Aiding the Recovery of ICU Survivors: Creation and Implementation of a Post-ICU Recovery Clinic

Abstract

Introduction: Advancements in critical care medicine have led to increase in Intensive Care Unit (ICU) survival. ICU survivors often experience cognitive, mental and physical impairments as part of a condition called Post- Intensive Care Syndrome (PICS). While there are several ICU follow-up programs, there is variability in their structure and approach. We describe the creation and implementation of a Post-ICU Recovery Clinic (PIRC). Methods: A retrospective observational study was conducted and included all patients seen in a PIRC of a quaternary health system from December 2019 to September 2020. PIRC visit variables included scores on several validated questionnaires screening for mental health and cognitive disorders, 6-minute walk test, pulmonary function test, change in occupational and driving status, and referrals made during PIRC visit. Statistics reported reflect exclusion of the missing data points. Results: The criteria utilized for patient selection was circulatory shock, acute respiratory distress syndrome (ARDS), mechanical ventilation >7 days, ICU admission >7 days, delirium, cardiac arrest and COVID-19 with ICU stay >2 days. A total of 63 patients were seen in PIRC, 41% of those were ARDS survivors. Given the COVID-19 pandemic, telemedicine was shortly implemented and 62% of the visits were virtual. Median age (IQR) was 59.1 (49.2-71.6), 59% were male, with near equal Caucasian and African American distribution. All patients who had an in-person visit were seen by a critical care physician and advance practice provider, pharmacist, psychiatrist and physical therapist during the visit. 36% screened positive for anxiety or depression as identified by the Patient Health Questionnaire-4 (PHQ- 4), and 11% screened positive for post-traumatic stress disorder (PTSD) identified by the Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Of the patients seen with in-person visit, 45% had either mild or moderate cognitive impairment identified by the Montreal Cognitive Assessment (MOCA). Median 6-minute walk distance was 66% predicted. Median FEV1, FVC, and DLCO was 86, 80, and 60% predicted respectively. From the 61% of patients who were working and 91% who were driving prior to hospitalization, only 22% and 65% had returned to those activities respectively. Thirty four (56%) patients had at least one referral made, with some patients receiving up to 6 referrals. Conclusion: A high prevalence of PICS and social impairments were identified in ICU survivors at a PIRC. Incorporating an inter-disciplinary team approach and standardized surveys were imperative to recognize these impairments in order to support return to the best state of recovery possible.