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Functional Outcomes, Goals, and Goal Attainment among Chronically Critically Ill Long-Term Acute Care Hospital
Randy Dubin1, Joshua M Veith2,3,4, Michael A Grippi5
1Department of Speech Pathology, Good Shepherd Penn Partners, Philadelphia, Pennsylvania.
Annals of the American Thoracic Society
|May 13, 2021
Summary
Long-term acute care hospital patients achieved communication and eating goals but rarely walking goals. Setting realistic expectations based on functional assessments is crucial for this vulnerable population.
Area of Science:
- Critical Care Medicine
- Rehabilitation Medicine
- Geriatric Medicine
Background:
- Long-term acute care hospital (LTACH) patients are ICU survivors with significant vulnerability.
- Limited data exists on rehabilitation goals and functional outcomes for LTACH patients with tracheostomy.
Purpose of the Study:
- To investigate patient-centered goals and functional outcomes, including swallowing, in ICU survivors admitted to LTACH with tracheostomy.
Main Methods:
- Prospective observational cohort study involving chronic critically ill LTACH patients.
- Assessed functional status using Medical Research Council scale, Montreal Cognitive Assessment, and Fiberoptic Endoscopic Evaluation of Swallow.
- Evaluated mental health using Hospital Anxiety and Depression Scale and Post-Traumatic Stress Syndrome 10-Questions Inventory.
Main Results:
- Eighty percent experienced ICU-acquired weakness, 72% cognitive impairment, and 74% pharyngeal dysfunction.
- Patient goals prioritized eating/drinking and speaking over walking or self-toileting.
- High goal attainment for speaking (97%) and eating/drinking (88%), but low for walking (21%) and self-toileting (18%).
- Discharge to home/rehab (52%) correlated with greater strength and better mobility/self-care.
Conclusions:
- Goal attainment in LTACH rehabilitation is variable, with communication and swallowing goals frequently met.
- Functional goals like walking remain challenging for this population.
- Emphasizes the need for individualized goal setting and realistic expectations informed by functional capacity in LTACH and post-acute care.
Keywords:
Fiberoptic Endoscopic Evaluation of Swallowchronic critical illnessdysphagiapost–intensive care syndrometracheostomyMore Related Videos
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