The Long Term ICU Patient
23/3/11
- increased frequency with older, more deconditioned patients presenting to ICU
- this patient are high risk
CARE IN ICU
Airway
- tracheostomy management (insertion, weaning, decannulation, complications)
Breathing
- slow respiratory weaning techniques
- sputum management
- humidification
Circulation
- volume status assessment and management
- arrhythmias: AF
- long term cardiac function optimisation
Disability + Neurological
-
delirium surveillance
optimize communication (writing boards, speaking valves)
high incidence of depression
glucose control (adequate not tight)
critical illness weakness
physio
Exposure + Infection
- nosocomial surveillance and prevention
- care with possible selection of multiresistant organisms
Feeding
- nutrition
- fluid balance
- fine bore N/G tube
Gastrointestinal
Jeremy Fernando (2011)
- stress ulcer prophylaxis (controversial)
- enteral nutrition establishment
Lines
- minimization of lines
- minimization of unnecessary blood tests
Labs
- see above
- twice weekly
Medications
- review with attempts to minimize
- convert all IV medications to oral formulations
FASTHUG
-
Feeding
Analgesia
Sedation
Thromboprophylaxis
Head elevation
Ulcer prevention
Glucose control
Family
- regular up dates
- clear communications
- multi-disciplinary team involvement
CARE IN HOSPITAL BUT OUTSIDE ICU
-
high risk patients
high readmission rate
should not be discharged out of hours
good careful handover
tracheostomy support
close liaison with ward teams
rehabilitation
POST ICU ISSUES
- at risk of many complications
- pressure areas
Jeremy Fernando (2011)
-
weakness
scars
fistulae
pain
sleep disturbance
cognitive dysfunction
psychological sequelae: PTSD
renal injury
ischaemic heart disease
DVT
-> most data suggesting: increase mortality, decreased level of functioning out to 5 years.
-> some data suggesting that good functional outcome can be achieved at 6 months (Dennis,
CCR, 2011)
OUTCOME ASSESSMENT
-
follow up clinics
European QL
Adjusted Life Years
SF-36
Glasgow outcome score
Jeremy Fernando (2011)