Week 5 Clinical Case

Case Details

Gordon Chahar is a 53 year old gentleman who presented to A+E on 12 Dec with bilateral lower limb weakness which had been progressively deteriorating over one week causing difficulty climbing stairs and rising from a chair. You may recall his clinical progress from the Week 3 discussion board.

Mr Chahar was diagnosed with GBS and was managed with intravenous immunoglobulin and plasma exchange therapies. He has now been ventilated in the intensive care unit for two weeks.

He remains profoundly weak, with 1/5 power in his upper and lower limbs. He is managing a short period (1 hour) of time on Pressure support ventilation, but becomes very tachypnoeic and tachycardic towards the end of these periods.

The focus of this discussion board will be around, indications for tracheostomy formation, ICU acquired weakness and Post Intensive Case Syndrome.

Qustions

• What are the indications for tracheostomy formation in ICU? With reference to the available literature, when is the optimal timescale for consideration of formation of a tracheostomy?

• What is ICU acquired weakness and what are the recognised risk factors for this? How might we prevent and manage ICU acquired weakness?

• What is post-intensive care syndrome and how can we best support ICU survivors and their families? What interventions have been trialled to reduce the incidence of post-ICU syndrome in patients and their families?