Medical and economic implications of physical disability of survivorship

Interventions developed in the last decade have led to impressive rates of survival from extreme critical illness. However, surviving an episode of critical illness is just the beginning. Discharge from the intensive care unit (ICU) is often the start of a long and challenging rehabilitation, mood disorders, cognitive impairment, financial hardship, and caregiver burden, burnout, and psychological distress. It has become increasingly apparent that the majority of patients who survive an episode of critical illness will have some degree of compromised physical function secondary to ICU Acquired Weakness (ICUAW) and a constellation of other physical disabilities. The spectrum of muscle, nerve, and brain dysfunction may be permanent and can significantly change the disposition for those who were previously independent. Furthermore, it may impose a substantial health care cost burden and compromise the reserve of even the most resilient family members. Important limitations in the current literature relate to our poor understanding of how to risk stratify, how to systematically educate and inform our patients and family caregivers about physical morbidity and complex patient care in the community, and how to develop, test, and implement rehabilitation programs tailored to individual need.