1Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, Utah.
2Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, Utah.
Ann Am Thorac Soc. 2019 Aug;16(8):947-956. doi: 10.1513/AnnalsATS.201812-913FR.
Critical illness can be lethal and devastating to survivors. Improvements in acute care have increased the number of intensive care unit (ICU) survivors. These survivors confront a range of new or worsened health states that collectively are commonly denominated post-intensive care syndrome (PICS). These problems include physical, cognitive, psychological, and existential aspects, among others. Burgeoning interest in improving long-term outcomes for ICU survivors has driven an array of potential interventions to improve outcomes associated with PICS. To date, the most promising interventions appear to relate to very early physical rehabilitation. Late interventions within aftercare and recovery clinics have yielded mixed results, although experience in heart failure programs suggests the possibility that very early case management interventions may help improve intermediate-term outcomes, including mortality and hospital readmission. Predictive models have tended to underperform, complicating study design and clinical referral. The complexity of the health states associated with PICS suggests that careful and rigorous evaluation of multidisciplinary, multimodality interventions-tied to the specific conditions of interest-will be required to address these important problems.
危重病可能对幸存者具有致命性和毁灭性。急性护理的改进增加了重症监护病房 (ICU) 幸存者的数量。这些幸存者面临一系列新的或恶化的健康状况，通常被称为重症监护后综合征 (PICS)。这些问题包括身体、认知、心理和存在等方面。人们对改善 ICU 幸存者的长期预后越来越感兴趣，这推动了一系列潜在的干预措施来改善与 PICS 相关的预后。迄今为止，最有希望的干预措施似乎与早期的身体康复有关。在后续护理和康复诊所中的晚期干预措施产生了混合的结果，尽管心力衰竭项目的经验表明，早期的病例管理干预措施可能有助于改善中期预后，包括死亡率和再次住院率。预测模型往往表现不佳，这使得研究设计和临床转诊变得复杂。与 PICS 相关的健康状况的复杂性表明，需要仔细和严格地评估多学科、多模式的干预措施——与特定的关注条件相关联——以解决这些重要的问题。
