Survivor follow-up

Recovery from a critical illness continues for a prolonged period after discharge from hospital, particularly after a severe critical illness involving a long stay. Mortality after hospital discharge is up to three times higher than that of the general population for two to three years after hospital discharge. Patients often experience a variety of physical and psychological symptoms after prolonged critical illness (see table opposite). If not recognised as a sequel to critical illness, this can lead to unnecessary treatment

and investigation, contributing further to their morbidity.

Many hospitals are now running critical care follow-up clinics to provide multidisciplinary support to patients after critical illness. These clinics allow patients to gain an understanding of their illness. There are usually gaps in the patient’s recollection of events. They may suffer hallucinations or delusions, or misinterpret events they have patchy knowledge of. This can lead to frustration and anger. Explanations to complete their knowledge are very helpful in helping patients come to terms with what happened to them and this is usually reassuring. Provision of information that helps the patient understand a realistic timeframe for their recovery overcomes any unrealistic expectations they may harbor.

The whole family dynamic often changes as a result of a critical illness. Close family members experience anxiety and depression during the critical illness. This changes to a state of overprotection after the illness which can often be frustrating for the patient.

A follow-up clinic also gives an opportunity for patients and relatives to provide feedback on areas of care that could be improved to the benefit of subsequent patients.

Typical problems post-critical care discharge

Weakness	Stress
Weight loss	Irritability
Fatigue	Depression
Poor appetite and taste changes	Anxiety
Voice changes	Amenorrhoea
Insomnia	Lack of confi dence
Skin and nail changes	Guilt
Itching	Poor concentration
Hair loss	Poor memory
Painful joints	Social isolation
Peripheral neuropathy	Sexual problems (Impotence/libido)