Paul Nicolas, Weiss Björn
Klinik für Anästhesiologie und Intensivmedizin (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Anaesthesiologie. 2025 Jan;74(1):3-14. doi: 10.1007/s00101-024-01483-5. Epub 2024 Dec 16.
With a decrease in mortality of critically ill patients in recent years, intensive care medicine research has shifted its focus on functional impairments of intensive care units (ICU) survivors. ICU survivorship is characterized by long-term impairments of cognition, mental health, and physical health. Since 2012, these impairments have been summarized with the umbrella term Post-Intensive Care Syndrome (PICS). Mental health impairments frequently entail new are aggravated symptoms of depression, anxiety, and posttraumatic stress disorder. Beyond impairments in the three PICS domains, critical illness survivors frequently suffer from chronic pain, dysphagia, and nutritional deficiencies. Furthermore, they have a higher risk for osteoporosis, bone fractures, and diabetes mellitus. Taken together, these sequelae reduce their health-related quality of life. Additionally, ICU survivors are challenged by social problems such as isolation, economic problems such as treatment costs and lost earnings, and return to previous employment. Yet, patients and caregivers have described post-ICU care as inadequate and fragmented. ICU follow-up clinics could improve post-ICU care, but there is insufficient evidence for their effectiveness. Thus far, large high-quality trials with multicomponent and interdisciplinary post-ICU interventions have mostly failed to improve patient outcomes. Hence, preventing PICS and minimizing risk factors by optimizing ICU care is crucial, e.g. by implementing the ABCDE bundle. Future studies need to identify effective components of post-ICU recovery interventions and determine which patient populations may benefit most from ICU recovery services.
近年来,随着危重症患者死亡率的下降,重症医学研究的重点已转向重症监护病房(ICU)幸存者的功能障碍。ICU幸存者的特征是长期存在认知、心理健康和身体健康方面的障碍。自2012年以来,这些障碍被统称为重症后综合征(PICS)。心理健康障碍常常表现为新出现或加重的抑郁、焦虑和创伤后应激障碍症状。除了PICS三个领域的障碍外,危重症幸存者还经常遭受慢性疼痛、吞咽困难和营养缺乏。此外,他们患骨质疏松症、骨折和糖尿病的风险更高。综上所述,这些后遗症降低了他们与健康相关的生活质量。此外,ICU幸存者还面临着诸如隔离等社会问题、诸如治疗费用和收入损失等经济问题以及重返以前工作岗位的问题。然而,患者和护理人员都认为ICU后的护理不足且零散。ICU随访诊所可以改善ICU后的护理,但尚无充分证据证明其有效性。到目前为止,针对多成分、跨学科的ICU后干预措施的大型高质量试验大多未能改善患者预后。因此,通过优化ICU护理来预防PICS并将风险因素降至最低至关重要,例如实施ABCDE集束化治疗方案。未来的研究需要确定ICU后康复干预措施的有效组成部分,并确定哪些患者群体可能从ICU康复服务中获益最大。