Passport to Successful Outcomes for Patients Admitted to ICU - Meeting Patient Goals of Care (Oct 4, 2024)_(3031530187)_(Springer).pdf

The second edition builds upon the previous content, exploring new and emerging evidence to enhance the structure and content of rehabilitation provided. It considers the additional impact of COVID-19 throughout each chapter. In addition, sadly not every patient survives their critical illness but good, multidisciplinary and holistic care is just as essential for these patients. The editors have added a chapter on end of life care, focussing on the importance of personalised care and family involvement and on PICS. Since its publication in 2020, healthcare professionals have faced unprecedented challenges caused by the COVID-19 pandemic. High levels of illness severity, along with stretched critical care capacity and workforces, meant rapid development of new patient pathways were required. This has deepened our understanding of the physical, psychological and cognitive impact of critical illness, as well as the need for services to deliver multi-professional, holistic programmes ofrehabilitation to maximise outcomes. An admission to ICU with a critical illness has a well-recognised physical, psychological and social impact all on the individual and their loved ones. Successful discharge from ICU requires significant attention to detail on all aspects of care concurrently to ensure a return to the best quality of life achievable. It is imperative consideration to rehabilitation needs remain in sharp focus from admission and throughout the recovery pathway. Early focus on the provision of structured rehabilitation and avoidance /prevention of ICU related complications are paramount to improve both short and long term outcomes. The new edition explores key areas to consider and ensure rehabilitation is delivered in a holistic way. A focus on promoting the best quality of life for the individual by careful attention to detail, encouraging benchmarking at every stage of their ICU journey to track progress and identify those most at need. The chapters are written by a range of multidisciplinary ICU team members, providing expert guidance and an evidence based approach to improve outcomes and return patients to their families. Foreword Preface Contents 1: The Person Before the Patient: The Importance of a Good History 1.1 Introduction 1.2 When to Attain a Patient History in the ICU 1.3 How to Obtain an Effective Patient History in the ICU 1.3.1 Taking a History from the Patient 1.3.2 Taking a History from the Patient’s Relatives 1.3.3 Video Consultations 1.3.4 Family Liaison Teams 1.3.5 The Clinical Frailty Scale 1.3.6 Patient Questionnaires: Key Relative Involvement 1.4 What a Good History Should Include in the ICU 1.5 Why an Early, Detailed History Is Important 1.5.1 Family: Key Relationships 1.5.2 Mobility 1.5.3 Functional Status and Housing 1.5.4 Hobbies, Interests and Work 1.5.5 Medical History 1.5.6 Lifestyle History 1.5.7 Understanding and Expectations 1.6 Conclusions References 2: Respiratory and Mechanical Ventilation Management: Avoidance of Complications 2.1 Introduction 2.2 Respiratory Management During Invasive Mechanical Ventilation 2.2.1 Endotracheal Suctioning 2.2.2 Subglottic Suctioning 2.2.3 Humidification of Respiratory Gases 2.3 Chest Physiotherapy 2.3.1 Manual or Ventilator Pulmonary Hyperinflation 2.3.2 Manual Chest Compressions/Vibrations (MCC) 2.4 Mechanical In-Exsufflation (MI-E) 2.5 Inspiratory Muscle Training References 3: Patient Care: From Body to Mind 3.1 Introduction: Patient Care in a Critical Environment 3.2 ‘Interventional Patient Hygiene’ 3.3 Bathing and Skin Integrity 3.4 Oral Care 3.5 Eye Care 3.6 Pain Assessment and Nursing Care 3.6.1 Assessment 3.6.2 Management 3.7 Conclusion References 4: Nutrition: One Size Does Not Fit All 4.1 Introduction 4.2 Presence of Pre-existing Conditions on Admission to ICU 4.2.1 Chronic Co-morbidities 4.2.2 Sarcopenia 4.2.3 Malnutrition 4.3 Factors Which Affect Nutritional Status During ICU Stay 4.3.1 Metabolic Response to Critical Illness 4.3.2 Iatrogenic Undernutrition 4.3.3 Immobilisation 4.4 Assessing Malnutrition in the Critically Ill Patient 4.4.1 Nutrition Screening Tools 4.4.2 Muscle Mass 4.5 Strategies to Improve Physical and Functional Outcomes 4.5.1 Targeted Nutrition Delivery 4.5.2 Volume-Based Feeding 4.5.3 Energy Versus Protein 4.5.4 Exercise and Protein 4.5.5 Supplementation 4.6 Recovery Phase of Critical Illness 4.7 Adequacy of Nutrient Delivery 4.7.1 Factors Influencing Nutritional Recovery 4.8 Potential Strategies to Facilitate Optimal Nutritional Delivery in the Recovery Phase of Critical Illness 4.8.1 Coordinated Multidisciplinary Approach to Nutritional Care 4.8.2 Systematic Handover to Ward-Based Staff 4.8.3 Patient Centred Nutritional Care and Family Engagement 4.8.4 Conclusion References 5: Promoting Independence 5.1 Introduction: What Is Dysphagia? 5.2 Dysphagia Assessment and Screening 5.3 Bedside Assessment 5.4 Instrumental Assessment of Swallow 5.5 Causes and Presentations of Dysphagia in the ICU 5.6 Post-extubation Dysphagia 5.7 Ventilation and Dysphagia 5.8 Tracheostomy and Dysphagia 5.8.1 COVID-19 5.9 Rehabilitation Principles 5.10 Swallow Rehabilitation 5.11 Conclusion References 6: Mobility and Function 6.1 Introduction: The Impact of Bed Rest 6.1.1 Skeletal Muscles 6.1.2 Respiratory Muscles 6.1.3 Cardiovascular System 6.1.4 Bone 6.2 Benefits of Early Rehabilitation 6.3 Commencing Mobilisation 6.3.1 Sitting on Edge of the Bed 6.3.2 Standing 6.3.3 Considerations 6.3.4 Challenging Situations 6.4 How to Measure Patient and Service Outcomes 6.5 ICU Discharge to the Ward 6.6 Discharge from the Hospital, What Happens Next? 6.7 Conclusion References 7: Infection Prevention and Control: Simple Measures, Challenging Implementation 7.1 Introduction 7.2 Healthcare-Associated Infection in the ICU 7.2.1 Definitions and Impact 7.2.2 The Big Four 7.2.2.1 VAP 7.2.2.2 CLABSI 7.2.2.3 CAUTI 7.2.2.4 SSI 7.3 The ICU Is the Hospital’s Hot Zone for HAI 7.4 Prevention Works! 7.4.1 Basics of Infection Prevention 7.4.1.1 Standard and Transmission-Based Precautions 7.4.1.2 Hand Hygiene: Cornerstone of Infection Prevention and Control 7.4.1.3 Principles for Preventing All Device-Related Infections 7.4.2 Evidence-Based Guidelines for Preventing the Big Four 7.4.2.1 Which Guideline to Follow? 7.4.2.2 Healthcare Professionals’ Adherence to the Recommendations Is Low 7.4.2.3 Barriers to Adherence 7.4.2.4 Strategies to Improve Guideline Adherence 7.5 Conclusions References 8: The Power of Communication 8.1 Speech and Communication Breakdown 8.1.1 Impact of Communication Impairment on Patients 8.2 Exploring the Impact of Voicelessness 8.2.1 Impact of Communication Impairment on the Family and Healthcare Staff 8.2.2 Addressing the Impact of Communication Impairment in the ICU 8.2.3 Conclusion 8.3 Alternative and Augmentative Communication Aids 8.3.1 Training and Staff Needs in the Critical Care Setting 8.4 Facilitating Verbal Communication 8.4.1 One-Way Valves 8.4.1.1 Closed Bias Valves 8.4.1.2 Open Bias Valves 8.4.1.3 Considerations for One-Way Valve Use 8.4.2 Leak Speech 8.4.3 Above Cuff Vocalisation (ACV) 8.5 Conclusion References 9: The Intensive Care Unit Environment: Impact and Prevention 9.1 Introduction 9.2 Sleep and Wakefulness 9.2.1 Sleep Architecture and ICU 9.2.2 Measuring Sleep 9.3 Sound and Noise 9.3.1 Measuring Sound 9.3.2 Sound in the ICU 9.3.3 The Impact of Noise on the ICU Patient 9.4 Light and Dark 9.4.1 Measuring Light Intensity 9.4.2 Circadian Rhythms 9.4.3 Light Intensity in the ICU 9.5 Humanising the ICU Environment 9.5.1 Improving Sleep in the ICU 9.5.2 What Can We Do to Prevent a Noisy Environment? 9.5.3 What Can We Do to Ensure Appropriate Light Intensity? 9.5.4 Other Strategies to Improve and Humanise the ICU Environment References 10: Psychology: Person-Centred Care a Key to Successful Recovery 10.1 Introduction: Patient Experience and Psychological Stressors in the ICU 10.2 Post-ICU Psychological Outcomes and Risk Factors 10.3 Early Interventions Addressing Delirium/Cognitive Changes in the ICU 10.4 Assessment and Interventions for Acute Stress in the ICU 10.5 Leaving the ICU 10.6 Going Home 10.7 Follow-Up Clinics 10.8 Return of Patient Diaries 10.9 Peer Support Groups 10.10 Psychological Interventions 10.11 Cognitive Interventions 10.12 The Psychological Impact and Outcomes of ICU During and Post-COVID 19 in the UK 10.13 Conclusion References 11: Post-intensive Care Syndrome 11.1 A History of PICS 11.2 Outcomes 11.3 Exposures 11.4 Defining Post-intensive Care Syndrome 11.5 Diagnosis and Assessment of PICS 11.6 Screening Tools 11.7 Prevalence and Features of PICS 11.8 PICS-F 11.9 Conclusion References 12: End-of-Life Care: A Dignified Death 12.1 Components of the Theoretical Model 12.1.1 Decisive Turning Point 1: Time Out 12.1.2 Decisive Turning Point 2: Shared Decision-Making 12.1.3 Decisive Turning Point 3: Consensus 12.1.4 Decisive Turning Point 4: Comfort Care 12.1.5 Decisive Turning Point 5: Family Care 12.1.6 Decisive Turning Point 6: Deceased Care 12.1.7 Decisive Turning Point 7: Follow-Up References