Society of Critical Care Medicine’s international consensus conference on prediction and identification of long-term impairments after critical illness

Mikkelsen, M. E. et al. (2020) Society of Critical Care Medicine’s international consensus conference on prediction and identification of long-term impairments after critical illness. Critical Care Medicine, 48(11), pp. 1670-1679. (doi: 10.1097/CCM.0000000000004586) (PMID:32947467) (PMCID:32947467)

Abstract

Background: After critical illness, new or worsening impairments in physical, cognitive, and/or mental health function are common among patients who have survived. Who should be screened for long-term impairments, what tools to use, and when remain unclear. Objectives: Provide pragmatic recommendations to clinicians caring for adult survivors of critical illness related to screening for postdischarge impairments. Participants: Thirty-one international experts in risk-stratification and assessment of survivors of critical illness, including practitioners involved in the Society of Critical Care Medicine’s Thrive Post-ICU Collaboratives, survivors of critical illness, and clinical researchers. Design: Society of Critical Care Medicine consensus conference on post-intensive care syndrome prediction and assessment, held in Dallas, in May 2019. A systematic search of PubMed and the Cochrane Library was conducted in 2018 and updated in 2019 to complete an original systematic review and to identify pre-existing systematic reviews. Meeting Outcomes: We concluded that existing tools are insufficient to reliably predict post-intensive care syndrome. We identified factors before (e.g., frailty, preexisting functional impairments), during (e.g., duration of delirium, sepsis, acute respiratory distress syndrome), and after (e.g., early symptoms of anxiety, depression, or post-traumatic stress disorder) critical illness that can be used to identify patients at high-risk for cognitive, mental health, and physical impairments after critical illness in whom screening is recommended. We recommend serial assessments, beginning within 2–4 weeks of hospital discharge, using the following screening tools: Montreal Cognitive Assessment test; Hospital Anxiety and Depression Scale; Impact of Event Scale-Revised (post-traumatic stress disorder); 6-minute walk; and/or the EuroQol-5D-5L, a health-related quality of life measure (physical function). Conclusions: Beginning with an assessment of a patient’s pre-ICU functional abilities at ICU admission, clinicians have a care coordination strategy to identify and manage impairments across the continuum. As hospital discharge approaches, clinicians should use brief, standardized assessments and compare these results to patient’s pre-ICU functional abilities (“functional reconciliation”). We recommend serial assessments for post-intensive care syndrome-related problems continue within 2–4 weeks of hospital discharge, be prioritized among high-risk patients, using the identified screening tools to prompt referrals for services and/or more detailed assessments.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mactavish, Mrs Pamela and McPeake, Dr Jo
• Authors: Mikkelsen, M. E., Still, M., Anderson, B. J., Bienvenu, O. J., Brodsky, M. B., Brummel, N., Butcher, B., Clay, A. S., Felt, H., Ferrante, L. E., Haines, K. J., Harhay, M. O., Hope, A. A., Hopkins, R. O., Hosey, M., Hough, C. "T." L., Jackson, J. C., Johnson, A., Khan, B., Lone, N. I., MacTavish, P., McPeake, J., Montgomery-Yates, A., Needham, D. M., Netzer, G., Schorr, C., Skidmore, B., Stollings, J. L., Umberger, R., Critical Care Registered Nurse-Knowledge, , Andrews, A., Iwashyna, T. J., and Sevin, C. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Critical Care Medicine
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 0090-3493
• ISSN (Online): 1530-0293
• Published Online: 18 September 2020
• Copyright Holders: Copyright © by 2020 Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
• First Published: First published in Critical Care Medicine 48(11): 16701-679
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303784		Collaboration Assessment of ICU Recovery Needs	Tara Quasim	Society of Critical Care Medicine (SCCM)	GN17CC589	Med - Anaesthesia
307748		Improving health and social care integration delivery in the acute care environment	Joanne McPeake	University of Cambridge (HEI-CAMB)	RG88620	HW - MRC/CSO Social and Public Health Sciences Unit