Discharge from ICU
Resources to help yourself or your loved ones after ICU discharge
Rate of survival from different types of critical illness has been improving over the past decades. This section explains what to expect following discharge from the ICU.
If the ICU admission was precautionary (i.e.: for closer monitoring following major surgery), the duration of stay is generally short. Discharge from the ICU would mean that the anticipated medical complications did not arise and the patient has been deemed fit for step down care. The patient will then continue on their course of recovery and rehabilitation.
If the ICU admission was for resuscitation in an emergency setting and/or significant complications had occurred, the duration of stay is likely to be long and the course complicated. In this situation, the patient may develop health problems related to their original illness, injury, or ICU treatment. These health problems cannot be totally prevented and can continue after the patient leaves the ICU or hospital. Collectively, these health problems make up a condition known as “Post-Intensive Care Syndrome”.
What Is “Post-Intensive Care Syndrome”?
Post-intensive care syndrome (PICS) is made up of health problems that develop during critical illness and remain following discharge from ICU. These problems can involve the patient physically, mentally or emotionally. Some of these problems include:
- ICU-acquired Weakness (ICUAW)
⁃ ICU-acquired weakness is muscle weakness and diffuse nerve injury that commonly develops during an ICU stay. It is associated with factors such as advanced age, severe illness, prolonged duration of bed rest and the use of certain types of medication. As many as 50% of patients who stay in the ICU for at least one week develop this complication.Prevention and treatment involve both passive and active muscle activity (even when in bed or when sedated). ICUAW may severely affect activity of daily living and the patient may require assistance with walking, grooming, dressing and even feeding. Recovery is possible with physical rehabilitation/exercise but may take more than a year.
- Cognitive or Brain Dysfunction
⁃ More than 40-50% of severely ill ICU patients develop problems with memory, attention, problem solving, and working on complex tasks (otherwise known as “delirium”). Risk factors include elderly age, existing brain conditions such as Parkinson’s Disease or stroke, severe disease as well as use of certain types of medication. These problems are known to persist beyond ICU discharge. There are several theories why this occurs but no specific treatment is known to be effective. Some patients improve with time but others may deteriorate further with time and never recover.
- Post Traumatic Stress Disorder (PTSD)
⁃ Critically ill patients may develop emotional problems such as depression or anxiety following critical illness. They may develop insomnia or nightmares and unwanted memories. Reminders of their ICU stay or illness may produce intense feelings or vivid traumatic images in their mind and cause cold sweats, palpitations, or high blood pressure. The condition may be so severe that it affects their personal life and ability to work/function. Psychiatric medications and psychological counseling may be useful in treatment.
How to Manage PICS?
Firstly, it is important to anticipate and look out for these complications. Understanding why the patient appears or behaves differently may reduce (caregiver) anxiety and frustration. Take time to assess the severity of the condition and consult relevant specialists to formulate a rehabilitation plan targeting physical and mental/emotional health. Recover requires significant effort on the part of the patient, team specialists and family.
Specialists who can help with rehabilitation include:
- Rehabilitative Medicine Specialist: A doctor who is specially trained to provide holistic and coordinated care for patients with PICS.
- Occupational therapist: Healthcare worker who helps the patient relearn life skills, such as grooming, dressing and feeding as well as the use of memory.
- Physical or Physio-therapist: Healthcare worker who helps restore the patient’s physical ability following injuries to the muscles, bones, tissues and nervous system. Particularly useful in ICU-acquired weakness.
- Psychiatrist: A doctor who is specially trained to diagnose and treat mental health problems. Particularly useful in Post Traumatic Stress Disorder.
- Psychologist: Healthcare worker who tests and assesses behavior/mental health and treat problems with thoughts, emotions and coping skills.
- Speech therapist: Healthcare worker who helps the patient with problems related to speech and swallowing.
Dealing with Disability Post Hospital Discharge
The patient may survive the ICU admission with a range of disability. Some may quickly be able to care for themselves while others may be very reliant on others for many aspects of life (movement, bathing, hygiene, feeding, etc). For the latter, there are many considerations and decisions to make before discharge home.
- Tube care
- Feeding, grooming
- Walking aids
- Living area