Surviving ICU

Question 1

Why might patients in ICU have respiratory problems?

Answer 1

• Due to reason for admission or PMHx
  eg chest trauma, rib #, lung contusion
  thoracic or abdominal surgery, pain, altered resp mechanics,
  effects of anaesthetic
  medical, community acquired pneumonia, asthma, COPD,
  covid etc
• Result of mechanical ventilation + other factors associated with ICU care

Question 2

What is the ABCDEF bundle?

Answer 2

Has good preventative outcomes for PICS.

• Awakening (w/ light or minimal sedation)
• Breathing (spontaneous breathing rituals)
• Co-ordination of care & communication across disciplines
• Delirium assessment, prevention, and management
• Early ambulation and mobility
• Family engagement and empowerment

Question 3

What can be the end result of respiratory complications in the ICU?

Answer 3

• Atelectasis
• Hypoxaemia
• Increased volume of airway secretions
• Reduced airway clearance
• Ventilator assisted pneumonia (VAP), more significant resp compromise, difficulties weaning from vent, death

Question 4

What factors can cause respiratory complications in the ICU?

Answer 4

• Mechanical ventilation
• Medication
• Position (decreased FRC, VQ mismatch)
• Immobility (muscle mass loss incl resp muscles, limited position changes altering airway clearance and vent)
• Sedation (lack of spont. cough, decreased cilial movement, less frequent position change)
• NGT

Question 5

What are some cardiovascular complications in ICU?

Answer 5

• Cardiac deconditioning
• Multisystem pathologies (eg sepsis, ARDS)
• Arrhythmia
• Hypo/hypertension
• Thromboembolism

Question 6

How much muscle mass can be lost within 10 days in ICU?

Answer 6

Around 20%

Question 7

What are some complications of muscle atrophy and weakness?

Answer 7

• Immobility
• Inflammation
• Dysfunctional micro-circulation
• Electrolyte disturbances

Question 8

What are some neurological complications in ICU?

Answer 8

• Decreased level of consciousness

- Delirium

Question 9

What are some additional complications in ICU?

Answer 9

• ICU acquired weakness, myopathies and neuropathies

- Multi organ dysfunction syndrome (MODS)

Question 10

What are some commonly used functional outcome measures for patients in ICU?

Answer 10

• Physical Function in Intensive Care Test scored (PFIT-s)

- Functional Status Score for the ICU (FSS-ICU)

Question 11

What is a common outcome measure for level of consciousness/sedation?

Answer 11

Richard Agitation Assessment Scale (RASS)

-5 = unarousable; 0 = alert and calm; +4 = combative

Question 12

What is a common outcome measure for delirium?

Answer 12

Confusion Assessment Method for the ICU (CAM-ICU)

CAM-ICU positive (delirium present) = feature 1 + 2 AND either 3 or 4
ie acute change or fluctuating course of mental status + inattention AND altered level of consciousness (from RASS) or disorganised thinking

Question 13

What are some examples of SHORT term physiotherapy goals for someone in ICU?

Answer 13

• Maintain strength and function
• Weaning from ventilator
• Prevent resp complications

Question 14

What are some examples of LONG term goals for someone in ICU?

Answer 14

• Address ICU acquired weakness, any injuries/conditions arising from being in ICU
• Address trauma, depression, anxiety, patient’s “new normal”

Question 15

What three domains can Post Intensive Care Syndrome (PICS) manifest?

Answer 15

• Physical
• Cognitive
• Psychological/mental health

Question 16

What physical impairments can come about as part of Post Intensive Care Syndrome (PICS)?

Answer 16

• ICU acquired weakness (incl polyneuropathy, critical illness myopathy)
• Fatigue
• Insomnia
• Pulmonary (impairments in lung volume and diffusion)
• Neuromuscular

Question 17

What cognitive impairments can come about as part of Post Intensive Care Syndrome (PICS)?

Answer 17

• Memory impairments
• Decreased executive function
• Attention difficulties
• Slower processing speed
• Visuospatial difficulties

Question 18

What mental impairments can come about as part of Post Intensive Care Syndrome (PICS)?

Answer 18

• Depression
• Anxiety
• PTSD
• Traumatic/delusional memories of time spent in ICU, restraint

Question 19

What percentage of ICU survivors still require assistance 12 months later?

Answer 19

More than 50%

Question 20

What percentage of ICU survivors return to pre-ICU employment status?

Answer 20

Around 50%

Question 21

What percentage of caregivers report persistent depressive symptoms?

Answer 21

Around 43%