在重症监护病房（ICU）出院后所面临的问题早在他们仍在病房时就已经开始，在那里，他们的许多特定问题可能未被识别，但当他们回到家中并面临多种限制时，这些问题就变得非常沉重，例如因体重减轻、虚弱、呼吸困难或关节僵硬而无法爬楼梯，以及焦虑、抑郁或创伤后应激障碍。随访咨询使我们对这些特定问题有了更好的了解，所获得的信息被用于改进重症监护本身，并为患者和家属提供优质服务。本文旨在概述成人 ICU 预后研究，并讨论它们如何影响和改善重症监护的实施。我们将解释如何从实际患者到预后研究，以及我们在了解重症疾病和重症监护的后果方面学到了什么。我们将主要围绕四个主题概述预后研究的发展、我们从中所学到的知识以及我们自己的经验：死亡率、身体残疾、神经心理残疾和健康相关生活质量。我们将介绍改善这些主要主题预后的干预措施，并解释如何从预后研究到临床干预，重点介绍改善预后的最新干预建议。
