SCCM Resource Library-Beyond ICU Care: The Journey Continues

Video Transcription

Good morning. Welcome to this session of the Society of Critical Care Medicine's 50th Annual Conference. Today's session, Beyond ICU Care, The Journey Continues.  I'm Ramona Hopkins, and I will be your moderator. I have no disclosures. The learning outcomes from this session are to determine which follow-up format can improve  the long-term outcomes of ICU patients in terms of morbidity and healthcare utilization, discover the psychological burden of ICU care, and evaluate strategies to improve outcomes,  and assess new methods of preventing the development of post-ICU physical sequelae. We have an outstanding group of speakers this morning.  Dr. Heidi Engel, a physical therapist, a clinical special in physical therapy at the University  of California, San Francisco Medical Center, will talk to us about physical recovery following ICU admission.  And the final speaker in this session will be Dr. Carla Sivan, the director of the ICU Recovery Center at Vanderbilt University Medical Center.  Her talk will be post-ICU follow-up, who would benefit from which format. Thank you for joining us. Hello.  I'm Heidi Engel, and I'm here to talk about physical recovery following ICU admission. My disclosures are a conflict of interest from paid presentations for the R. Joe Huntley  Medical Equipment Company on the topics of ICU early mobility. The objectives for this talk are to just describe to you post-intensive care sequelae  after patients leave the hospital and go home, and what some of the barriers and challenges are to overcome what would be an improved post-ICU recovery.  So we know that a stay in the intensive care unit is incredibly depleting, and it really does not matter who you are or how old you are. Your body is in crisis.  And when a body is in crisis, one of the areas that is sacrificed most readily is skeletal muscle tissue.  Skeletal muscle, when it is depleted and is in a process of breakdown, as it is when someone is in an intensive care unit and critically ill, is described as ICU-acquired weakness.  And what this results in is some severe atrophy of the muscle fibers themselves. The cross-sectional area depletes rather quickly.  And what is left behind is a disorganized architecture of the muscle itself. So it just does not contract effectively.  At the same time, the excitation of the muscle from the nerve is also depleted and run down, and there's a hypo-excitability of the muscle.  And so therefore, you have pretty disorganized, not very effective muscle tissue. Now the problem with that is not simply that muscle moves bone through space.  It's not just that muscle is converting the chemical energy of your metabolism into the mechanical energy of moving your bones and body through space.  The thing that's really intriguing about skeletal muscle is it really and truly is your suit of armor in the world. Skeletal muscle protects you in so many ways.  It regulates your metabolism. It's vital to folks in terms of their blood sugar levels.  It is also something that your body will sacrifice automatically as a way to stimulate an immune response.  When skeletal muscle breaks down, it releases myokines, and those myokines stimulate the immune system.  So obviously, if you're critically ill, your skeletal muscle is going to work extra hard to sacrifice itself to save your life.  So with this in mind, resilience is ever most important in terms of what the outcome after the patient leaves the ICU is, and in terms of their quality of life, and in terms of  their ability to return to their previous selves. So we know that in the first week of an ICU stay, the thing that is most relevant to the  patient and their recovery is the admitting event, the crisis, and stabilizing that crisis.  And really, that's what the focus of our attention at that point should be on, and what we can project will be the resolution of this crisis and critical illness.  And as weeks go on, things such as comorbidities and the physiologic reserve of the person, how much skeletal muscle they have, and how much cardiopulmonary fitness they have really  starts to be the most significant aspect of how well they will recover. And so considering the resilience the person has can give you a lot of information about  will they be developing post-intensive care syndrome afterwards, and to what extent will their disability be impacting their lives.  So the other thing that happens besides just the depletion of skeletal muscle and bone integrity and the physical depletion as a result of an ICU stay is it's also very debilitating  to the cognitive and psychological part of the person. So we know that in studies of delirium and in structured interviewed research of people  post-ICU stays, that there is a fragmented self that remains, that the whole cognitive psychosocial aspect of this person's being has really been rearranged as a result of  both the medical care and the critical illness that they sustained. And this has a huge impact on the physical recovery of the person as well, because when  your sense of yourself and your capability does not match what this new depleted body is, it's very distressing, but it's also very difficult for the brain to be able to communicate  out to the muscles. So as well as the wasted architecture of the body, you have an inability to communicate and control the body as it wants to move through space.  And this very often leads to fatigue and the sensation of fatigue. And this is somewhat interesting today because fatigue has suddenly become in the lingo of  the popular press and the media. Fatigue now is noted by people who have what they call long haul COVID-19, the COVID-19 long haulers. And what fatigue is, is it's not being tired.  It is a distressing, persistent, subjective sense of physical, emotional, and cognitive tiredness, not proportional to recent activity. And it interferes with usual functioning.  And people will describe it as a sense of their body being extraordinarily heavy or that they will be going about the daily routine of their lives and suddenly they will be hit  with this overwhelming wave of just complete exhaustion. So this type of fatigue really is a component of recovery, not just for people with cancer,  which is something that has identified fatigue for a long period of time, the cancer rehab community, but we know that it also occurs in people who've had a prolonged critical  illness. And so what can we do physically about someone who's suffering this level of fatigue, this level of depletion, and where could it be coming from?  So what I want to present is this concept of relativity in the aerobic system, in the cardiopulmonary system and aerobic fitness.  And so what we know about aerobic capacity is that aerobic capacity is measured in VO2 max, which is milliliter kilograms per minute of oxygen consumption.  So an average 35 to 40-year-old will have a capacity of 25 to 30 milliliter kilograms per minute of oxygen consumption in order to move about through their day.  This is someone who's not especially athletic, but it is someone who is high-functioning in the community.  Cancer patients, we know, regardless of the type of cancer they may have had, end up often with an exceptionally low aerobic capacity, again, as a result of both the illness and  the treatment and the continuous depletion that goes along with those. And so a cancer patient at the end of treatment often will have a 14 to 20 milliliter kilograms  per minute capacity. That's their VO2 max. Well we also happen to know that a heart disease patient listed for cardiac transplant will have a VO2 max that that's low.  We understand intuitively why that heart disease patient has such a low oxygen capacity, but it's important to understand that there are other types of severe illness and treatment  that can create the same effect. Now in terms of giving you this concept of relativity, it's again important to think  about someone who has amazing aerobic capacity, and that would be Lance Armstrong when he was at the peak of his cycling career. He had an 80 milliliter per kilogram minute VO2 max.  Now it's also important to remember he was a cancer survivor, and therefore it's always possible the human body is so adaptable, so malleable, so responsive to the right sorts  of stress and input and stimulation, that Lance Armstrong could go from a substantially reduced aerobic capacity to again climbing mountains in the Pyrenees in France.  So here we go looking at our aerobic exercise dosages again, and if we continue with this concept of relativity, we understand that our critically ill person leaves the hospital,  has a dramatically reduced VO2 max, and we see something as simple as climbing the front stairs to their house.  So on the front steps to their house, that is an activity that requires five metabolic equivalents of energy in order to get up, which would require an aerobic capacity of  18 milliliter kilograms per minute. So think about it. If you are a cancer patient, if you are a critically ill person with a substantially  reduced VO2 max, now you have the problem of your daily activities are the equivalent of a vigorous exercise.  Every little thing you do now has become equivalent to a vigorous exercise. Of course, that would be exhausting and fatiguing if you felt like just getting up and going  through your daily routine was the same as climbing a mountain.  So that means what we have ahead of us after you leave the intensive care unit, and you may have some of this profound depletion of your cardiopulmonary system, your nervous  system, the connection of your nervous system to your musculoskeletal system is that you're really now going to be in a marathon training phase, and that marathon training phase is  going to require some real transitions in self-awareness, some reestablishing the connection of your brain to your whole body again.  How do we recruit those muscles, develop core strength, postural integrity? How do we get through some of the musculoskeletal pain that has developed?  We know that people, when they leave the ICU, when they go home, shoulder pain is highly prevalent in these patient populations because they've lost all their rotator cuff  muscles, and they were never encouraged to reach up over their head in the course of their stay in the ICU.  They've lost a lot of their shoulder mobility, and so anytime they do move, they pinch the rotator cuff tendons.  We know the calf muscles are highly depleted, and so those become—and that the Achilles tendon becomes very tight, and so the ankles and calves can be very painful as well.  So the exercise has to be very graded, and it has to be able to treat all these other various things besides just plain strengthening or just walking.  What we know about how to motivate people to engage in a type of training and exercise program to restore themselves afterwards, we know from this study in 2009 that if you  have a general practitioning physician giving you the advice you need to start an exercise or walking program versus that same person plus an exercise physiologist giving you a  detailed prescription for the types of exercise that you really need and how to dosage that  correctly and give the right forms of intensity, that compared to the doctor just giving the  advice compared to the doctor plus the exercise physiologist plus the recording of what you  do with the pedometer or an exercise diary, the one that gives the most consistent, effective return on the investment is the physician plus the exercise physiologist plus asking  the recovering patient to please record what they do so they have a sense of self-awareness and reward in what has worked and when they have their good days and bad days.  And again, it's just really bringing the entire person back together within their body and within their thought process about how they cope with this new body and how they restore  this new body. Because we recognize that post-intensive care syndrome is really about ending the fragmentation  of the mental, spiritual, physical, and emotional person and bringing it together as one.  And exercise can be a form of helping people bring all these fragmented bits of self together to become whole again.  In order to have the types of tools and outcome measures we need to potentially measure our  progress with this, if we're having a post-intensive care syndrome clinic, I recommend things such  as the SPPB, the 30-second sit-to-stand, the two-minute walk test, unilateral stands. But I do not recommend the AMPAC six clicks. It is not designed as an outcome measure.  And I think it's important that we establish some of the more validated outcome measures and not these subjective tools as a way to help us measure what our patient's progress is.  Because exercise actually is a complex, individualized activity prescription. And really, in this population, because we do have this disconnect, this new sense of  self that has to be developed, this person usually wakes up with their identity of who they are being who they were, not who they actually are now.  And this discordance adds to the whole neurological and central nervous system disconnected from that depleted skeletal muscle.  So besides strength training, we need things that help ground the person's psychology and cognition into their body, which often means things such as yoga or dance or gardening.  And then we have all the exercise training principles that always need to apply. A good exercise program has weight training, strength training, cardio-pulmonary training,  cardiovascular training, balance and acquisition of new skills to really help the person understand best how to move their body through space. But it has to be carefully monitored.  And there has to be considerations for such thing as the training effect. How strong is it with heart rate variability?  So in conclusion, remember resilience is a premorbid state. It counts a lot for how our patients do or do not develop a post-intensive care depletion.  Any ICU stay is depleting of a whole person.  It's a discordant pre- and post-identity. We do have tools to rebuild people, but they are very specific exercise prescriptions.  And we need to consider sleep, nutrition, and medication as part of that recovery. I have references here on these slides if you want to dive into much more detailed information.  Thank you so much for having me today.  Hi, everybody. I'm Carla Steven. I'm the Director of the ICU Recovery Center at Vanderbilt. And I'm going to be talking about post-ICU follow-up today, who would benefit from which  format.  I do have some modest funding from the Society of Critical Care Medicine and the Department of Defense for some studies that will be mentioned in today's talk.  And an overview of what I'm going to talk about in the next 15 minutes or so will include  just a brief overview of post-intensive care syndrome, the models of care that are available  after the hospital, serial assessments, identifying patients for future interventions, and future directions.  So by now you probably know what post-intensive care syndrome is. It's a name we came up with to describe this variety of problems that patients encounter  after they have suffered and survived a critical illness.  And these may include physical impairments, including muscle weakness, decreased pulmonary function and pain, cognitive impairments, which Dr. Jackson is going to be talking about,  mental health, including depression, anxiety, and PTSD, and their families also may experience these things. There's a high burden of chronic health conditions in this population,  and this of course impacts us as clinicians as well and healthcare systems.  Since the onset of the COVID-19 pandemic, there's been increased interest in the sequelae of critical illness and in COVID-19 in specific. This is an article for the New York Times  that highlighted some of the cognitive and depression and anxiety issues that plague some of our patients. This is in fact one of our patients here at Vanderbilt  who was featured after the ICU.  And so that's led to a new level of scrutiny as to what we might be able to do to improve recovery from critical illness. And there are a number of different models of post-ICU care  that have been employed and implemented around the country and around the world.  I'm probably gonna spend the most time talking about post-ICU clinics, which are often multidisciplinary clinics that take place in larger medical centers  like we have here at Vanderbilt. But most patients who recover from a critical illness will in fact be seen by their primary care physician  if they're seen by anybody. And there are increasing numbers of peer support groups, both online and in person that are available to patients. And because of the pandemic,  telemedicine has become more and more available. And so the pandemic has in fact pushed telemedicine into existence in many places where it did not exist before.  But first we have to figure out which patients would benefit from such a service because it certainly would not be a good use of resources to see every single patient  who passes through the doors of the ICU. We do know that there are some features that may predict more severe impairments after a critical illness.  And this is from the SCCM consensus statement that was just published in 2020. Mark Michelson is the first author.  And it noted that pre-existing cognitive dysfunction before critical illness, pre-existing mental health problems and pre-existing frailty are unsurprisingly predictors  of post-ICU problems. But lots of people come into the ICU perfectly healthy and then end up with post-ICU problems. And the people who might be at most risk for those things  are those who get a lot of sedation, who experience delirium, who have early memories of frightening experiences in the ICU, and of course, who have severe physiologic impairments  as represented by sepsis, shock, and hypoxia.  After the critical illness, there might be some things that we can pick up. This was a study here by Wara et al, published last year in 2020, which I'm happy to say was last year,  in critical care medicine that tried to predict post-intensive care syndrome, PTSD, as evidenced by markers of post-traumatic stress at hospital discharge.  Clinically, we've been using a number of clinical criteria to identify patients for follow-up for many years. We started our clinic here at Vanderbilt in 2011 and 12,  and we started out by screening patients based on delirium, mechanical ventilation, or shock of any etiology. And although we've tried a bunch of different things  to figure out if there's an easier way to identify patients since then, those three have actually proven to be quite sensitive and specific for the patients we wanna see in clinic.  But there are others. Socioeconomic features have been identified as predictors of more trouble after the hospital stay, including insurance status, social isolation,  and chronic illness. There are a couple of readmission risk calculators that have been developed, and we have not found those to be particularly useful  for identifying the patients we wanna see in clinic. But they're certainly an option in terms of winnowing down a large patient population.  So now I just wanna talk about some of the different models of post-ICU care that are out there. First, and perhaps the easiest in terms of entry,  is the self-directed or informational model. And this is basically just giving the patient some written information. In this case, these are some snippets  from the intensive care rehab manual put out by St. Helens and the NHS in the UK.  There are also some online resources. ICU Steps is a great one, also out of the UK, that was started by patients and has some information for patients and support information.  And basically just handing this to the patients and allowing them to self-direct rehab after the hospital. This was studied in the control arm, actually,  by Jones et al in this article down here from CCM in 2003.  As I mentioned, most patients, if they see anyone after the ICU stay, it will be their primary care physician. And this is an interesting study that was done in Germany  where most patients do have a primary care physician that attempted to liaison with a general practitioner and provide some additional support and training to the PCP  to improve survival of patients, outcomes of patients who had survived sepsis. And the primary outcomes were not significantly different between groups,  but the physical impairments did seem to be better in the intervention group.  Post-ICU clinics have been getting a lot more attention, especially since the pandemic. And many folks out there, perhaps you're one of them who were planning  or trying to start a post-ICU clinic when COVID hit, were actually able to get their clinics pushed into existence because of the increased demand for post-ICU services  caused by the pandemic. But these can take many forms.  They can be in-person, remote, or telemedicine, or a hybrid of the two. They're often multidisciplinary, certainly in the US, and many have adjacent or integrated peer support.  So that would be perhaps a peer support group that meets separately from the clinic, or as in the case of the NIH NICE program in Glasgow,  they have the peer support actually integrated into the clinic, which is quite a nice model. There are a number of different specialties that might participate in a post-ICU clinic.  The work really starts in the ICU. As soon as you know that the patient is gonna improve and perhaps have a chance to discharge to home, we're thinking about ICU recovery.  ICU diaries have been a compliment to post-ICU programs in many settings.  There may be anticipatory guidance provided by a nurse visit prior to discharge, and social work also has a big role in and after the hospital. And then once the patient gets home,  you might stay in touch with them via home health. That's done increasingly by telemedicine these days, and there are programs that have a heavy case management arm  that are seeking to prevent readmissions and meet patients' needs after the hospital without a readmission or an ER visit. And then once you get to the clinic,  there are certainly a number of different specialists who might be very useful. I would love to have all of these in our clinic.  I've highlighted in yellow the ones that we have here in our clinic at Vanderbilt.  But there are certainly clinics out there that have one or more of all of these specialties, and that may include pharmacy, physical therapy,  occupational therapy, respiratory therapy, psychology or psychiatry, nutrition, nurse and nurse practitioners, speech therapists, palliative care specialists, social workers,  of course, physicians and spiritual care specialists.  Telemedicine, I'd like to say a special word about because it's really come into its own over the past year. We were in the process of studying telemedicine  to deliver a post-ICU clinic model when COVID hit. So that was lucky, I guess, because we were all suited up and ready to go with telemedicine,  and we were able to continue enrolling for Teleport. And we're learning a lot about telemedicine for post-ICU recovery. There really are a lot of advantages.  One is that you can reach patients at this early critical time period, this post-hospital period, especially early before your follow-up appointments  have occurred where problems often end patients back up in the ICU, or at the very least in the ER because they don't have a place where they can get the care that they need.  Startup costs are really low. You can get a fancy telemedicine set up for a couple thousand dollars. And even if you have telemedicine integrated into your EMR,  it might just be a matter of getting a camera set up.  You can pull in your multidisciplinary team members from all different places. So even if they're quarantining, they can do a post-ICU clinic.  And you get to see a lot of the patient's home environment and their family members are more likely to be present.  We use this as something of a screen and triage the early telemedicine visit where we can identify problems and try to get the patients to the right resources  before they have to come back in the hospital. Certainly there are disadvantages including limited objective data collection. You can do a limited physical exam  and you certainly can't give something like a breathing treatment or a vaccine, which we do fairly frequently in in-person clinic. And there are some regulatory hurdles,  even despite COVID, some licensure issues. For example, you still have to have an active license in the state where the patient is physically located  at the time of the visit in most cases, at least in the US. Unclear whether these payers will continue to reimburse for telemedicine visits, but there are some promising signs  that we will be able to continue.  And patients have highlighted for us, this is from a qualitative study by Joe McPeak and collaborators for the collaborative assessment of ICU recovery needs or care and study.  And I just highlighted some of the things that I think are really well-suited to telemedicine including care coordination, provision of educational materials,  normalizing recovery and managing expectations, setting goals and providing advice for welfare support and employment, which is really important to these patients  after they leave the hospital.  Once you get patients into clinic or on a telemedicine visit, there are a number of tools that are being used as screening tools. None of these were developed specifically  for the post-ICU population, but they're in widespread use. This is again from the consensus statement, which is now published no longer in press, CCM 2020,  that gave a strong recommendation for the use of the Montreal Cognitive Assessment Test for cognition screening and the hospital anxiety and depression.  And this is the depression scale for anxiety and depression. All of these can be done over telemedicine and in some cases just over the phone.  The IESR or the abbreviated impact of events scale six, which is a six question version is commonly used for screening for post-traumatic stress. And if we get patients into clinic,  we and many others use a six minute walk as sort of a global measure of physical function. And the IFD is also in widespread use.  And one of the other things that we've learned over the years is that PICS is not just a snapshot in time, but needs change over time.  And although we have focused a lot of our efforts in terms of transitions of care on the hospital discharge, patients tell us that they have many other time points  that are targets for improving post-ICU care. And these include well after discharge as well as before discharge. In fact, starting even in the ICU  as soon as we know that somebody is gonna survive. So I'm just gonna switch gears for a minute and talk about peer support. This is a really nice paper.  Joe McPeak was also the first author on this one. This is out of the Thrive Collaborative Report in 2019 about models of peer support that are in use.  And there are a number out there. These can also be in combination. For example, Jim Jackson here at Vanderbilt also leads our support group  and that's also completely online right now. So a lot of options if you're interested in starting a peer support group. In addition to peer support, the ICU diary, as I mentioned,  or visits back to the ICU can be very useful for select patients. Not everyone wants to visit the ICU, but some certainly do. And especially now when there's so much focus  on burnout of our ICU staff and everybody's working so hard upstairs, often with poorer outcomes than we're used to in non-COVID times,  the concept of integrating ICU staff into post-ICU care is, I think, more important than ever. This slide was actually put together by Sarah Bloom  who's one of our nurse practitioners who is very active in the ICU taking care of patients up there. And she describes really feeling like  she was missing all these pieces of the patient's recovery that once she started coming down to clinic really allowed her to provide better care and guidance to patients  who were still in the midst of their critical illness.  There are many things that you can do right this moment to improve post-ICU recovery for patients, even if you don't have a clinic, a peer support group, or an ICU rehab manual.  And a lot of this really hinges on normal, good discharge planning, including summarizing for the patient what happened during the hospitalization. That's even more challenging now  that we have so much turnover in teams and such prolonged hospitalizations in COVID-19. Really executing the discharge planning  that we want to be happening and we think is happening. And that's just basic things like medication reconciliation, making sure that they get the appropriate rehab  all the vaccines that they need, which hopefully will include COVID-19 vaccines shortly.  Home health, physical therapy, occupational therapy, durable medical equipment, make sure those things actually are getting to the patient  and that they have follow-up appointments in hand when they leave the hospital. All of this really needs to be written down as well as spoken because a lot of these patients  have very impaired memory, even when they leave the hospital and some may still be somewhat delirious  and their family members are likewise bombarded with a lot of different pieces of information and team members. So writing things down is very helpful.  Talk about the trajectory, tell them what you expect for them and what sorts of things are normal and what sorts of things should cause them  to seek a reevaluation and give them resources. One of our patients many years ago said, I didn't even know what to Google when I was having all these problems  and I didn't trace the source of these issues to my critical illness or the ICU care. And so give patients resources. There are many online, for example, the ICU steps.  We have a great website here at Vanderbilt called icudelirium.org, which has a ton of information for patients as well as physicians and clinicians.  So future directions, we still have a lot to learn. We can't say for sure which model is best for which patient, but the APICS study or Addressing Post-Intensive Care Syndrome,  which was just re-upped for a COVID version, I think will go a long way to answering some of these questions about exactly what the unmet needs are for patients  after hospitalization and how we can provide those. We're looking at outcomes and recovery after COVID leading to ECMO. This is a multicenter study.  And of course I mentioned teleport.  This study is not specific to post-ICU, but I'm very proud of it, not only because of the logo, but because it's led by one of our fantastic trainees  who's a surgical resident here at Vanderbilt. So look for more about that coming soon. And you can also fill it out. It's a survey study looking at the impact  of restricted visitation on patients, families, and healthcare workers. So if you're a healthcare worker or a patient or a family, you can fill it out as any of those roles.  And really none of what I talked about today would have been possible in isolation. All of the studies that I mentioned and the knowledge that we've gained  has been gained in collaboration with other centers. These started out as the Thrive Collaboratives and are now in existence as the Critical and Acute Illness Recovery Organization  or CHIRO. If you have a post-ICU clinic or a peer support group or both or neither, but you want one, please visit us at this site down here to get more information.  We're onboarding new members twice a year.  And with that, I'll end. Thank you very much for your attention.

Video Summary

The video discusses physical recovery and post-ICU follow-up for patients. In terms of physical recovery, it explains how a stay in the ICU can have a significant impact on skeletal muscle and lead to ICU-acquired weakness. This depletion of skeletal muscle can result in atrophy and an inability to effectively contract or move the body. The video emphasizes that physical recovery is essential for an individual's overall well-being and quality of life after leaving the ICU. It suggests that exercise and rehabilitation programs can play a crucial role in restoring physical function and improving outcomes. The video also addresses the cognitive and psychological effects of ICU care. It highlights the fragmented sense of self and cognitive impairments that can occur after a critical illness. The speaker explains that these cognitive and psychological factors can further impact physical recovery and contribute to sensations of fatigue. In terms of post-ICU follow-up, the video discusses different models of care, such as self-directed or informational approaches, primary care physician visits, and specialized post-ICU clinics. It also mentions the role of telemedicine in enabling remote follow-up care. The speaker emphasizes the importance of identifying which patients would benefit most from post-ICU follow-up, based on factors such as pre-existing conditions, severity of illness, and potential risk for long-term complications. The video concludes by highlighting the need for ongoing research and collaboration in the field of post-ICU recovery and follow-up care.

Asset Subtitle

Patient and Family Support, 2021

Asset Caption

The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Learning Objectives

Determine which follow-up format can improve the long-term outcomes of ICU patients in terms of morbidity and healthcare utilization
Discover the psychological burden of ICU care and evaluate strategies to improve outcomes
Assess new methods of preventing the development of post-ICU physical sequelae

Physical Recovery Following ICU Admission
Heidi J. Engel

Post-ICU Follow-Up: Who Would Benefit From Which Format?
Carla M. Sevin

Meta Tag

Content Type Presentation

Knowledge Area Patient and Family Support

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Rehabilitation Medicine

Year 2021

Keywords

physical recovery

post-ICU follow-up

ICU-acquired weakness

skeletal muscle

exercise and rehabilitation programs

cognitive impairments

telemedicine

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