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Post Intensive Care

Post Intensive Care

 
 
 
 
 

Overview

Professor Suveer Singh is internationally experienced in clinical respiratory intensive care and renowned for expertise, education and research in the field. He runs the ICU and ARDS-ECMO follow up clinic at the Royal Brompton Hospital, London, a world renowned centre for cardiorespiratory diseases.

He is also lead editor of the Oxford Textboook of respiratory critical care, and a researcher in many trials of respiratory and intensive care medicine.

Post-intensive care management focuses on the care and recovery of patients who have been discharged from an Intensive Care Unit (ICU) or those who are severely ill but do not require full ICU care. These patients may still need close monitoring and advanced support, often provided in high-dependency units (HDUs). Proper post-intensive care management can help prevent further complications, optimize recovery, and improve overall outcomes. This care involves multidisciplinary teams led by senior clinicians with expertise in critical care, supported by skilled nursing and technical staff.

Sleep Clinic (ICU)

Critical illness, by definition, requires a higher level of care, usually in an intensive care unit, high dependency unit or intermediate care facility. The role of the specialist in critical care is both as a diagnostician and to manage the patient through the illness, utilising a specific set of knowledge and practical skills, particular to intensive care.

Symptoms and Causes

Patients transitioning from intensive care or those with acute illnesses can experience various complications. Common issues include:

1. Breathing Difficulties:

  • Patients may struggle with respiration due to post-operative complications, lung infections (such as pneumonia), or conditions like pulmonary embolism. Post-ICU breathing difficulties may also arise due to acute coronary syndromes, which require careful monitoring and management.

2. Sepsis:

  • Sepsis, an underrecognised and often inadequately managed complication, is a severe and widespread infection that can lead to organ failure. Sepsis accounts for a significant percentage of deaths in critically ill patients and demands prompt recognition and treatment to improve survival rates.

3. Fluid Imbalances:

  • Patients may experience difficulty with fluid management, especially if they have renal dysfunction (kidney failure) or heart failure. In these cases, improper fluid balance can worsen outcomes and lead to complications like edema or dehydration.

4. Infections:

  • Post-ICU patients are at increased risk of developing infections due to weakened immune systems, invasive procedures, or prolonged hospital stays.

5. Post-Operative Complications:

  • These can include inadequate coughing (leading to mucus build-up), wound infections, or surgical complications that need close monitoring and intervention.

Diagnosis

Diagnosing complications in post-intensive care patients involves a combination of clinical assessment and advanced diagnostics. The most common diagnostic approaches include:

1. Clinical Assessment:

  • Detailed physical examinations and monitoring of vital signs, such as oxygen saturation, heart rate, blood pressure, and temperature, help identify any deviations from normal recovery.

2. Laboratory Tests:

  • Blood tests to assess infection markers (e.g., elevated white blood cells, C-reactive protein), organ function (e.g., kidney and liver function tests), and electrolyte balance are essential in detecting complications.

3. Imaging:

  • Chest X-rays or CT scans can help diagnose pneumonia, pulmonary embolism, or other respiratory complications. Ultrasound or echocardiography may be used to evaluate heart function or detect fluid imbalances.

4. Fluid Monitoring:

  • Regular monitoring of fluid intake and output helps to manage hydration and detect issues related to renal dysfunction or heart failure.

5. Sepsis Screening:

  • Recognizing early signs of sepsis, such as fever, rapid heart rate, altered mental status, and low blood pressure, is critical. Blood cultures may be taken to identify the causative pathogen.

Treatments

Post-intensive care treatment plans focus on managing complications, supporting recovery, and preventing deterioration. Key interventions include:

1. Respiratory Support:

  • Oxygen therapy, breathing exercises, and sometimes non-invasive ventilation (such as CPAP or BiPAP) may be required to support patients with breathing difficulties. In severe cases, mechanical ventilation may be considered.

2. Sepsis Management:

  • Rapid identification and treatment of sepsis are vital. The Surviving Sepsis Campaign recommends early fluid resuscitation, source control (e.g., removal of infected devices), and timely administration of broad-spectrum antibiotics, followed by targeted antibiotic therapy once the pathogen is identified.

3. Fluid and Electrolyte Management:

  • Close monitoring of fluid levels is essential for patients with heart failure or renal dysfunction. Diuretics may be prescribed to manage excess fluid, while intravenous fluids may be given to prevent dehydration. Balancing electrolytes is also crucial for maintaining stable body functions.

4. Medications:

  • Antibiotics: For patients with infections, appropriate antibiotics are given based on culture results and the suspected source of infection.
  • Anticoagulants: In cases where there is a risk of blood clots or pulmonary embolism, anticoagulants may be prescribed to prevent clot formation.
  • Corticosteroids: These may be used to manage inflammation and reduce the immune response in some critical cases.

5. Monitoring and Support:

  • Continuous monitoring by a skilled team of nurses, respiratory therapists, and physicians is critical in managing post-intensive care patients. Early intervention by experts in critical care or HDU staff can significantly improve outcomes.

6. Rehabilitation:

  • Physiotherapy and occupational therapy are essential for restoring mobility, improving breathing function, and supporting the patient's return to daily activities after discharge from critical care.

Post-intensive care management is essential for improving patient outcomes following a critical illness or surgery. Addressing complications such as sepsis, breathing difficulties, and fluid imbalances early on, supported by continuous monitoring and timely interventions, can lead to better recovery and prevent further deterioration.

Locations

Treatments are available at the following locations:

Cromwell Hospital

164-178 Cromwell Rd,
London SW5 0TU

One Welbeck

1 Welbeck Street, Marylebone
London, W1G 0AR

London Bridge Hospital

27 Tooley St,
London SE1 2PR

Chelsea Oupatients Centre

280 King's Rd,
London SW3 5AW

Chelsea & Westminster Hospital

369 Fulham Rd,
London SW10 9NH

Sloane Hospital

125 Albemarle Rd,
Beckenham BR3 5HS

Lister Hospital

Chelsea Bridge Rd,
London SW1W 8RH

Royal Brompton Hospital

Sydney Street, London
SW3 6NP

The London Clinic main hospital

20 Devonshire Place
London W1G 6BW

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Meet Our Respiratory Experts

Prof. Suveer Singh is an experienced specialist in Respiratory Medicine, Sleep Apnoea and other Sleep Disorders (Insomnia), Respiratory Critical Care, Acute respiratory infection (including COVID) and post ITU recovery.

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Client Success Stories

Breathing Easy: Stories of Success from Respiratory Patients

Discover the inspiring narratives of individuals who have triumphed over respiratory conditions, showcasing resilience, determination, and the power of the human spirit.

It is rare to find a doctor who gives so much genuine care to a consultation. Whilst he obviously knows his craft, he took time to get to know me, my medical issues and also my concerns in a way that was more than outwardly respectful.
Exceptional professionalism and quality of care provided by Professor Suveer Singh. Appreciated his empathetic manner and quality of listening in the initial consultation, his thoroughness in testing, and his careful explanation of the analysis, test results and recommended course of action.
Dr Singh has been really dedicated and professional in his care for me. He took time to explain things that I didn't understand and was genuinely interested in diagnosing me. I am truly appreciative of his care and expertise and would recommend it.