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Mejía Vanegas D, Arias Díaz JA, Leyton Toro L, Ayala Grajales KY, Becerra Londoño AM, Vallejo Ospina JI, Rincón Hurtado ÁM. Calidad de vida y funcionalidad en sobrevivientes de cuidados intensivos: Una revisión exploratoria. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introducción: La calidad de vida en pacientes críticos que sobreviven al tratamiento en unidades de cuidados intensivos es inferior al de la población general. La condición de salud basal y la severidad de la condición clínica al ingreso a terapia intensiva son factores de riesgo para la calidad de vida y la funcionalidad. Objetivo: Analizar el nivel de conocimiento en la calidad de vida y la funcionalidad de los sobrevivientes de cuidados intensivos. Materiales y métodos: Se realizó una revisión exploratoria en las bases de datos: Scielo, PubMed, Science Direct, ProQuest, Redalyc, Dialnet, OVID, Scopus, publicados entre enero del año 2010 y mayo del año 2020. El estudio se desarrolló según la estructura de la Metodología PRISMA. Se revisaron y analizaron los textos completos que cumplían los criterios de inclusión para la selección final de los artículos. Resultados: De 1814 artículo seleccionados, se eligieron 65 artículos que describen la calidad de vida y la funcionalidad en pacientes después de cuidados intensivos, y finalmente, 16 artículos son incluidos, donde se analizaron las características de los artículos, las características de la población estudiada, y las variables de análisis sobre la evaluación de la calidad de vida y la funcionalidad en los sobrevivientes después cuidados intensivos. Conclusión: Los estudios sobre calidad de vida y funcionalidad en sobrevivientes de cuidados intensivos se realizaron en mayor proporción en Europa en los años 2010 a 2016. Con estudios observacionales prospectivos que correlacionan los factores que determinan la salud mental y física después del egreso de cuidados intensivos. Se aplicaron múltiples escalas siendo las más utilizadas SF-36 y el EQ-5D para evaluar la calidad de vida y del índice de Barthel para determinar el estado de funcionalidad en los egresados de cuidados intensivos. El SF-36 y el índice de Barthel reportaron una afectación en la calidad de vida y en la funcionalidad en la población sobreviviente de cuidados intensivos.
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Kawakami D, Fujitani S, Morimoto T, Dote H, Takita M, Takaba A, Hino M, Nakamura M, Irie H, Adachi T, Shibata M, Kataoka J, Korenaga A, Yamashita T, Okazaki T, Okumura M, Tsunemitsu T. Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:69. [PMID: 33593406 PMCID: PMC7888178 DOI: 10.1186/s13054-021-03501-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/10/2021] [Indexed: 02/06/2023]
Abstract
Background Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients’ subjective significance of impairment. Methods A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID). Results Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1–18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively. Conclusions Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.![]() Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03501-z.
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Affiliation(s)
- Daisuke Kawakami
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, 2-1-1, Minatojima minamimachi, Chuo-ku, Kobe-City, Hyogo Prefecture, 650-0047, Japan.
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, 216-8511, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo Prefecture, 663-8501, Japan
| | - Hisashi Dote
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka Prefecture, 430-8558, Japan
| | - Mumon Takita
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa Prefecture, 216-8511, Japan
| | - Akihiro Takaba
- Department of Emergency and Critical Care Medicine, Hiroshima General Hospital, Hatsukaichi, JAHisoshima Prefecture, 738-8503, Japan
| | - Masaaki Hino
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, 710-8602, Japan
| | - Michitaka Nakamura
- Department of Critical Care Medicine, Nara Prefecture General Medical Center, Nara, Nara Prefecture, 630-8581, Japan
| | - Hiromasa Irie
- Department of Anesthesiology, Kurashiki Central Hospital, Kurashiki, Okayama Prefecture, 710-8602, Japan
| | - Tomohiro Adachi
- Emergency and Critical Care Center, Tokyo Women's Medical University Medical Center East, Tokyo, 116-8567, Japan
| | - Mami Shibata
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Wakayama Prefecture, 641-8510, Japan
| | - Jun Kataoka
- Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, 279-0001, Japan
| | - Akira Korenaga
- Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Wakayama Prefecture, 640-8558, Japan
| | - Tomoya Yamashita
- Department of Emergency and Critical Care, Osaka City General Hospital, Osaka, 534-0021, Japan
| | - Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Kita, Kagawa Prefecture, 761-0793, Japan
| | - Masatoshi Okumura
- Department of Anesthesiology, Aichi Medical University Hospital, Nagakute, Aichi Prefecture, 480-1195, Japan
| | - Takefumi Tsunemitsu
- Department of Emergency Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo Prefecture, Amagasaki, 660-8550, Japan
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Rodríguez-Villar S, Rodríguez-García JL, Arévalo-Serrano J, Sánchez-Casado M, Fletcher H. Clinical residual symptomatology and associated factors in multiple organ failure survivors: A long-term mortgage. ACTA ACUST UNITED AC 2017; 64:550-559. [PMID: 28549793 DOI: 10.1016/j.redar.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate which residual clinical symptoms multi-organ failure (MOF) patients may exhibit post discharge from Intensive Care Units (ICU) and to identify the associated factors that cause such symptoms. MATERIAL AND METHODS A total of 545 adult patients admitted to a medical & surgical ICU in Spain diagnosed with MOF on admission were included in the study. Follow up in the form of a telephone survey regarding the patients clinical symptoms were conducted at 6 and 12 months after discharge from ICU. RESULTS A total of 266 patients were followed up at both 6 and 12 months post ICU discharge; 62.2% were male; age 60±18 years; 67.8% medical patients. The most common symptoms to appear following hospital discharge included: asthenia (173; 76%), sleep disturbances (112; 50%) and depression (109; 48%). CONCLUSIONS The study revealed frequent residual clinical symptoms persisting for almost a year post ICU discharge, most notably arthromyalgia and asthenia. Depression symptoms during the first 6 months post-hospital discharge were also common among multiple organ failure survivors. The presence of symptomatology over time was found to be related to a poor functional situation at 6 and12 months post ICU discharge, length of hospital stay and severity of illness score on ICU admission.
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Affiliation(s)
| | - J L Rodríguez-García
- Servicio de Medicina Interna, Hospital Universitario de Albacete, Albacete, España
| | - J Arévalo-Serrano
- Servicio de Medicina Interna, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - M Sánchez-Casado
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud, Toledo, España
| | - H Fletcher
- Critical Care Department, King's College Hospital, London, Reino Unido
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Steenbergen S, Rijkenberg S, Adonis T, Kroeze G, van Stijn I, Endeman H. Long-term treated intensive care patients outcomes: the one-year mortality rate, quality of life, health care use and long-term complications as reported by general practitioners. BMC Anesthesiol 2015; 15:142. [PMID: 26459381 PMCID: PMC4604105 DOI: 10.1186/s12871-015-0121-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 10/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the one-year mortality rate and its predictors regarding long-term intensive care-treated patients together with their health-related quality of life (HRQL), place of living, healthcare use and long-term complication characteristics after intensive care unit (ICU) discharge. METHODS A retrospective cohort study was performed in a 20-bed mixed ICU. The patients that were treated for more than 72 h between 2007 and 2012 were included in this study. The one-year mortality rate was calculated, and the characteristics of the ICU survivors that died within one year after ICU discharge were further analysed. For all patients, the Dutch version of the SF-36 questionnaire was used to assess their current HRQL. The results were compared with a normal population. Additionally, patients were questioned about their place of living, and their general practitioners (GPs) were questioned about the patients' possible long-term complications. RESULTS Seven hundred and forty patients were included in this study, and their one-year mortality rate was 28 %, of which half died within the first week after ICU discharge. The one-year mortality rate predictors included age at the time of ICU admission, APACHE IV-predicted mortality score, number of comorbidities and ICU re-admissions. The ICU survivor HRQL was significantly lower compared with the normal population. Half of the patients did not return to their pre-hospital place of living, and numerous possible long-term complications were reported, particularly decreased tolerance, chronic fatigue and processing problems of relatives. CONCLUSIONS One-year mortality rate of long-term ICU-treated patient was 28 %, and this was predicted by age, disease severity, comorbidities and ICU re-admissions. The ICU survivors reported a lower HRQL, and a minority of these patients returned home directly after hospital discharge; however, GPs reported numerous possible long-term complications.
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Affiliation(s)
- Simone Steenbergen
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, PO box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Saskia Rijkenberg
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, PO box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Tamara Adonis
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, PO box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Gerda Kroeze
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, PO box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Ilse van Stijn
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, PO box 95500, 1090 HM, Amsterdam, The Netherlands.
| | - Henrik Endeman
- Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, PO box 95500, 1090 HM, Amsterdam, The Netherlands.
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Rodríguez-Villar S, Fernández-Méndez R, Adams G, Rodríguez-García JL, Arévalo-Serrano J, Sánchez-Casado M, Kilgour PM. Basal functional status predicts functional recovery in critically ill patients with multiple-organ failure. J Crit Care 2015; 30:511-7. [PMID: 25817326 DOI: 10.1016/j.jcrc.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/15/2015] [Accepted: 02/08/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to investigate the effect of baseline demographic, clinical, and functional characteristics of intensive care unit (ICU) patients with multiple-organ failure (MOF) on their functional recovery at 6 and 12 months posthospitalization. MATERIALS AND METHODS A total of 545 consecutively admitted adult patients with MOF during on admission were included in the study. Patients' functional status was prospectively assessed and compared with the baseline status and at 6 and 12 months postdischarge, using the Modified Rankin Scale and the Glasgow Outcome Scale Extended. Severity of disease on admission was assessed using the Acute Physiology and Chronic Health Evaluation II and the Simplified Acute Physiology Score II. RESULTS A total of 266 patients were followed up. Functional status among MOF survivors improved between the 6th and 12th month postdischarge from the ICU. Higher functional status before admission, lower severity scores on admission, and younger age positively affected the improvement in functional status after ICU discharge. CONCLUSIONS The level of functional status befre ICU admission should be considered not only in research studies looking a long-term outcomes from ICU but also in the clinical care planning of critically ill patients during and after their ICU admission.
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Affiliation(s)
| | | | - Gary Adams
- Insulin and Diabetes Experimental Group, University Nottingham, Nottingham, UK
| | | | - Juan Arévalo-Serrano
- Internal Medicine Department, Príncipe de Asturias Hospital, Alcalá de Henares, Madrid, Spain
| | | | - Peter M Kilgour
- School of Medicine, University of St Andrews, North Haugh, UK
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Gellar JE, Colantuoni E, Needham DM, Crainiceanu CM. Variable-Domain Functional Regression for Modeling ICU Data. J Am Stat Assoc 2014; 109:1425-1439. [PMID: 25663725 DOI: 10.1080/01621459.2014.940044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We introduce a class of scalar-on-function regression models with subject-specific functional predictor domains. The fundamental idea is to consider a bivariate functional parameter that depends both on the functional argument and on the width of the functional predictor domain. Both parametric and nonparametric models are introduced to fit the functional coefficient. The nonparametric model is theoretically and practically invariant to functional support transformation, or support registration. Methods were motivated by and applied to a study of association between daily measures of the Intensive Care Unit (ICU) Sequential Organ Failure Assessment (SOFA) score and two outcomes: in-hospital mortality, and physical impairment at hospital discharge among survivors. Methods are generally applicable to a large number of new studies that record a continuous variables over unequal domains.
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Affiliation(s)
- Jonathan E Gellar
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
| | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
| | - Dale M Needham
- Pulmonary & Critical Care Medicine, and Physical Medicine &, School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205
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Needham DM, Dinglas VD, Morris PE, Jackson JC, Hough CL, Mendez-Tellez PA, Wozniak AW, Colantuoni E, Ely EW, Rice TW, Hopkins RO. Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow-up. Am J Respir Crit Care Med 2013; 188:567-76. [PMID: 23805899 DOI: 10.1164/rccm.201304-0651oc] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
RATIONALE We hypothesized that providing patients with acute lung injury two different protein/calorie nutritional strategies in the intensive care unit may affect longer-term physical and cognitive performance. OBJECTIVES To assess physical and cognitive performance 6 and 12 months after acute lung injury, and to evaluate the effect of trophic versus full enteral feeding, provided for the first 6 days of mechanical ventilation, on 6-minute-walk distance, cognitive impairment, and secondary outcomes. METHODS A prospective, longitudinal ancillary study of the ARDS Network EDEN trial evaluating 174 consecutive survivors from 5 of 12 centers. Blinded assessments of patients' arm anthropometrics, strength, pulmonary function, 6-minute-walk distance, and cognitive status (executive function, language, memory, verbal reasoning/concept formation, and attention) were performed. MEASUREMENTS AND MAIN RESULTS At 6 and 12 months, respectively, the mean (SD) percent predicted for 6-minute-walk distance was 64% (22%) and 66% (25%) (P = 0.011 for difference between assessments), and 36 and 25% of survivors had cognitive impairment (P = 0.001). Patients performed below predicted values for secondary physical tests with small improvement from 6 to 12 months. There was no significant effect of initial trophic versus full feeding for the first 6 days after randomization on survivors' percent predicted for 6-minute-walk distance, cognitive impairment status, and all secondary outcomes. CONCLUSIONS EDEN trial survivors performed below predicted values for physical and cognitive performance at 6 and 12 months, with some improvement over time. Initial trophic versus full enteral feeding for the first 6 days after randomization did not affect physical and cognitive performance.
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Affiliation(s)
- Dale M Needham
- Outcomes after Critical Illness and Surgery Group, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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