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Common problems you might experience during your critical care stay
Rehabilitation
After being critically unwell you may experience ongoing physical and psychological challenges. These may continue and/or change as you progress through your recovery from the critical care unit to the ward and to home.
Rehabilitation is a process that aims to enable you to return to completing daily tasks at home and be as independent as possible. Everyone will have different rehabilitation needs (some you may recover from quickly but others may take longer) and these are assessed early in your critical care stay and throughout your recovery. Rehabilitation goals will be discussed and agreed with you and may involve support from several members of the therapy team including Physiotherapy, Occupational Therapy, Speech and Language Therapy, Dietetics and Psychology.
Below are some of the common difficulties people experience following a critical care stay and information and resources to help you manage these problems.
Common problems
During critical illness your lungs and breathing muscles can get weak along with other parts of your body. When you are critically ill, you may have help with your breathing from a ventilator. This machine pushes air into the lungs and oxygen can be added if required. Your lungs can get weak from being on this machine as it takes over the breathing muscles to rest them while you are unwell.
Whilst on a ventilator (breathing machine) it is common to have more secretions in your lungs. This will be cleared with suction, the process of passing a thin tube through the breathing tube and into the lungs.
Some people need a tracheostomy tube during their admission to critical care. This is a tube that is placed in to your airway (windpipe) to help you breathe. It is usually temporary and used while the critical care team are working to get you off the ventilator. Once you are able to breathe without the ventilator, the critical care team will work to reduce your dependency on the tracheostomy and remove it when safe to do so.
When you are getting better, you may notice that you cannot breathe as deeply as you used to do. You may even feel out of breath when doing an activity that you did not struggle with before. As you begin to recover, these muscles can become stronger again.
If you would like further information regarding managing your breathing after critical illness, please click on the link below:
It is common to lose strength in your arms and legs. This will affect your ability to do daily activities, move in bed, sit up and stand up. You may also experience stiffness within your joints which may cause you pain. This is normal and the whole team will work with you to regain your strength, function and independence.
Through your recovery we will use supportive chairs to help you sit. Different equipment may be used as you progress to help you get out of bed, join in with everyday tasks, stand and walk.
The following link shows some exercises you could do to help strengthen your hands.
Your therapy team can help you with more specific exercises and rehabilitation equipment on critical care.
It is normal to feel tired after any activity whilst you build up your strength. This will improve with time and practice. The team can advise on how best to pace, plan and prioritise your activities and rehabilitation to manage this.
It is common to have difficulty communicating when in critical care. This can be due to breathing tubes preventing you using your voice, trauma/damage from breathing tubes affecting your vocal cords or injury to your brain that affects speech and language.
It is common to have changes to your voice after being intubated. This is because the breathing tube passes through your voicebox and can cause trauma and irritation to your vocal cords and other structures around them. This often results in temporary changes to your voice. The Speech and Language Therapist will assess your voice function, advise you regarding any strategies/exercises you can do to help and if necessary arrange for an Ear, Nose and Throat (ENT) assessment as well.
Click here for more information relating to voice problems after intubation.
This is a general introduction into the effect that a stay in critical care can have on your nutritional needs.
Some people recover quickly and will not require much ongoing support however, others will require more time and help with their recovery.
Artificial Feeding
When people first come to critical care, they often cannot eat or drink as they normally would, and need a feeding tube. Most people will have a feeding tube placed through their nose, down their throat and into their stomach.
Some people may not be able to eat and drink normally for a longer period of time so may have a feeding tube placed directly into their stomach. Others may have issues with their stomach meaning they cannot use their stomach to get enough nutrition. These patients may have nutrition delivered directly into their blood stream via a drip.
Some people only need feeding tubes for a short time, other people might need it for longer. Once you are no longer on a ventilator (breathing machine), the Dietitian will aim to remove the feeding tube once you can eat and drink enough.
Common eating and drinking difficulties
It is common during and after being in critical care to struggle to eat and drink for several reasons. These can include
- not feeling hungry
- feeling full quickly
- feeling sick
- feeling tired or weak
- your smell and taste changing.
It can take some time for your appetite to return to normal.
Some people will have difficulties swallowing (dysphagia). Swallowing function can also be affected during critical illness as a result of trauma from breathing tubes, general weakness and damage to the brain and nerves.
Swallowing involves the same muscles as voicing and talking. This means that as with your voice, it is common for your swallowing to be affected by having a breathing tube in place. This can make it difficult for people to swallow food and drink as they usually would, and at times people also struggle to swallow their saliva.
Part of the Speech and Language Therapist’s job is to assess swallowing safety and recovery and make sure that people are getting their food and fluids in a way that is safe for them. If your swallowing is affected it can result in food and drink going the ‘wrong’ way and causing a chest infection. This might mean that you have to start eating and drinking slowly and the types of food you have may be limited. The Speech and Language Therapist will work with the Dietitian to make sure you get enough food and fluids safely.
Click here for further information swallowing difficulties (dysphagia) after intubation.
The Occupational Therapist can help you to be as independent as possible, and give you equipment if needed to use when you eat and drink.
It is common for you to lose weight and muscle during your critical care stay. Eating and drinking well will help you get better.
Further resources
If you are experiencing some of the problems mentioned above you will find help and guidance on how to overcome these difficulties on the following links:
As you start to recover, doing some basic daily activities such as washing your face or brushing your teeth is an important part of getting stronger and more independent. Doing these tasks will give you some cognitive stimulation and promote wellbeing.
The team will encourage you to start doing more for yourself and where possible you will be supported to participate in everyday tasks such as toileting, feeding and dressing.
The Occupational Therapist can help you find ways of taking part in these activities, progressing to being more independent as your abilities change. This may be achieved through different ways of doing things or using aids and equipment to help.
We may discuss with you having things brought in from home which may help the task feel more personal and help you get back into a daily routine.
Being unwell and in hospital can affect your memory and thinking. You might feel confused and find it hard to concentrate and understand what is going on around you. You might also find it difficult to remember things. This is normal, and it will get better over time as your physical condition improves.
As many as two out of three critically ill patients can develop delirium. Delirium is described as a state of acute confusion. It can make it difficult to think clearly, pay attention and understand what is going on around you. Sometimes you may even see or hear things that are not there but seem very real. You might also experience very real and disturbing dreams. It can leave you feeling frightened and lead to behaviour that is out of character.
Things that may help to manage delirium include:
- reassurance and reorientation from those around you
- familiar people and items around you
- ensuring that if required, glasses / hearing aids are used
- a structured routine
- where possible, participation in everyday tasks.
Delirium is usually temporary and will improve as your physical condition improves. You will start to feel more alert and sleep better. Once you feel better, it may help to talk to one of the team to help you make sense of your experience.
Click here for more information on Delirium and intensive care
It is normal to experience many different emotions whilst you are in Critical Care. You might feel frightened, overwhelmed, worried, sad, low or stressed. You might find it difficult to cope with these feelings due to problems with thinking and memory, and difficulties communicating. When you feel able to, it may help to talk to one of the team to help you make sense of how you are feeling.
