Disability After Critical Illness

Disability after Critical Illness
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Abstract
Critical diseases were identified by Coopersmith et al. (2012) as a significant cause of disability and mortality in both developing and developed nations. In particular, critical diseases are associated with both neurocognitive and physical impairments. In the United States, chronic diseases and critical illnesses account for nearly 40% of all deaths recorded in a year. On the same note, the United States spends more than 263 dollars per year in managing critical illnesses. Although advances in medical technology have gradually lead to quick diagnosis and better treatment interventions leading to the long life expectancy of critically-ill patients, much still has been to be done to improve the neurocognitive abilities associated with critical illnesses (Coopersmith et al., 2012).
Early identification of victims prone to develop critical illnesses in the wards dramatically reduces further deterioration and subsequent disability (Kahn et al., 2010). Timely interventions such as administration of intravenous fluids, adequate analgesia, respiratory therapy, and oxygen administration have been proven to deter symptom deterioration. Moreover, early identification of patients at risk gives time to the nurses and the physicians to discuss the case and decide the definitive treatment (Kahn et al., 2010).
Understanding the risk factors and the pathophysiology of critical illnesses helps in formulating and implementing preventive measures (Kahn et al.

, 2010). Many studies have assessed the effects of critical illnesses on the patient, the viable treatment options, and the preventive measures. In the following piece of work, Herridge & Cameron (2013) establishes the link between cognitive outcomes and critical illnesses.
Disability after Critical Illness
In their introductory remarks, Herridge & Cameron (2013) identified that critical diseases cause not only functional disabilities but also neurocognitive impairments. Patients may present with symptoms similar to those of Alzheimer’s disease. The article emphasizes the importance of timely intervention and interprofessional individualized care for the patient as the key to quick recovery and symptom control. Herridge & Cameron (2013) pointed out that decrements in cognitive functions linked to conditions such as acute respiratory distress syndrome can be prevented by timely administration of oxygen in hypoxic patients. In essence, quick identification and appropriate medical interventions lead to better treatment outcome.
Cognitive impairment in critically ill patients is independent of coexisting medical conditions, age, and the definite diagnosis made at the hospital (Herridge & Cameron, 2013). Notwithstanding, the cognitive outcomes relies upon; a thorough evaluation and assessment of the patient`s cognitive ability upon admission, potential confounders such as delirium and cerebrovascular risk, the presence of genetic factors that may predispose patients to cognitive dysfunction, and psychological assessment by a professional psychologist. Furthermore, patients’ drug exposure while in the ICU also compounds cognitive impairment (Herridge & Cameron, 2013). During the patient assessment, the psychologist must pay close attention to brain injury which may be caused by either physical trauma on the head or delirium. A family history of cognitive impairment must be assessed and further confirmed by evaluation of apolipoprotein E in the affected patient.
Research studies involving neurocognitive testing encounter an array of challenges. Herridge & Cameron (2013) specified that unreliable follow up system, the death of the participants and subject withdrawal are among the challenges faced. Narrowing to the specific cause of withdrawal helps the research to understand the full spectrum of disability.
In addition to pharmacological interventions, non-pharmacological measures such as exercise may positively influence treatment outcome based on the present condition of the patient. Herridge & Cameron (2013) affirmed that training might be limited by the ICU acquired weakness. Apart from discerning the role of exercise in critical care patient, gaining an understanding on how brain dysfunction affects; functional independence, treatment outcomes, family caregivers, social life, health care utilization, and quality of life serves as a basis to formulate non-pharmaceutical interventions.
Family caregivers may be directly or indirectly affected by the critically ill patient (Herridge & Cameron, 2013). Due to the abrupt, unexpected change in the life of their loved ones, family and friends may be emotionally disturbed; they present with depression and post-traumatic stress disorder. Conditions such as stroke cause physical disability and the affected patients become a burden to the caregivers. With time, sustainability and continuity of care are affected since the family members become frustrated and avoid the patient.
The authors concluded by calling for more research on a broad spectrum of patients to determine the impact of cognitive impairment on quality of life, job loss, patient-centered outcome, and healthcare utilization. Besides, the author also argued researchers who may focus on this topic in the future to embrace consistent follow-up of patients during their study. Finally, Herridge & Cameron (2013), called for more studies to be done to shed more light on the effects of critical illnesses on the caregivers. Managing critical diseases requires concerted efforts from health care providers, the patient, the family caregivers, and the society as a whole.
Critique: Lessons learned
Managing critical illnesses requires a collective effort from the healthcare providers, the patient, and the family just as mentioned by Herridge & Cameron (2013). The medical team must be sensitive and responsive to the patients’ needs for better treatment outcome. Most importantly, the nurses and the physicians must single out critically ill patients predisposed to neurocognitive impairment and timely institute the appropriate interventions. The earlier the intervention, the better the treatment outcome. Persistent follow up must be done to track the patient’s progress after discharge from the hospital.
Critical illness is most likely the cause of cognitive impairment in all the affected patients irrespective of the age of the patient and other concurrent chronic conditions. Nonetheless, crucial risk factors such as delirium, brain injury, cardiovascular risk, and frailty put the patient at an increased risk of developing cognitive deficiencies. Although the researchers outlined the risk factors, they failed to talk about iatrogenic causes of chronic illnesses. Herridge & Cameron (2013) should have mentioned critical illness neuropathy, a common disabling condition acquired by patients in intensive care unit. The study did not include hypercholesterolemia, tobacco, hypertension, and diabetes mellitus as risk factors.
During history taking, physicians must ask the patient about any family history of cognitive impairment, and this is important because cognitive impairment can be inherited. Any slight suspicion can be confirmed by the presence of apolipoprotein E in the patients’ genome.
Contrary to my expectations, Herridge & Cameron (2013) did not link critical illnesses to chronic illnesses, yet the two are complementary to each other. In fact, some chronic debilitating ailment such as cancer mainly contributes to the development of critical illnesses.
When managing critically ill patients, the author talks about patient-centered care, this is right, but the authors should have spoken about nursing models such as interprofessional nursing model. According to Finkelman (2016), the interprofessional nursing model is patient-centered and brings together all healthcare provider with the aim of managing the patient.
Physical exercise is one of the interventions mentioned by the Herridge & Cameron (2013). From my standpoint, other non-pharmacological interventions such as cognitive stimulation therapy, music therapy, and reminiscence can also be employed in enhancing cognitive abilities of the patients.
References
Coopersmith, C. M., Wunsch, H., Fink, M. P., Linde-Zwirble, W. T., Olsen, K. M., Sommers, M. S., … & Deutschman, C. S. (2012). A comparison of critical care research funding and the financial burden of critical illness in the United States. Critical care medicine, 40(4), 1072-1079.
Finkelman, A. (2016). Leadership and management for nurses: Core competencies for
Quality care. Pearson.
Herridge, M., & Cameron, J. I. (2013). Disability after critical illness. N Engl J Med, 369(14), 1367-1369.
Kahn, J. M., Benson, N. M., Appleby, D., Carson, S. S., & Iwashyna, T. J. (2010). Long-term acute care hospital utilization after critical illness. Jama, 303(22), 2253-2259.