Abstract
Each year, many patients across the world are admitted to Intensive Care Units (ICUs). Patients in these units require close monitoring and advanced therapeutic support to maintain the function of their vital organs. This type of care cannot be provided on a standard ward since specialized devices and techniques are required, along with the experience of those staff members who have been trained in their use.
Admission to an ICU can occur as a planned event such as after elective surgery or as an unplanned event as the result of an emergency admission. In either scenario, it is a significant in-hospital experience and one that affects patients in different ways. Whilst there is an abundance of literature about the clinical management of patients on the ICU, what is less frequently written about, are the specific effects of such an admission (both long- and short-term) on patients and their next of kin. In this special collection, we explore how admission to the ICU affects both patients and their caregivers.
Patients in the ICU may develop multiple health problems related to their original illness as well as secondary problems due to mechanical ventilation and other invasive treatments. Post-intensive care syndrome (PICS) is a collection of physical, cognitive, and mental health-related symptoms that continue to persist after a patient leaves the unit and it can affect anyone who survives a critical illness. Physicians have traditionally focused on the immediate, short-term outcomes of ICU patients; however, there is now more awareness of the longer-term outcomes of ICU survivors. It is now recognized that, although ICU survival has improved, patients do not return to their former level of functioning for some time even after discharge from the unit. In addition to the critically ill ICU survivor, the family and loved ones who provide the needed care and support can also develop similar mental health-related symptoms of PICS. The quality of life of both the patient and caregivers can therefore be affected by an admission episode to the ICU.
Our aim is to provide an overview of topics relating to the experience of patients and their caregivers in the ICU. Recurrent themes have emerged such as the importance of communication, shared decision making, and identification of the longer-term effects that contribute to PICS.
The article by Professor Ross Zbar, from the United States, vividly describes his own experience as a patient in the ICU and his journey in managing the sequelae of PICS. From the United Kingdom (UK), Eskell et al. report the experience from our own ICU of the consequences of restricted visiting during the coronavirus disease 2019 (COVID-19) pandemic and how this impacted on patients and their families. Suggestions are also made relating to chaplaincy support for patients who were unable to be visited by loved ones. Restricted visiting, although necessary during the pandemic, further added to the burden of PICS experienced by ICU survivors and their caregivers.
Similarly, the case report by Özlü et al from Turkey describes the effects that critical illness in a newborn child can have on a family. The case report explores the complex effects on the role of the mother and change in role of the spouse. Abeywickrema et al. from the UK discuss the issues around end-of-life care decisions and emphasize the importance of communicating decisions with sensitivity. They highlight the importance that ICU teams play in ensuring that shared decision-making discussions occur early, allowing compassionate care to be placed at the heart of ICU management. Bulbuloglu et al. discuss the effect of environmental stressors on patient experience in the medical, surgical, and COVID-19 ICUs in a Turkish healthcare system. Drury et al. report on their results from a randomized controlled trial in three ICUs in Western Australia. The intervention involved the use of printed prompts for families prior to meetings with ICU staff. They make suggestions for future studies exploring the improvement of communication with families and how to support them as surrogate decision makers on behalf of ICU patients.
We hope that this collection, which describes the multiple challenges encountered by patients and caregivers in a modern ICU setting, will be of interest not only to physicians directly involved in the specialty but also to the wider public. Through raising awareness of the problems encountered by our patients, we hope to provide them with the enhanced support that they need after an admission to the ICU.
