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Review
. 2024 Jun 14:36:e20240265en.
doi: 10.62675/2965-2774.20240265-en. eCollection 2024.

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

[Article in English, Portuguese]
Cassiano Teixeira  1 , Regis Goulart Rosa  2
Affiliations
Review

Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up

[Article in English, Portuguese]
Cassiano Teixeira et al. Crit Care Sci. .

Abstract
in English, Portuguese

A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.

RESUMO: Parcela significativa de indivíduos que enfrentaram doença crítica sofre de síndrome pós-cuidados intensivos, caracterizada por comprometimento novo ou exacerbado da função física, cognitiva ou de saúde mental. Além disso, os sobreviventes geralmente apresentam maior risco de consequências adversas, como infecção, eventos cardiovasculares maiores, reinternação e taxas de mortalidade elevadas, durante os meses após a hospitalização. Esses achados reforçam a necessidade urgente de prevenção e manejo eficazes da deterioração da saúde a longo prazo no ambiente de cuidados intensivos. Embora haja poucas evidências conclusivas de ensaios clínicos randomizados bem desenhados, potenciais intervenções incluem estratégias como limitação da sedação, mobilização precoce, presença da família durante a internação na unidade de terapia intensiva, implementação de programas de transição multidisciplinares (da unidade de terapia intensiva para a enfermaria e do hospital para o domicílio) e acompanhamento especializado após a alta hospitalar. Esta revisão objetiva fornecer um resumo conciso da literatura médica recente sobre os desfechos a longo prazo após doenças críticas e destacar potenciais abordagens para prevenir e abordar a deterioração da saúde de sobreviventes de cuidados intensivos.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1. Potential risk factors for psychiatric morbidity following intensive care unit discharge include preexisting psychiatric illness and the presence of psychiatric symptoms during hospitalization.(13,48)
The emojis represent the quality of life of patients based on the number of psychiatric morbidities. ICU - intensive care unit; PTSD - posttraumatic stress disorder.
Figure 2
Figure 2. Recommended approach to functional assessments across the continuum of critical illness and recovery.
ICU - intensive care unit.
Figura 1
Figura 1. Os potenciais fatores de risco para morbidade psiquiátrica após alta da unidade de terapia intensiva incluem doença psiquiátrica preexistente e sintomas psiquiátricos durante a internação.(13,48)
Os emojis representam a qualidade de vida dos pacientes de acordo com o número de morbidades psiquiátricas. UTI - unidade de terapia intensiva; TEPT - transtorno do estresse pós-traumático.
Figura 2
Figura 2. Abordagem recomendada para avaliações funcionais ao longo da doença crítica e recuperação.
UTI - unidade de terapia intensiva.
See this image and copyright information in PMC

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Supplementary concepts