Long-term complications of critical care.
OBJECTIVE
As critical care advances and intensive care unit mortality declines, the number of survivors of critical illness is increasing. These survivors frequently experience long-lasting complications of critical care. As a result, it is important to understand these complications and implement evidence-based practices to minimize them.


METHODS
Database searches and review of relevant medical literature.


RESULTS
Critical illness and intensive care unit care influence a wide range of long-term patient outcomes, with some impairments persisting for 5-15 yrs. Impaired pulmonary function, greater healthcare utilization, and increased mortality are observed in intensive care survivors. Neuromuscular weakness and impairments in both physical function and related aspects of quality of life are common and may be long-lasting. These complications may be reduced by multidisciplinary physical rehabilitation initiated early and continued throughout the intensive care unit care stay and by providing patient education for self-rehabilitation after hospital discharge. Common neuropsychiatric complications, including cognitive impairment and symptoms of depression and posttraumatic stress disorder, are frequently associated with intensive care unit sedation, delirium or delusional memories, and long-term impairments in quality of life.


CONCLUSIONS
Survivors of critical illness are frequently left with a legacy of long-term physical, neuropsychiatric, and quality of life impairments. Understanding patient and intensive care risk factors can help identify patients who are most at risk of these complications. Furthermore, modifiable risk factors and beneficial interventions are increasingly being identified to help inform practical management recommendations to reduce the prevalence and impact of these long-term complications.
Section of Pulmonary/Critical Care Medicine, Washington Hospital Center, Washington, DC, USA.
Sanjay V
SV
Desai
Tyler J
TJ
Law
Dale M
DM
Needham
D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D003266:Continuity of Patient Care; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003693:Delirium / Q000453:epidemiology / Q000209:etiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology; D008991:Monitoring, Physiologic / Q000379:methods; D009468:Neuromuscular Diseases / Q000453:epidemiology / Q000209:etiology; D011788:Quality of Life; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment; D017741:Survivors; D013995:Time