Do critical illness survivors with multimorbidity need a different model of care?

There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.

Automated summary

There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has found little benefit in rehabilitation interventions, and it is now recognized that a person's existing health status, particularly multimorbidity and frailty, strongly influences their long-term outcomes. This review explores the complex relationships between multimorbidity and patient outcomes after critical illness, and proposes potential strategies to optimize patient recovery by addressing various factors including medical conditions, treatment burden, functional status, healthcare delivery, and social support. Providing patient-centered care that proactively identifies critical illness survivors with multimorbidity and meets their unique challenges and needs is crucial for facilitating recovery and improving outcomes.