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Did Nietzsche Know Anything About Critical Illness Survivors? by Margaret Herridge

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Traditionally, the focus of critical care has simply been on keeping patients alive. This is not enough, now we need to focus on giving them their lives back too. Learn about the challenge of critical care survivorship in this talk.

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Did Nietzsche Know Anything About Critical Illness Survivors? by Margaret Herridge

  1. 1. Did Nietzsche Know Anything about Critical Illness Survivors? Margaret Herridge
  2. 2. I have no conflict of interest to declare
  3. 3. That which doesn’t kill us makes us stronger
  4. 4. 4
  5. 5. Toronto ARDS Outcomes Program
  6. 6. N Engl J Med 2011; 364:1293-304
  7. 7. 7 Am J Resp Crit Care Med 1999:160:50 Brain Imaging and Behavior 4:22-34, 2010 N Engl J Med 2013;369:1306-16 • Cognitive Dysfunction • Moderate TBI • Mild Alzheimer Dementia • Depression 17-43%
  8. 8. Persecutory Delusions/PTSD Crit Care Med 1998; 26: 651-9 BMJ 1999; 319:427-9 Crit Care 2010; 14: 125
  9. 9. 9 General Health and Vitality Decline Linked to Healthcare Utilization and Cost N Engl J Med 2011; 364:1293-304
  10. 10. Toronto ARDS Outcomes Program
  11. 11. Toronto ARDS Outcomes Program
  12. 12. Toronto ARDS Outcomes Program
  13. 13. 13
  14. 14. 15
  15. 15. 17 • ~30 % moderate to severe depressive symptoms and PTSD at 1 year AJRCCM 2005; 17: 987-994 N Engl J Med 2016;374:1831-41
  16. 16. Post Traumatic Growth Trauma may be defined as any event that profoundly changes an individual’s fundamental schemas, beliefs, goals and that affects the individual’s narrative Subjective experience of positive psychological change as a result of struggle with trauma- may occur with mood disorders Clinical Psychology Review 2006;26:626-53
  17. 17. 19 Determinants of PTG • Women > Men • Younger > Older • Higher Income and Education • Extraversion/Openness/Agreeableness Journal of Traumatic Stress 2004:17:11-21 Journal of Loss and Trauma 2009;14:364-388
  18. 18. 20 1. Changes in Perception of Self 2. Changes in Experience of Relationships 3. Change in One’s Life Philosophy
  19. 19. 21 Preparedness and Resilience • Ability of transformed assumptive worlds to resist subsequent trauma • To ‘bounce back’ from another psychological earthquake Caloun and Tedeshi, 2014
  20. 20. He who has a why to live can bear almost any how
  21. 21. 23
  22. 22. 24 • Embrace continuum of illness and recovery • Disability, Resilience and Growth • Know your Patient and their Loved Ones • Listen and Sustain Hope • Be Honest about Uncertainty

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