A new series of definitions of sepsis1 along with simple guidance for early diagnosis has recently been published, and a NICE guideline is due shortly.2 Sepsis is an extreme manifestation of the body responding to a severe infection—in part adaptive and protective, but potentially maladaptive and life threatening. Naturally, perhaps, the focus has been on early diagnosis and management. This is not always performed well, as highlighted by a 2015 report from the UK National Confidential Enquiry into Patient Outcome and Death.3 In a linked paper, Prescott and colleagues (doi:10.1136/bmj.i2375) report that patients who survive an episode of sepsis have a significant excess risk of mortality for a prolonged period of time.4 In the past, staff working in intensive care units discharged patients to the rest of the hospital with a feeling of a job well done; somehow that part of the patient’s journey had come to an end and recovery was about to begin. Since then numerous publications have challenged this optimistic assumption. For substantial numbers of patients, leaving the intensive care unit does not represent the end of something, rather it represents the start of something else, often not anticipated by them or understood by others. Many studies have described the difficulties sustained by patients and of course their families. Such difficulties include loss of muscle mass and strength,5 cognitive dysfunction, anxiety and depression,6 and post-traumatic stress.7 Along with this come challenges, both medical and financial, for those who become informal caregivers.8 9 In the UK this has been addressed, at least in ambition, with the publication of NICE guidelines for rehabilitation after critical illness.10
over 3 years ago
Failure to complete rehabilitation after anterior cruciate ligament (ACL) reconstruction is associated with a marked increase in the risk of graft rupture, researchers report.
over 3 years ago