Care of ICU survivors in the community: a guide for GPs

Specialists in intensive care medicine have long focused on the prevention of short-term mortality. As intensive care unit (ICU) mortality continues to improve, interest in outcome measures has expanded to include the morbidity and mortality of survivors. Over the last 10 years it has been increasingly recognised that critical illness is a medical condition itself, irrespective of the underlying cause for ICU admission, and patients experience physical, psychological, and cognitive dysfunction after hospital discharge (Figure 1). However, because relatively few patients ultimately require critical care, many GPs may have little contact with these patients. It may therefore be difficult to provide the additional support required by ICU survivors. This short paper highlights some of the physical and psychological difficulties that patients face after discharge from ICUs, and will hopefully help GPs to plan long-term management of their patients in the community. Figure 1. Post-intensive care syndrome signs and symptoms. ICU = intensive care unit. PTSD = post-traumatic stress disorder. Twenty-five per cent of patients who survive ICU report symptoms consistent with post-traumatic stress disorder (PTSD), with patients who have a previous history of anxiety or depression being at highest risk of developing PTSD. Critical illness results in PTSD in 22% of cases1 for a variety of reasons — patients suffer life-threatening illness, the treatments provided are often invasive, many medications used have neurological and psychological effects (in particular benzodiazepines, corticosteroids, inotropes, and vasopressors), and almost all patients will experience sleep deprivation, …