Interventions to improve long-term outcomes after critical illness.
OBJECTIVE
The aim of this article is to review the literature specifically on interventions that are targeted at improving health related quality of life in survivors of critical illness. Although there is a growing literature describing the impairment in quality of life of survivors of critical illness, there are a considerably smaller number of studies describing effective interventions at treating or preventing these complications. The topic is complex because critical illness spans a number of diseases including spinal cord injury and myocardial infarction that have an extensive rehabilitation literature.


RESULTS
To date there are limited studies to guide clinicians in treatments to prevent or treat the sequelae of critical illness. Standard therapies such as daily interruption of sedation and lung protective ventilation do not appear to worsen long-term outcomes. Insulin therapy and stress dose corticosteroids may be beneficial in preventing neuromuscular complications and posttraumatic stress disorder, respectively. A self-help manual for survivors appears to improve physical functioning.


CONCLUSIONS
Research interest in developing interventions to improve long-term outcome after critical illness is in its infancy and it is too early to make strong clinical recommendations. Multiple potential treatment areas exist both within the ICU and after patients leave the hospital for intensivists to target.
Rubenfeld
Gordon D
GD
Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. nodrog@u.washington.edu
D000367:Age Factors; D019090:Case Management; D015897:Comorbidity; D016638:Critical Illness; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011788:Quality of Life; D012944:Social Support; D017741:Survivors