POST-INTENSIVE CARE SYNDROME & OTHER LONG-TERM PHYSICAL AND COGNITIVE DISABILITY
Definition: Generally defined as new or worsening cognitive, psychiatric, and/or physical function
- Cognitive: Memory, executive function
- Psychiatric: Depression, anxiety, PTSD
- Physical: ICU-acquired weakness is most common
Risk factors:
- Pre-existing factors: Neuromuscular disorders, prior cognitive impairment, psychiatric disease, frailty, medical comorbidities
- ICU-specific factors: Mechanical ventilation, delirium, sepsis, ARDS
Management:
- Daily sedation interruptions, delirium avoidance and management, early ambulation and physical therapy, nutritional optimization, avoidance of hypoglycemia and hypoxemia
- Post-discharge treatment with physical therapy and rehab, occupational therapy, social support, mental health services
Clinical importance:
See Also7 Must-Have ICU Nursing Skills | AMN HealthcareWhat are the 6 Cs and why are they important?Report: Trends in Nursing 2024 | IntelyCareIntensive care unit stress and burnout among health-care... : Indian Journal of Psychiatry- Survivors of critical illness report lower quality of life (QOL) scores
- Family members of survivors report lower QOL scores
- Survivors of critical illness have higher likelihood of rehospitalization, higher unemployment rates, and higher overall mortality
COMPLICATIONS ASSOCIATED WITH MECHANICAL VENTILATION
See “Intubation and Mechanical Ventilation” under Key Medications and Interventions
DELIRIUM
Definition: Sudden, acute onset, fluctuating changes in consciousness and cognition
- Can be hypoactive (diminished responsiveness, apathy) or hyperactive (agitation)
Importance:
- Delirium increases hospital length of stay and mortality (3× in mechanically ventilated patients), long-term cerebral dysfunction, SNF placement, and dementia after ICU discharge
- Common: Prevalence of 50% in ICU patients
Risk factors:
- Nonmodifiable: Older age, cognitive impairment/dementia, substance use disorder
- Modifiable: Medications, pain, acute renal failure, critical illness, environment, weakness, extra drains, lines and tubes
Assessment: CAM-ICU (Confusion Assessment Method): validated, RN-driven protocol
Management:
- Reverse underlying cause(s)
- Maximize nutrition
- Reorientation
- Correct sensory deficits (e.g., replace hearing aids, glasses)
- Limit extraneous stimuli in the environment
- Promote normal sleep pattern
- Avoid restraints if possible. Use bedside coaches/sitters
- Pharmacologic management (if all earlier interventions fail): Use with caution, best indication is to protect patient/staff safety if pulling at devices or interfering with care; no evidence that antipsychotics reduce duration of delirium or mortality
Antipsychotics (haloperidol, quetiapine, risperidone)
Benzodiazepines only if withdrawal is suspected
INFECTIONS
Central line-associated bloodstream infections (CLABSI)
Pathogens:
- Typically skin flora with coagulase-negative staph, S. aureus, enterococci. Infections with Gram-negative organisms (E. coli, Klebsiella, Pseudomonas) less common
- Often infection from skin colonization but can be from hematogenous spread from bloodstream infection occurring from another, distant focus
Risk factors: Duration of use, catheter material, insertion conditions, site care, placement site (subclavian < internal jugular ≤ femoral), host immunodeficiency
Clinical importance: Nosocomial infection associated with higher morbidity and mortality
Management: Empiric systemic antibiotics, catheter removal. May need ID consultation depending on the organism/clinical situation.
Catheter-associated UTI (CAUTI)
Definition: Culture growth of ≥1000 CFU/mL with symptoms compatible with UTI in a patient with an indwelling urethral or suprapubic catheter OR in a patient who had ...
