Society of Critical Care Medicine’s International Consensus Conference on Prediction and Identification of Long-Term Impairments after Critical Illness

Mark E. Mikkelsen , Mary Still , Brian J. Anderson , Nazir I Lone

Research output: Contribution to journalArticlepeer-review

Abstract

Background: After critical illness, new or worsening impairments in physical, cognitive, and/or mental health function are common among patients who have survived. Who should be screened for long-term impairments, what tools to use, and when, remain unclear.
Objectives: Provide pragmatic recommendations to clinicians caring for adult survivors of critical illness related to screening for post-discharge impairments.
Participants: 31 international experts in risk-stratification and assessment of survivors of critical illness, including practitioners involved in the Society of Critical Care Medicine’s (SCCM) Thrive Post-ICU Collaboratives, survivors of critical illness, and clinical researchers.
Design: SCCM consensus conference on post-intensive care syndrome (PICS) prediction and assessment, held in Dallas, in May, 2019.
Meeting Outcomes: We concluded that existing tools are insufficient to reliably predict PICS. We identified factors before (e.g., frailty, pre-existing functional impairments), during (e.g., duration of delirium, sepsis, acute respiratory distress syndrome), and after (e.g., early symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD)) critical illness that can be used to identify patients at high-risk for cognitive, mental health, and physical impairments after critical illness in whom screening is recommended. We recommend serial assessments, beginning within 2-4 weeks of hospital discharge, using the following screening tools: Montreal Cognitive Assessment test; Hospital Anxiety and Depression Scale; Impact of Event Scale-Revised (PTSD); 6-minute walk and/or the EuroQol-5D-5L (physical function).
Conclusions: Beginning with an assessment of a patient’s pre-ICU functional abilities at ICU admission, clinicians have a care coordination strategy to identify and manage impairments across the continuum. As hospital discharge approaches, clinicians should use brief, standardized assessments and compare these results to patient’s pre-ICU functional abilities (“functional reconciliation”). We recommend serial assessments for PICS-related problems continue within 2-4 weeks of hospital discharge, be prioritized amongst high-risk patients, using the identified screening tools to prompt referrals for services and/or more detailed assessments.
Original languageEnglish
JournalCritical Care Medicine
Early online date18 Sep 2020
DOIs
Publication statusE-pub ahead of print - 18 Sep 2020

Fingerprint

Dive into the research topics of 'Society of Critical Care Medicine’s International Consensus Conference on Prediction and Identification of Long-Term Impairments after Critical Illness'. Together they form a unique fingerprint.

Cite this