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A New Normal: Helping ICU Survivors Recover

Posted: Dec. 12, 2017

Valerie Danesh, PhD, RN, CCRP and assistant professor

More than five million Americans with life-threatening illnesses are admitted to Intensive Care Units (ICUs) annually. Owing to advances in critical care treatment, many of them are surviving their stay. That’s the good news.

Because the number of these patients is expected to increase in coming years as the U.S. population ages and life expectancy rises, maintaining and improving the health of survivors is increasingly important. Many ICU survivors must manage sequelae or “after-effects” that are a direct consequence of critical illness, including new onset depression, anxiety, post-traumatic stress disorder or cognitive impairment that are often paired with physical frailty following hospital discharge.

The term Post-Intensive Care Syndrome (PICS) arose earlier this decade and describes the long-term dysfunctions resulting from treatment in the ICU. These dysfunctions include physical, cognitive, and psychiatric impairment and may last for months or years after the ICU patient survives and returns home. These problems involve the patient’s body, thoughts, feelings, or mind and may also affect the family and caregivers.

PICS can manifest in a variety of ways. Common symptoms include fatigue, weakness, limited mobility, anxiety, depressed mood, sleep disorders, and mental processing issues, such as balancing a checkbook. The burden of caregiving often leads to similar psychological symptoms in family caregivers.

Valerie Danesh, PhD, RN, CCRP and assistant professor, wants to find a way to reverse that tide and improve the chances that people can successfully manage the sequelae of critical illness as they resume life after hospital discharge.

“ICU patients are shrouded in medications and often don’t realize what’s really happening to and around them during critical illness,” Danesh said. “Those who survive aren’t necessarily thriving. Surviving the illness does not equate to a return of pre-hospital abilities and function, and post-hospitalization deficits are well-documented, particularly for patients who require life support and/or develop delirium while hospitalized.”

Danesh’s current research focuses on clinical deteriorations and evaluating subsequent interventions across the continuum of care, including acute, sub-acute and home health care. She believes that strengthening the continuity of care by managing PICS will improve patients’ lives and the lives of those who care for them.

ICU survivors are often left to self-manage severe dysfunction that is a direct consequence of critical illness. With a $20,000 grant from the School of Nursing’s Center for Transdisciplinary Collaborative Research in Self-Management Science, Danesh is launching a pilot study to develop self-management interventions for ICU survivors with PICS.

“When you think of the ICU, you don’t often think of self-management because many patients are dependent upon life support machines or are obtunded. But self-management can come into play following ICU discharge,” she said.

The ultimate goal of this program of research is to generate a body of science that will inform the development and delivery of self-management interventions that promote self-management behaviors and improve the health status, well-being and cost of health for ICU survivors.

Given the relative recentness and rarity of ICU survivor-specific follow-up care in the U.S., designing effective PICS programs is essential. First steps for her project include a comprehensive needs assessment to assess the needs, opportunities, and threats to sustainable and efficacious self-management strategies for this understudied population.

“Research will help clarify the spectrum of self-management needs, find more effective ways to prevent these long-term complications and more effectively treat symptoms to improve functional recovery,” Danesh said. “It’s a fairly new area of study, but vastly important for improving patient outcomes.”

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