ICU Virtual Medical Follow-Up Clinic

ICU Virtual Medical Follow-Up Clinic **Problem list** **1. Post-Intensive Care Syndrome (PICS)** Patient reports persistent fatigue, muscle weakness, and some difficulties with short-term memory since discharge from ICU three months ago. He describes feeling overwhelmed by daily tasks and experiencing occasional vivid nightmares related to his ICU stay. - **Investigations**: No recent investigations explicitly mentioned in the transcript beyond self-reported symptoms. Previous ICU stay records confirm prolonged ventilation and sepsis. - **Examination**: Reduced grip strength noted bilaterally. Mini-Mental State Examination (MMSE) score of 26/30, indicating mild cognitive impairment. Affect is flat. - **Management**: Discussed graded exercise programme with patient, emphasizing low-impact activities. Recommended cognitive rehabilitation exercises, such as brain training apps. Referred to occupational therapy for assessment of daily living activities and potential adaptive strategies. Provided information on PICS support groups and encouraged participation. **2. Chronic Obstructive Pulmonary Disease (COPD) Exacerbation (Resolved)** Patient was admitted to ICU three months prior due to a severe COPD exacerbation requiring mechanical ventilation. Current respiratory symptoms are stable, with occasional mild dyspnoea on exertion. Using salbutamol inhaler as needed, approximately 2-3 times per week. - **Investigations**: Recent spirometry (two weeks prior to follow-up) showed FEV1 45% predicted, consistent with severe COPD. No acute infection markers were present in recent blood tests. - **Examination**: Chest auscultation reveals scattered expiratory wheezes, particularly at bases. Oxygen saturation 96% on room air. No increased work of breathing. - **Management**: Reaffirmed importance of regular use of maintenance inhalers (fluticasone/salmeterol). Reviewed inhaler technique. Discussed influenza and pneumococcal vaccination schedule. Emphasised smoking cessation support resources. Advised to seek medical attention if experiencing increased shortness of breath, sputum production, or fever. **Other issues** - Nutritional intake: Patient expresses difficulty maintaining appetite, leading to some unintentional weight loss since discharge. Advised on high-calorie, high-protein supplements and small, frequent meals. - Social isolation: Patient lives alone and reports feeling isolated. Provided details for local community centres and befriending services. **Discharge planning and follow-up** General ICU follow-up advice given included information on the Post-ICU Recovery Clinic helpline, national PICS support organisations, and the importance of ensuring all routine vaccinations are up to date. Specific follow-up actions communicated to GP: Requested a follow-up appointment in approximately one month to review progress with PICS management, assess occupational therapy referral, and monitor COPD stability. Advised GP to consider repeat spirometry in 6-12 months. Requested GP to monitor patient's weight and consider a referral to a dietitian if nutritional status does not improve.