Post Intensive Care Syndrome

Transcription

1 Post Intensive Care Syndrome Annie Johnson APRN, ACNP BC, CCRN Mayo Clinic Rochester, MN February 28 th, 2018 Disclosures Relevant Financial Relationship Award from Society of Critical Care Medicine: Thrive Peer Support Collaborative

2 Learning Objectives Define Post Intensive Care Syndrome (PICS), associated risk factors, and long term consequences Recognize available resources to address PICS through education, therapy, and support groups Integrate knowledge into practice to guide at risk patients/families towards available resources Breaking it down What do we know? What are we doing about PICS now? What can you do?

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4 Breaking it Down What do we know? What are we doing about PICS now? What can you do? Definition Impairments in physical, cognitive or mental health Needham DM et al. Crit Care Med Feb;40(2):502-9.

5 Physical Pain Weakness Muscle loss Neuropathy Decreased appetite Hair loss Beau s lines Cognitive Memory disorders Difficulty with executive function Aphasia Mental Anxiety Depression PTSD Insomnia Physical Critical illness = functional decline or early death Ferrante et. Al, JAMA Internal Medicine, April 2015 Volume 175(4) Mechanical ventilation and sepsis = ICU Acquired Weakness (ICUAW) Davidson, et al. AACN Advanced Critical Care Vol. 27(2) 2016

6 Cognitive BRAIN ICU study: 821 pts enrolled adult, resp failure, septic shock, or cardiogenic shock 40% = moderate traumatic brain injury 26% = Alzheimer s Disease Jackson et al. The Lancet. Respiratory Medicine, 2(5), Mental Health 621 acute respiratory distress survivors 80% = anxiety 68% = depression 46% = PTSD 33% = all three domains Huang, M. et al. Crit Care Med May;44(5):954 65

7 Risk Factors Critical illness/injury Sepsis, ARDS, MOF, shock, NMB drugs Anxiety, pain Pre existing conditions Hypoxemia, hypo/hyperglycemia Sedation Mechanical ventilation Delirium Independent risk factor for disability with ADLs Longer duration of delirium = worse cognitive outcome Gunther ML et al. Crit Care Med Jul;40(7): Brummel NE et al. Crit Care Med Feb;42(2):

8 Incidence of Delirium in ICU Up to 80% of patients on mechanical ventilation develop delirium Karnatovskaia LV, et al. J Crit Care Feb;30(1):130 7 BRAIN ICU study = 74% positive for delirium Jackson et al. The Lancet. Respiratory Medicine, 2(5), Incidence of PICS 44% with no symptoms of PICS however 56% of pts did 20% of patients with symptoms had overlap 7% physical 16% cognitive 4% all 3 13% mental health Jackson JC, et al.lancet Respir Med May;2(5):369 79

9 Long Term Consequences in hospital length of stay/readmissions Negative impact on quality of life Posttraumatic stress disorder, anxiety, depression Functional disability Delay in return to work or even loss of work Burden of caregiving can lead to PICS F and isolation Norman BC et al. Crit Care Med Nov;44(11): What can be done?

10 PATIENT S PERSPECTIVE ON POST ICU SYNDROME Breaking it Down What do we know? What are we doing about PICS now? What can you do?

11 Global Initiative Awareness, Research, Support Awareness intensive Care Syndrome.aspx icudelirium.org icusteps.org connect.mayoclinic.org/page/pics/ diary.org/diary/start.html

12 Research Prevention

13 Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients* Barnes Daly, Mary Ann MS, RN, CCRN, DC; Phillips, Gary MAS; Ely, E. Wesley MD, MPH, FCCM Critical Care Medicine: February 2017 Volume 45 Issue 2 p doi: /CCM Feature Articles Research Treatment Post ICU follow up

14 Support

15 Support SCCM Thrive Facebook Page ICUsteps Mayo Clinic Connect More Learning Objectives What do we know? What are we doing about PICS now? What can YOU do?

16 What is your role? Recognize & Raise awareness Prevent Support Recognize Know pts history and look for s/s of PICS Summary: New or worsening impairment in physical, cognitive, and/or mental status Risks = DELIRIUM, critical illness Don t forget about family!

17 Awareness = Educate Use your resources! Summary: Great sites exist Create your own! Educate not only the pts/families, but each other as well Prevent Prevent delirium Summary: Become familiar with the ABCDEF bundle ICU Liberation: websites, conferences, podcasts, etc. Proven to positively affect pt outcomes

18 Support Refer patients/family members to support group Consider development of face to face support group Summary: Pts are not alone but often feel like it Join international collaborative/create a local support system Listen to their stories All I remember is darkness. Nothingness No one told me what happened so I was very confused as to where I was and why I m still trying to make sense of it all. ICU via Mayo Clinic Connect I am a year out I cry at the drop of a hat. I went back to work full time only to find I cannot physically do the work due to the pain. ICU via Mayo Clinic Connect Information is what I needed the little things like the memory problems, the massive muscle weakness, the length of recovery, the weakness and fatigue which felt like it would never end. The sudden crying, the being so easily startled, the anxieties about seemingly little things, I needed reassurance that it wasn't just me. ICU survivor:

19 WE HAVE AN ETHICAL AND PROFESSIONAL RESPONSIBILITY TO ADDRESS THE UNMET NEEDS OF PATIENTS WITH PICS MAURENE HARVEY, SCCM 2016 TAKE HOME MESSAGE Special Thanks Lisa Daniels, MD Devang Sanghavi, MD Andrea Lehnertz, APRN, CNS Katie Bowron, RN Mitch Moore, PhD Karnatovskaia, MD Stephanie Schleiger, RN Amelia Tetlie, RN Jenn Elmer, APRN, CNS, DNP Tami Marsland Melania Zell, RN Chris Farmer, MD Moreno Franco, MD Grace Arteaga, MD Daniel Rohe, PhD, LP Margaret Gowan Jan Vrchota, APRN, CNS Devin Roloff, MBA Jazarea LaRocque, RN And above all Amanda Gobin, RN Heidi Moser, RN Emily Dong, RN our patients! Alison Rideout, RN Amelie Tetlie, RN Norman Purmal, RN Whitney Gessert, RN Jessica Fretty, RN Erica Wagner, RN Emily Hayes, RN Marina Steinhauer, RN Katherine Letellier, RN Shawn Bishop Colleen Young Shen, YongChun, M.D. Survey Research Center Critical Care IMP Biomedical Statistics Those we forgot

20 References Barnes Daly, Mary, Ann MS, RN, CCRN, DC, Phillips, Gary, Ely, E. & Wesley MD, MPH. (2017). Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals: Implementing PAD Guidelines Via the ABCDEF Bundle in 6,064 Patients*. Critical Care Medicine, 45, doi: / CCM Brummel, N. E., Jackson, J. C., Pandharipande, P. P., Thompson, J. L., Shintani, A. K., Dittus, R. S., Girard, T. D. (2014). Delirium in the Intensive Care Unit and Subsequent Long term Disability Among Survivors of Mechanical Ventilation. Critical Care Medicine, 42(2), Davidson, Judy, RN, DNP & Harvey, Maurene. (2016). Patient and Family Post Intensive Care Syndrome. AACN Advanced Critical Care, 27, doi: /aacnacc Ferrante, L. E., Pisani, M. A., Murphy, T. E., Gahbauer, E. A., Leo Summers, L. S., & Gill, T. M. (2015). Functional Trajectories Among Older Persons Before and After Critical Illness. JAMA Internal Medicine, 175(4), Gunther, M. L., Morandi, A., Krauskopf, E., Pandharipande, P., Girard, T. D., Jackson, J. C., for the VISIONS Investigation (VISualizing Icu SurvivOrs Neuroradiological Sequelae). (2012). The Association between Brain Volumes, Delirium Duration and Cognitive Outcomes in Intensive Care Unit Survivors: A Prospective Exploratory Cohort Magnetic Resonance Imaging Study. Critical Care Medicine, 40(7), References Huang, M., Parker, A. M., Bienvenu, O. J., Dinglas, V. D., Colantuoni, E., Hopkins, R. O., & Needham, D. M. (2016). Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A One Year National Multi Center Study. Critical Care Medicine, 44(5), Jackson, J. C., Pandharipande, P. P., Girard, T. D., Brummel, N. E., Thompson, J. L., Hughes, C. G., for the BRAIN ICU (Bringing to light the Risk Factors And Incidence of Neuropsychological dysfunction in ICU survivors) Study Investigators++. (2014). Depression, Posttraumatic Stress Disorder, and Functional Disability in Survivors of Critical Illness: results from the BRAIN ICU (Bringing to light the Risk Factors And Incidence of Neuropsychological dysfunction in ICU survivors) Investigation: A Longitudinal Cohort Study. The Lancet. Respiratory Medicine, 2(5), (14) Karnatovskaia, Lioudmila, Johnson, Margaret, Benzo, Roberto & Gajic, Ognjen. (2015). The spectrum of psychocognitive morbidity in the critically ill: A review of the literature and call for improvement. Journal of Critical Care, 30, doi: /j.jcrc Needham, Dale, MD, PhD, Davidson, Judy, DNP, RN, Cohen, Henry, Hopkins, Ramona, et al. (2012). Improving longterm outcomes after discharge from intensive care unit: Report from a stakeholders' conference*. Critical Care Medicine, 40, doi: /ccm.0b013e318232da75 Norman, Brett, Jackson, James, Graves, John, Girard, Timothy, MD, MSCI, Pandharipande, Pratik, et al. (2016). Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort*. Critical Care Medicine, 44, doi: /ccm

21 To Contact Me Annie Johnson APRN, ACNP BC, CCRN Mayo Clinic Rochester, MN