INTRODUCTION TO POST-ICU CLINICS
Patient Care Vignette
A 52-year-old woman who works as a software engineer is admitted to the intensive care unit (ICU) with acute respiratory distress syndrome due to Streptococcal pneumonia. She requires 10 days of mechanical ventilation, including the use of deep sedation, neuromuscular blockade (temporary chemical paralysis), and prone-positioning therapy. She experiences delirium upon extubation (removal of the breathing tube), which continues for several days in the ICU. She is discharged to an acute rehabilitation facility and ultimately returns home after 6 weeks in the rehabilitation facility.
At home, she continues to experience ongoing vivid dreams related to her ICU stay and feels intrusive thoughts about her illness, anxiety over getting sick again, and persistent shortness of breath that limits her activity. She is assisted at home by her husband and she is able to perform activities of daily living independently. She finds that focusing on tasks, such as cooking or reading, is still challenging and she often loses her train-of-thought. She is not sure if she will be able to return to work. She visits her primary care doctor who recently learned about a post-ICU clinic with multidisciplinary expertise to help with her recovery.
As the population of ICU survivors grows, there is an increasing need for healthcare clinicians to understand the sequelae that these patients experience and how to best care for them after their ICU stay. Over the past two decades, some healthcare institutions have established multidisciplinary “post-ICU” clinics to address this goal. Previously, these clinics primarily existed in Europe, and to only a limited extent elsewhere. Interest in post-ICU care has globally increased as a result of both the COVID-19 pandemic and the increasing recognition of long-term sequelae of critical illness.
Limited data exist to inform the structure and implementation of post-ICU clinics. However, substantial evidence now describes the sequelae of critical illness. Further, experts within the critical care and rehabilitation communities advocate for novel follow-up care for ICU survivors re-entering the community. For example, the National Institute for Health and Care Excellence (NICE) guidelines for post-acute care recommend that “adults in critical care for more than 4 days should have a review by a healthcare professional 2 to 3 months after leaving critical care to talk about their recovery and any problems they might have.” This review is specifically designed to identify those who have problems that they might not recognize (e.g., post-intensive care syndrome; see Introduction and Chapter 4), issues that they have not been able to address with locally available resources (e.g., certain kinds of specialty rehabilitation), or new conditions that have developed as a result of prior care (e.g., ventral hernia; see Chapter 23).
This chapter will explore the current landscape of post-ICU clinics including current evidence, best practices for clinic structure, ongoing challenges, and future directions.
HOW AND WHY THIS PROGRAM WORKS