Peer support to improve recovery following critical care discharge: a case-based discussion

We report the case of a self-employed builder aged 58-years, with a medical history of ischaemic heart disease and type II diabetes. He was transferred to our intensive care unit (ICU) from another local hospital for treatment of gallstone pancreatitis. He stayed in critical care for 19 days, with a total hospital stay of 9 weeks. He and his wife have consented to the presentation of their case.

This patient required level three care (ICU care) for 3 days. He required level two care (high dependency care) for a further 16 days due to complications related to his acute kidney injury and pancreatitis. He was mechanically ventilated for 3 days with a worst P/F ratio of 150 mmHg and underwent renal replacement therapy for 8 days. As per standard practice in the ICU at the time, he was visited by physical therapy on 17 of his 19 ICU days. This patient has two children and a wife who works as a Nursery Teacher. After discharge from hospital, he returned to his own home.

At discharge from hospital, aerobic capacity was assessed using the incremental shuttle walk test. The patient scored a metabolic equivalent of 2.4 on this test (this represents an ability to undertake a low intensity exercise programme).1 Grip strength measurements were obtained and were 16 kg (right hand) and 12 kg (left hand), less than half of expected when compared with the population norm.2

At home, further nutritional support from a nasogastric tube (NGT) was required. The patient also had significant fatigue, limb weakness, lethargy, decreased balance and shortness of breath. At 2 months post-discharge from hospital, neither he nor his wife had returned to work. In light of these problems, at 2 months post-ICU discharge, both the patient and his wife were invited to participate in Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE).