This document discusses follow up care after critical illness. It notes that more patients are surviving critical illness but often experience post-intensive care syndrome (PICS), which can impair physical, cognitive, or mental health after leaving the ICU. Quality of life is often impaired for ICU survivors regardless of their initial diagnosis. Follow up clinics have been shown to improve coordination of care and patient/family satisfaction. The document advocates for a multidisciplinary approach to follow up care and evaluates initiatives like the SCCM THRIVE program to understand survivor experiences and how to improve recovery support.

1. Follow up after critical illness
Naomi Hammond
Post-Doctoral Research Fellow/Operational Lead –Critical Care Division, TGI
Clinical Research Manager - Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital
Senior Lecturer – UNSW Sydney
@NaomiHammond

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4. Increased number of survivors
Iwashyna, J Am Geriatr Soc. 2012

5. But it’s not just about survival

6. Post intensive care syndrome
“New or worsening impairments in physical,
cognitive or mental health status arising after
critical illness and persisting beyond acute care
hospitalisation. The term can be applied to a
survivor (PICS) or family member (PICS-F)”
Elliot, R., et al. Crit Care Med. 2014
Needham, D.M. et al. Crit Care Med. 2012

7. Conceptualising PICS
Needham, D.M., et al. Crit Care Med, 2012

8. Thompson et al, ICM, 2018
38%
45%
42% 37%25%
Quality of life in sepsis and non-sepsis patients
Regardless of diagnosis
post ICU quality of life
may be impaired

9. Thompson et al, ICM, 2018
38%
45%
42% 37%25%
Quality of life in sepsis and non-sepsis patients

10. Is an ICU follow-up clinic the answer?
Cuthbertson, B.H., et al. BMJ 2009
Schmidt, K., et al. JAMA 2016

11. Is it how we measure QOL?

12. JAMA Intern Med, 2015
Post-ICU rehab didn’t improve HRQOL
BUT, those receiving the intervention reported
greater satisfaction with coordination of care,
health service referrals, and information received

13. The patient experience
“I had nightmares so
vivid they stay with
you…like when I was a
child”
“My first memory is
waking up to a priest at
the end of the bed who
told me I’d be dead by
Tuesday”
“I remember
nothing”
“I’m very relieved to
hear other people had
nightmares. I thought I
was the only one”

14. The patient experience
BRAIN-ICU Study, NEJM, 2013

15. Crit care 2009
Important contribution to physical, emotional and
psychological recovery
Provided continuity of care for tests, monitoring, referrals
Those without felt abandoned or disappointed due to no
feedback on progression, no referrals, or ability to find out
about their illness/ICU stay

16. 16
We can’t forget the family “She’s different now.
She’s not the same
person as she was when
she came in”

17. Multidisciplinary approach
Huggins, E.L,AACN Adv Crit Care 2016

18. Aim:
Evaluate the SCCM THRIVE Initiative via
• Identifying what helped survivors in their recovery
• Capture elements of survivorship that are generalizable
regardless of follow up or not
• Gain knowledge to feed back into the initiatives
Primary: Survivorship experience from patients
2ndry: Survivorship experiences from caregivers and clinicians
Collaborative Assessment of ICU Recovery Needs (CAIRN)
NCT03513289

19. More patients are surviving critical illness
PICS is a very real problem in both the patient and the
family
Follow up is important to patients and family
A one stop shop
A multidisciplinary team approach
Take home message

20. What would you want for follow
up after ICU?