Rolfsen Mark L, Wilcox M Elizabeth, Mart Matthew F, Jackson James C, Sevin Carla M, Ely E Wesley
Vanderbilt University Medical Center, Division of Allergy, Pulmonary and Critical Care Medicine, and The Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN.
Department of Critical Care Medicine, Faculty of Medicine & Dentistry, and the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Chest. 2025 Jan 31. doi: 10.1016/j.chest.2025.01.024.
Millions of people around the world survive critical illness each year only to realize that they and their loved ones are grappling with a new "normal" after hospital discharge for which their medical team may not have adequately prepared them. Up to one-half of all ICU survivors suffer from new or worsening impairments in physical, cognitive, and psychological domains of health that are often not realized until they attempt to re-enter their previous lives. These devastating long-term sequelae of critical illness, collectively described as post-intensive care syndrome (PICS), can carry enormous consequences for an ICU survivor's ability to care for their family, return to work, and regain their previous quality of life for months to years after their inciting illness. Despite mounting research on PICS and survivorship, a knowledge gap exists whereby ICU team members may not always be aware of PICS and may not counsel their patients on the challenges awaiting them after discharge. Understanding how best to communicate these challenges to patients and families is crucial in preparing for survivorship beyond the ICU. In this review, we summarize PICS and possible recovery trajectories of ICU survivors. We then discuss communication strategies, emphasizing the role of empathy. Finally, we provide a suggested framework to handle these crucial conversations. We aim to equip clinicians with the knowledge and framework to care for a patient who has survived critical illness but now faces the possibility of struggles inadequately addressed by our health care system.
每年，世界各地数以百万计的人在重病后幸存下来，却发现他们自己以及他们的亲人在出院后正努力应对一种新的“常态”，而他们的医疗团队可能并未让他们为此做好充分准备。多达一半的重症监护病房（ICU）幸存者在身体、认知和心理健康领域出现新的损伤或原有损伤加重，而这些往往直到他们试图重新回归以前的生活时才被意识到。这些危重病带来的毁灭性长期后遗症，统称为重症监护后综合征（PICS），可能会对ICU幸存者在引发疾病后的数月至数年里照顾家人、重返工作岗位以及恢复以前生活质量的能力产生巨大影响。尽管对PICS和幸存者问题的研究越来越多，但仍存在知识差距，即ICU团队成员可能并不总是了解PICS，也可能没有就出院后等待患者的挑战向他们提供咨询。了解如何最好地向患者及其家属传达这些挑战，对于为ICU之外的幸存者生活做好准备至关重要。在这篇综述中，我们总结了PICS以及ICU幸存者可能的康复轨迹。然后我们讨论沟通策略，强调同理心的作用。最后，我们提供一个处理这些关键对话的建议框架。我们的目标是让临床医生具备相关知识和框架，以便照顾那些在重病后幸存但现在面临我们的医疗保健系统未充分解决的挣扎可能性的患者。
