Viva - Rehab

Question 1

Imporance of rehab

Answer 1

Regain quality of life after critical illness

Reduce economic burden

• ongoing medical/psych care
• patient earning
• Carers and family members
• government benefits

Question 2

Why do we need rehab

Answer 2

Physical problems
Weakness

Can’t self care/work

25% of pts need help with self care.

Psych - relationships, normal activity’s

Question 3

Outline the ongoing rehab issues

Answer 3

Physical, Psych, Nutiriton, Pain, Drugs

Physical - weak, stiff, paraetheisa
Postural hypotension
Low CV reserve
Incontinence, sexual dysfunction, communication issues (trachy)
Iatrogenic - tracheal stenosis etc

Psych - anxiety, PTSD, survivors guilt, depression, guilt for relatives/burden
Effect of scars/marks
Poor sleep cycle (related to opiates/benzos)
Cognition - memory, low attention, confused, apathy

Nutrition - low appetite, altered taste and smell, swallowing

Chronic pain

Drug withdrawal

Ongoing organ support - RRT, nutrition, VADs

Question 4

How to test whether rehab has worked

Answer 4

HRQoL tools - SF36, EuroQol 5d (mobility, self care, actives, pain, anxiety)

Beware loss to follow up (those who do well will want to tell you)

Use of follow up clinics - NICE guidance
Poor uptake, evidence for usefulness?? Too sick to go, too well to go.

PRACTICAL study - nurse led follow up - no benefit

Question 5

Rehab interventions

Answer 5

NICE CG83 and ICS rehab prescriptions

Intervene early!
Assess the patient and their rehab needs
Any pre-existing issues

Set goals - short (before discharge), medium (normal activity)

Consider CPAx.

Debrief family and patient.

MDT, things to reduce ICU-AW

Follow up, recovery times

Question 6

What is PTSD

Answer 6

9-27% of ITU survivors

Severe anxiety triggered by recurrent re-living of life events

Lasts over a month

Impairs social function

Triad - intrusive unpleasant flashbacks
Avoidance behaviours
Increased level of alertness

Question 7

Risk factors for PTSD

Answer 7

Previous psych issues
Sedation and prolonged MV
Benzos
Delirium
ARDS
Sepsis

Factual memory reduces PTSD - follow up clinic may allow to address flashback

Diaries - though evidence is mixed

Question 8

Role of outpatient clinic

Answer 8

Early diagnosis of sequela and refer
Long term outcome data
Patient feedback
Advise/reassures
Assess previous decision making