Hello everybody:
First of all, I would like to remind you that today we have an appointment with the Planet: from 20:30 to 21.30 is The blackout by climate change


And returning to today´s post … what about that patient with long ICU stay when leave our units? How grade of dependent would they have? Would they have depression, nightmares or could sleep? Would they be able to return to previous situation ?

Nice opinion piece published in The New Yorker on February 21, 2014 .

In ” The limbo between a life worth living and death”, Dra Lamas tells us the Charlie Atkinson´s story,  a 76 years old patient without personal previous illness who suffered a septic shock by the West Nile Occidental Virus, transmitted by a mosquitos´s bite. Ather a month in the ICU, he could leave the Hospital, dependent on mechanical ventilation and with delirium (he only knew his name). He had just crossed the dangerous line between suffering a prolonged illnes and the hope of recovery. A limbo known as “chronic and critical illness”.

This term was first described in the 80s, to talk about patients who survive a devastating disease or aggressive surgery , but remain dependent on some form of life support. It is the big difference between leave ICU out alive or  with good quality of life.

These patients often rely on a respirator , we all know they are more prone to infections and suffer neurological damage or psychiatric conditions . And the suffering itself, a similar sentiment is generated in families too. Half of them die the first year, and many of them are finally confined in an institution that can give them the care they require . Only 10% get regain their independence .
As the population ages and technology increases , the list of patients of this type grows exponentially. And few of them come to the conclusion that never improve, despite everything. Few of us know what a chronic hospital , what that is, we know little about what happens to discharge from the ICU , and what comes next : tracheostomy,  sepsis related catheter, pressure ulcers, percutaneous gastrostomy , persistent vegetative states and so on.
Those who work in ICUs were not trained to think long term : life, immediacy, emergency stopping us .
But what is next? Should we stop and think? . Should we work and improve communication with our patients and families, and between us? . Should we form ourselves in Psychology or listen more to the specialists in Rehabilitation? . Are we specialized in  give hope or remove to our ill patients?

I love to read your opinions …
Good weekend, and turn out the light scoundrels !