The role of transient epithelial ion transport reduction in rapidly reversible pulmonary edema.

Ariel M Modrykamien has provided an excellent review of the long-term consequences of treatment in the ICU and the importance of developing ICU clinics to provide comprehensive care to ICU survivors.1 The long-term outcomes of post-ICU admission include reductions in quality of life, lung function, and nutritional status, and impacts on psychological outcomes and cognition. Patients and their close relatives are affected by the trauma of ICU experiences. ICU follow-up clinics emerged in the United Kingdom, Norway, and Sweden around 1990. “Intensive care aftercare” was introduced in 2002 as a collaborative effort by a nurse and a physician in the United Kingdom,2 but, as pointed out, most clinics were led by nurses. Many follow-up clinics were initiated by nurses, who also provided intensive care diaries for the patients, to help them come to terms with their ICU experiences, many of which they had no recall.3 Patient diaries assist the patient in reconstructing the illness narrative.4 A randomized controlled trial in 6 European countries demonstrated that diaries reduced new-onset post-traumatic stress disorder following critical illness.5 My main concern in the presentation of the follow-up clinic as a new paradigm for intensivists is that physicians are encouraged to “take over” a practice that was pioneered by nurses. Follow-up clinics are indeed an area that calls for inter-professional collaborative practice, including nurses, physicians, respiratory therapists, physiotherapists, psychologists, and others. It is a shame if the concept of ICU follow-up becomes medicalized, and fails to recognize the emotional and existential aspects of post-ICU care.