2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Continuum of Intensive Care / Continuum of Intensive Care
2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Continuum of Intensive Care
2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Continuum of Intensive Care
1
Emotional and Psychological Recovery After ICU
Indunil Karunarathna
1
,S Gunathilake
1
, Kapila De Alvis
1
, K Gunawardana
1
, S Rajapaksha
1
, A Warnakulasooriya
1
, P
Athulgama
1
, Sanjeewa Dius
1
, R Ranwala
1
, Sau Bandara
1
, Sanjaya Godage
1
, PN Rodrigo
1
, Asoka Jayawardana
1
, U
Vidanagama
1
, C Fernando
1
, U Ekanayake
1
, T Hapuarachchi
1
, P Gunasena
1
, P Aluthge
1
, N Perera
1
,
1. Ministry of Health / Teaching Hospital Badulla / University of Colombo. 2024 © Uva Clinical Anaesthesia and Intensive Care ISSN 2827-7198 / Continuum of
Intensive Care
Abstract: Traditionally, critical illness was viewed as an isolated event, with intensive care units (ICUs) operating
somewhat independently and often serving as a last resort for severely ill patients who could no longer be managed
on general wards. However, there is growing recognition that critical illness is part of a broader disease trajectory, and
optimizing outcomes requires comprehensive management before, during, and after ICU admission. Early
identification of critical illness, prior to it becoming life-threatening, is a significant challenge. This process
necessitates enhanced and continuous monitoring of at-risk patients, staff training to detect clinical deterioration,
effective systems for escalating care, and timely responses.
The availability of critical care physicians 24/7 and the establishment of rapid response or medical emergency teams
equipped with intensive care expertise have enhanced the capacity to assess and manage deteriorating patients on
wards, initiate early interventions, and determine the need for ICU admission. Early involvement of intensivists is also
crucial for patients undergoing high-risk procedures, such as transplantation or cardiac surgery.
Post-ICU care considerations begin during the ICU stay, with efforts focused on mitigating long-term physical and
psychological effects of critical illness. Strategies such as minimal sedation, effective communication, and early
mobilization play pivotal roles in improving patient recovery and minimizing sequelae.
Keywords: Disease trajectory, Communication, Outcomes, Critical illness, Post-ICU care, ICU discharge, Continuum
of care, ICU readmissions, Post-Intensive Care Syndrome (PICS), Multidisciplinary teams, Telemedicine, Patient
outcomes, Psychological recovery, Family support, Rehabilitation, Monitoring systems, Standardization,
Communication tools, Emotional well-being, ICU-acquired weakness, Long-term care
Key Points
ICU Discharge Decisions: Premature discharges increase
risks; proper timing is critical.
Communication: Essential for transitions; ensures
continuity and clarity in care.
Monitoring Post-ICU: Early detection of deterioration
reduces readmissions and improves outcomes.
Post-ICU Clinics: Address physical, psychological, and
emotional needs; enhance recovery.
Post-Intensive Care Syndrome (PICS): Includes
physical, cognitive, and emotional challenges requiring
holistic care.
Family Involvement: Educating and supporting families
is vital for the recovery process.
Telemedicine: Offers virtual follow-ups, improving
accessibility and continuity of care.
Multidisciplinary Teams: Collaboration among
healthcare providers enhances patient outcomes.
Standardized Protocols: Necessary for consistent and
effective post-ICU care.
Rehabilitation: Physical and cognitive therapy tailored to
individual needs.
Patient Empowerment: Involving patients in their
recovery planning fosters better outcomes.
Emotional Health: Psychological support mitigates
PTSD and depression risks.
Timing of Care: Avoiding out-of-hours discharges
improves safety.
Continuity Across Settings: Seamless transitions
between ICU, ward, and home reduce gaps in care.