Bridging the ICU and Beyond: Towards Integrated Survivorship Models for Critical Illness
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Authors
Jawa, Natasha Arianne
Date
2025-07-29
Type
thesis
Language
eng
Keyword
Critical Care , Neurology , Neuroscience , Nephrology
Alternative Title
Abstract
Objectives: This thesis examines the evolving burden of critical illness, focusing on the neurocognitive and psychosocial sequelae that persist beyond intensive care unit (ICU) discharge. This work advances our understanding of neurologic vulnerability, intervention development, and long-term recovery for ICU survivors and caregivers.
Chapter 1 outlines the acute and chronic consequences of critical illness, highlighting the urgent need to move beyond mortality as a primary outcome.
Chapter 2 explores the impact of one prototypical systemic illness—kidney disease—through a systematic review and meta-analysis of brain imaging studies across the kidney disease spectrum, revealing widespread neurological vulnerabilities that worsen with disease severity.
Chapter 3 uses robotic neurocognitive testing to identify domain-specific impairments, demonstrating a gradient of neurocognitive impairment that parallels worsening kidney disease, and showing that patients with acute kidney injury (AKI) may be particularly vulnerable to neurocognitive dysfunction.
Chapter 4 focuses in on patients with AKI, characterizing the acute neurological changes occurring in patients admitted to the ICU with AKI requiring kidney replacement therapy. This work also identifies the substantial challenges to long-term follow-up in this cohort, due to both high mortality and retention barriers.
Chapter 5 synthesizes the evidence on post-ICU interventions, demonstrating that structured, multidisciplinary follow-up can improve physical, psychological, and functional outcomes for ICU survivors and caregivers, while also revealing persistent barriers to broader implementation of such interventions.
Chapter 6 describes the development, implementation, and evaluation of a patient- and caregiver-centered post-ICU follow-up care pathway, co-designed with families to include ICU diaries, educational resources, and longitudinal clinic visits, resulting in high fidelity and improved psychological recovery.
Chapter 7 emphasizes that ICU survivorship entails a continuum of neurologic vulnerability, even after a single acute event, and emphasizes the need for innovative, patient-centered long-term care models to improve outcomes for ICU survivors and caregivers alike.
Conclusions: Critical illness results in complex, enduring neurocognitive and functional impairments inadequately addressed by current ICU practices. This thesis highlights the continuum of neurological vulnerability, the exacerbating role of kidney dysfunction, and the need for proactive, patient- and caregiver-centered follow-up models to improve ICU recovery trajectories, laying the foundation for future multi-center trials and targeted interventions.