Abstract
BackgroundWhile 80% of critically ill patients treated in an intensive care unit (ICU) will survive, survivors often suffer a constellation of new or worsening physical, cognitive, and psychiatric complications, termed post-intensive care syndrome. Emerging evidence paints a challenging picture of complex, long-term complications that are often untreated and culminate in substantial dependence on acute care services. Clinicians and decision-makers in the Fraser Health Authority of British Columbia are working to develop evidence-based community healthcare solutions that will be successful in the context of existing healthcare services. The objective of the proposed review is to provide the theoretical scaffolding to transform the care of survivors of critical illness by a synthesis of relevant clinical and healthcare service programs.MethodsRealist review will be used to develop and refine a theoretical understanding of why, how, for whom, and in what circumstances post-ICU program impact ICU survivors’ outcomes. This review will follow the recommended five steps of realist review which include (1) clarifying the scope of the review and articulating a preliminary program theory, (2) searching for evidence, (3) appraising primary studies and extracting data, (4) synthesizing evidence and sharing conclusions, and (5) disseminating and implementing recommendations.DiscussionThis realist review will provide a program theory, encompassing the contexts, mechanisms, and outcomes, to explain how clinical and health service interventions to improve ICU survivor outcomes operate in different contexts for different survivors, and with what effect. This review will be an evidentiary pillar for health service development and implementation by our knowledge user team members as well as advance scholarly knowledge relevant nationally and internationally.Systematic review registrationPROSPERO CRD42018087795
Highlights
While 80% of critically ill patients treated in an intensive care unit (ICU) will survive, survivors often suffer a constellation of new or worsening physical, cognitive, and psychiatric complications, termed post-intensive care syndrome
Review objective and questions The objective of this review is to explain how clinical and health service interventions to improve ICU survivor outcomes operate in different contexts for different survivors, and with what effects
We initially identified intervention program theory areas in line with Maley and Mikkelsen’s framework as follows: increasing awareness of post-intensive care syndrome (PICS), educating survivors and caregivers, mitigating risks of physical and neuropsychological impairment, providing access to appropriate services, and coordinating longitudinal care [27]
Summary
While 80% of critically ill patients treated in an intensive care unit (ICU) will survive, survivors often suffer a constellation of new or worsening physical, cognitive, and psychiatric complications, termed post-intensive care syndrome. The objective of the proposed review is to provide the theoretical scaffolding to transform the care of survivors of critical illness by a synthesis of relevant clinical and healthcare service programs. An increase in the use of intensive care unit (ICU) services over the past two decades, coupled with tremendous strides in the diagnosis and treatment of life-threatening conditions, like multiple organ system failure, respiratory failure, sepsis, and shock, has resulted in growing numbers of ICU survivors. Medical teams that support these patients after their discharge have little evidence to guide therapy and prevent the complications that result from the accumulation of injuries during the hospital stay [10]. There is consensus that clinical and healthcare service interventions for this high-risk population are required, but the development and implementation of models of care are in their infancy
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