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KEY POINTS

  • 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, and neurocognitive and neuropsychological dysfunction.

  • These morbidities may not be wholly reversible, and the decrement in function is 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. However, efficacy as measured by functional outcomes and independence remains questionable.

  • ICU multidisciplinary early mobility rehabilitation programs designed for patients who had good premorbid functional status improve functional outcomes at ICU and hospital discharge. The role and durability of early rehabilitations intervention on longer-term outcomes in less functional patients at ICU admission are less clear.

  • ICU diaries have been shown to improve psychological outcomes and improve health-related quality of life, but not posttraumatic stress disorder among ICU survivors and may result in less posttraumatic stress disorder among relatives of ICU patients.

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

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

INTRODUCTION

Surviving critical illness is only the beginning of the recovery process. It is increasingly clear that an episode of critical illness results in long-term physical and neuropsychological dysfunction. This contributes to ongoing health care utilization, excessive costs, and the risk of financial and mental health devastation of families.1–10 The potential reversibility of these newly acquired deficits remains unclear.2,10 Resultant muscle, nerve, and brain dysfunction may necessitate a change in disposition where those who were previously living independently may require assisted living situations or comprehensive care after their critical illness.4,5 Acquired morbidity comes at a significant additional cost with some reports that health care utilization after critical illness exceeds that for patients with chronic disease.2,11–13

In this chapter, we review important advances in outcomes after critical illness including established data on functional and neuropsychological disability in recovering ICU patients and family caregivers. We review existing models of early rehabilitation and intervention after critical illness. Most literature remains focused on long-term outcomes after acute lung injury, but emerging data on sequelae of critical illness will be included here as it adds depth to our current understanding of the complex spectrum of the post-ICU course and the post-ICU syndrome (PICS).10 Next we reflect on the global impact of and strategies to address chronic critical illness and PICS complicating COVID-19 infection. We then address future directions of outcomes work and potential rehabilitation strategies for patients and families after critical ...

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