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KEY POINTS

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  • Survivors of critical illness experience important functional decrements and decreased health-related quality of life due to ICU-acquired weakness and a spectrum of other physical disabilities, neurocognitive and neuropsychological dysfunction.

  • These morbidities may not be wholly reversible and the decrement in function may be more marked in older patients, those with a greater burden of comorbid illness or longer ICU length of stay.

  • Poor neurocognitive outcomes have been linked to delirium, hypoxia and sedative-hypnotic use, hypoglycemia, and possibly conservative fluid management; dysfunction is similar to that of moderate traumatic brain injury and mild dementia.

  • Approximately one-third to one-half of survivors of critical illness will develop long-term neurocognitive impairments.

  • Early mobility during critical illness is safe and feasible.

  • ICU multidisciplinary early mobility rehabilitation programs designed for patients who had good premorbid functional status improve functional outcome at ICU and hospital discharge. The role for these programs in less functional patients at ICU admission is unclear as is the lasting effect of this early rehabilitation intervention on longer-term outcomes.

  • ICU self-help manual has been shown to improve physical outcomes after critical illness.

  • ICU diaries have been shown to improve psychological outcomes in patients after critical illness.

  • Neurocognitive rehabilitation has shown some early benefit on outcome and requires further study.

  • Family caregivers also experience psychological morbidity and are important modifiers of patient outcome over time.

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ABSTRACT

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An episode of critical illness is transformative. Patients suffer important new nerve, brain, and muscle injury that results in important functional limitations that affect health-related quality-of-life (HRQoL) outcomes. The spectrum of morbidity varies according to individual risks but prevalent disabilities transcend diagnostic groupings. Each patient who enters the intensive care unit (ICU) will begin to degrade his or her muscles through upregulation of different proteolytic pathways, and although the inciting stimulus, or its magnitude, may differ somewhat across patients, the result is the same. This argues for an approach to rehabilitation that is etiologically neutral and based on an understanding of molecular pathophysiology that can be mapped to functional outcome and tailored to individual need. Neuropsychological dysfunction is important and also potentially irreversible and similar to that of moderate traumatic brain injury and mild dementia. Cognitive interventions may need to follow a similar rehabilitation model to those proposed for ICU-acquired weakness (ICUAW). Family caregivers should be part of the rehabilitation intervention as they represent important risk modifiers of short- and longer-term outcomes.

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KEYWORDS

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cognition, critical illness, family caregiver, ICU-acquired weakness, muscle biology, neuropsychological disability, outcomes, rehabilitation

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BACKGROUND

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Surviving critical illness is only the beginning. Only recently has it become clear that an episode of critical illness results in long-term physical and neuropsychological dysfunction, ongoing health care utilization and incurred costs, and the risk of financial and mental health devastation of families.1-9 This acquired disability may be irreversible.2 The legacy of muscle, nerve, and brain dysfunction may ...

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