The continuum of critical care.

Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE

Publication: London, UK : BioMed Central Ltd
Original Publication: London : Current Science Ltd, c1997-

Continuity of Patient Care/*trends ; Critical Care/*methods; Critical Illness/therapy ; Humans ; Intensive Care Units/organization & administration

Until relatively recently, critical illness was considered as a separate entity and the intensive care unit (ICU), often a little cut-off from other areas of the hospital, was in many cases used as a last resort for patients so severely ill that it was no longer possible to care for them on the general ward. However, we are increasingly realizing that critical illness should be seen as just one part of the patient's disease trajectory and how the patient is managed before and after ICU admission has an important role to play in optimizing outcomes. Identifying critical illness early, before it reaches a stage where it is life-threatening, is a challenge and requires a combination of improved and more frequent or continuous monitoring of at-risk patients, staff training to recognize when a patient is deteriorating, a system to "call for help," and an effective response to that call. Critical care doctors are now widely available 24 h a day for consultation, and many hospitals have rapid response or medical emergency teams composed of staff trained in intensive care and with resuscitation skills who can attend patients on the ward who have been identified to be deteriorating, assess them to determine the need for ICU admission, and initiate further tests and/or initial therapy. Early intensivist input may also be important for patients undergoing interventions that are likely to result in ICU admission, e.g., transplantation or cardiac surgery. The patient's continuum after ICU discharge must also be taken into account during their ICU stay, with attempts made to limit the longer-term physical and psychological consequences of critical illness as much as possible. Minimal sedation, good communication, and early mobilization are three factors that can help patients survive their ICU stay with minimal sequelae.

Anaesthesia. 1999 Jun;54(6):529-34. (PMID: 10403864)
N Engl J Med. 2000 May 4;342(18):1301-8. (PMID: 10793162)
QJM. 2001 Oct;94(10):521-6. (PMID: 11588210)
Anaesth Intensive Care. 2009 May;37(3):426-31. (PMID: 19499862)
Resuscitation. 2010 Sep;81(9):1209-11. (PMID: 20598425)
Curr Opin Crit Care. 2010 Oct;16(5):505-9. (PMID: 20711076)
Crit Care. 2011;15(1):R28. (PMID: 21244671)
Intensive Care Med. 2011 Nov;37(11):1800-8. (PMID: 21845504)
N Engl J Med. 2014 Jun 26;370(26):2506-14. (PMID: 24963569)
JAMA Neurol. 2015 Jan;72(1):25-30. (PMID: 25402214)
Crit Care. 2015 Jun 12;19:254. (PMID: 26070457)
J Hosp Med. 2016 Jun;11(6):438-45. (PMID: 26828644)
JAMA. 2016 Feb 23;315(8):762-74. (PMID: 26903335)
JAMA. 2016 Feb 23;315(8):801-10. (PMID: 26903338)
Intensive Care Med. 2016 Jun;42(6):962-71. (PMID: 27075762)
J Crit Care. 2016 Aug;34:125-30. (PMID: 27288625)
JAMA. 2016 Oct 18;316(15):1583-1589. (PMID: 27706466)
Resuscitation. 2017 Jan;110:133-140. (PMID: 27865775)
Crit Care. 2017 Mar 14;21(1):52. (PMID: 28288655)
N Engl J Med. 2017 May 4;376(18):1737-1747. (PMID: 28467879)
Crit Care Med. 2017 Oct;45(10):1660-1667. (PMID: 28671901)
Br J Anaesth. 2017 Dec 1;119(suppl_1):i135-i142. (PMID: 29161399)
Crit Care. 2017 Dec 5;21(1):296. (PMID: 29208005)
Curr Opin Anaesthesiol. 2018 Apr;31(2):144-150. (PMID: 29351145)
Crit Care. 2018 Feb 12;22(1):22. (PMID: 29429412)
Eur J Anaesthesiol. 2018 May;35(5):325-333. (PMID: 29474347)
Crit Care Med. 2018 Jun;46(6):850-859. (PMID: 29498938)
Crit Care Med. 2018 Jul;46(7):1175-1180. (PMID: 29642108)
Intensive Care Med. 2018 Jul;44(7):1115-1129. (PMID: 29938369)
Chest. 2018 Oct;154(4):781-787. (PMID: 30217640)
N Engl J Med. 1999 Feb 11;340(6):409-17. (PMID: 9971864)

Keywords: Communication; Disease trajectory; Outcomes

Date Created: 20190616 Date Completed: 20191219 Latest Revision: 20200225

20221213

PMC6570628

10.1186/s13054-019-2393-x

31200740