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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review. Aust Crit Care 2024; 37:354-368. [PMID: 37684157 DOI: 10.1016/j.aucc.2023.07.008] [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: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
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Affiliation(s)
- Lynsey Sutton
- Clinical Nurse Specialist, Wellington Intensive Care Unit, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Riddiford Street, Newtown, Wellington 6021, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
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Abstract
Many Intensive Care (ICU) survivors experience long lasting impairments in physical and psychological health as well as social functioning. The objective of our study was to evaluate these effects up to 10 years after ICU discharge. We performed a long-term prospective cohort study in patients admitted for longer than 48 h in a medical-surgical ICU. We evaluated health-related quality of life (HRQOL) before ICU admission using the Short-form-36 (SF-36), at ICU discharge, at hospital discharge and at 1, 2, 5 and 10 years follow up (all by patients). Changes in HRQOL were assessed based on linear mixed modeling. We included a total of 749 patients (from 2000 to 2008). During 10 years 475 (63.4%) patients had died, 125 (16.7%) patients were lost to follow up and 149 (19.9%) patients could be evaluated. The mean scores of four HRQOL dimensions (i.e., physical functioning (p < 0.001; mean 54, SD 32, effect size 0.77, 95% CI [0.54-1.0]), role-physical (p < 0.001; mean 44, SD 47, effect size 0.65, 95% CI [0.41-0.68] general health (p < 0.001; mean 52, SD 27, effect size 0.48; 95% CI 0.25-0.71) and social functioning (p < 0.001; mean 72, SD 32, effect size 0.41, 95% CI [0.19-0.64]) were still lower 10 years after ICU discharge compared with pre-admission levels (n = 149) and with an age reference population. Almost all SF-36 dimensions changed significantly over time from ICU discharge up to 10 years after ICU discharge. Over the 10 year follow up physical functioning of medical-surgical ICU survivors remains impaired compared with their pre-admission values and an age reference population. However, effect sizes showed no significant differences suggesting that surviving patients largely regained their age-specific HRQOL at 10 years.
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Olsen HT, Nedergaard HK, Hough CL, Korkmaz S, Jensen HI, Strøm T, Toft P. Non-sedation-Does it improve health-related quality of life after critical illness? A 3-month follow-up sub-study of the NONSEDA trial. Acta Anaesthesiol Scand 2021; 65:481-488. [PMID: 33377183 DOI: 10.1111/aas.13775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Critical illness is associated with severely impaired health-related quality of life (HRQoL) for years following discharge. The NONSEDA trial was a multicenter randomized trial on non-sedation versus sedation with a daily wake-up trial in critically ill, mechanically ventilated patients in Scandinavia. The aim of this sub-study was to assess the effect of non-sedation on HRQoL and degree of independence in activities in daily living (ADL) 3 months post-ICU. METHODS All survivors were asked to complete the Medical Outcomes Study Short-Form 36 questionnaire (SF-36) and the Barthel Index 3 months post-ICU. To limit missing data, reminders were sent. If unsuccessful, telephone interviews could be used. Outcomes were the level of HRQoL and ADL-function in each group. All outcomes were assessed blinded. RESULTS Of the 700 patients included 412 survived to follow-up. A total of 344 survivors participated (82%). Baseline data were equal between the two groups. Mean SF-36 scores for the non-sedated vs sedated patients were as follows: Physical Function 45 vs 40, P = .69, Bodily Pain: 61 vs 52, P = .81, General Health: 50 vs 50, P = .84, Vitality: 42 vs 44, P = .85, Social Function: 75 vs 63, P = .85, Role Emotional: 58 vs 50, P = .82, Mental Health: 70 vs 70, P = .89, Role Physical: 25 vs 28, P = .32, Physical Component Score: 38 vs 37, P = .81, Mental Component Score: 48 vs 46, P = .94, Barthel Index: 20 vs 20, P = .74. CONCLUSION Randomization to non-sedation neither improved nor impaired health-related quality of life or degree of independence in activities in daily living 3 months post-ICU discharge.
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Affiliation(s)
- Hanne T Olsen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Helene K Nedergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Serkan Korkmaz
- Department of Business and Economics, University of Southern Denmark, Odense M, Denmark
| | - Hanne I Jensen
- Department of Anesthesiology and Intensive Care, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Thomas Strøm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense C, Denmark
- Department of Anesthesia & Critical Care Medicine, Hospital Soenderjylland, University of Southern Denmark, Denmark
| | - Palle Toft
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense C, Denmark
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O’Brien SG, Carton EG, Fealy GM. Long-Term Health-Related Quality of Life After Venovenous Extracorporeal Membrane Oxygenation. ASAIO J 2020; 66:580-585. [DOI: 10.1097/mat.0000000000001042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Health related quality of life and predictive factors six months after intensive care unit discharge. Anaesth Crit Care Pain Med 2019; 38:137-141. [DOI: 10.1016/j.accpm.2018.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 05/07/2018] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
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Gerth AMJ, Hatch RA, Young JD, Watkinson PJ. Changes in health-related quality of life after discharge from an intensive care unit: a systematic review. Anaesthesia 2019; 74:100-108. [PMID: 30291744 PMCID: PMC6586053 DOI: 10.1111/anae.14444] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2018] [Indexed: 12/26/2022]
Abstract
Quality of life after critical illness is becoming increasingly important as survival improves. Various measures have been used to study the quality of life of patients discharged from intensive care. We systematically reviewed validated measures of quality of life and their results. We searched PubMed, CENTRAL, CINAHL, Web of Science and Open Grey for studies of quality of life, measured after discharge from intensive care. We categorised studied populations as: general; restricted to level-3 care or critical care beyond 5 days; and septic patients. We included quality of life measured at any time after hospital discharge. We identified 48 studies. Thirty-one studies used the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and 19 used the EuroQol-5D (EQ-5D); eight used both and nine used alternative validated measures. Follow-up rates ranged from 26-100%. Quality of life after critical care was worse than for age- and sex-matched populations. Quality of life improved for one year after hospital discharge. The aspects of life that improved most were physical function, physical role, vitality and social function. However, these domains were also the least likely to recover to population norms as they were more profoundly affected by critical illness.
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Affiliation(s)
- A. M. J. Gerth
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - R. A. Hatch
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - J. D. Young
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - P. J. Watkinson
- Critical Care Research GroupNuffield Department of Clinical NeurosciencesUniversity of OxfordUK
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Polmear CM, Nathan H, Bates S, French C, Odisho J, Skinner E, Karahalios A, McGain F. The effect of intensive care unit admission on smokers' attitudes and their likelihood of quitting smoking. Anaesth Intensive Care 2018; 45:720-726. [PMID: 29137583 DOI: 10.1177/0310057x1704500612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We sought to estimate the proportion of patients admitted to a metropolitan intensive care unit (ICU) who were current smokers, and the relationships between ICU survivors who smoked and smoking cessation and/or reduction six months post-ICU discharge. We conducted a prospective cohort study at a metropolitan level III ICU in Melbourne, Victoria. One hundred consecutive patients who met the inclusion criteria were included in the study. Inclusion criteria consisted of patients who were smokers at time of ICU admission, had an ICU length of stay greater than one day, survived to ICU discharge, and provided written informed consent. A purpose-designed questionnaire which included the Fagerstrom test for nicotine dependence and evaluation of patients' attitude towards smoking cessation was completed by participants following ICU discharge and prior to hospital discharge. Participants were re-interviewed over the phone at six months post-ICU discharge. Of the 1,062 patients admitted to ICU, 253 (23%) were current smokers and 100 were enrolled. Six months post-ICU discharge, 28 (33%) of the 86 participants who were alive and contactable had quit smoking and 35 (41%) had reduced smoking. The median number of reported cigarettes smoked per day reduced by 40%. Participants who initially believed their ICU admission was smoking-related were more likely to have quit six months post-ICU discharge (odds ratio 2.98; 95% confidence interval 1.07 to 8.26; <i>P</i>=0.036). Six months post-ICU discharge, 63/86 (74%) of participants had quit or reduced their smoking. Further research into targeted smoking cessation counselling for ICU survivors is indicated.
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Affiliation(s)
| | | | | | | | | | | | - A Karahalios
- Research Fellow, Biostatistics Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria
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Haines KJ, Berney S, Warrillow S, Denehy L. Long-term recovery following critical illness in an Australian cohort. J Intensive Care 2018; 6:8. [PMID: 29445502 PMCID: PMC5800039 DOI: 10.1186/s40560-018-0276-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/22/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Almost all data on 5-year outcomes for critical care survivors come from North America and Europe. The aim of this study was to investigate long-term mortality, physical function, psychological outcomes and health-related quality of life in a mixed intensive care unit cohort in Australia. METHODS This longitudinal study evaluated 4- to 5-year outcomes. Physical function (six-minute walk test) and health-related quality of life (Short Form 36 Version 2) were compared to 1-year outcomes and population norms. New psychological data (Center for Epidemiological Studies-Depression, Impact of Events Scale) was collected at follow-up. RESULTS Of the 150 participants, 66 (44%) patients were deceased by follow-up. Fifty-six survivors were included with a mean (SD) age of 64 (14.2). Survivors' mean (SD) six-minute walk distance increased between 1 and 4 to 5 years (465.8 m (148.9) vs. 507.5 m (118.2)) (mean difference = - 24.5 m, CI - 58.3, 9.2, p = 0.15). Depressive symptoms were low: median (IQR) score of 7.0 (1.0-15.0). The mean level of post-traumatic stress symptoms was low-median (IQR) score of 1.0 (0-11.0)-with only 9 (16%) above the threshold for potentially disordered symptoms. Short-Form 36 Physical and Mental Component Scores did not change between 1 and 4 to 5 years (46.4 (7.9) vs. 46.7 (8.1) and 48.8 (13) vs. 48.8 (11.1)) and were within a standard deviation of normal. CONCLUSIONS Outcomes of critical illness are not uniform across nations. Mortality was increased in this cohort; however, survivors achieved a high level of recovery for physical function and health-related quality of life with low psychological morbidity at follow-up. TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.
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Affiliation(s)
- Kimberley J. Haines
- Physiotherapy Department, Western Health, Furlong Road, St. Albans, VIC 3021 Australia
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville, VIC 3010 Australia
| | - Sue Berney
- Department of Physiotherapy, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Stephen Warrillow
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084 Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, 200 Berkeley Street, Parkville, VIC 3010 Australia
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Hydroxyethyl starch versus saline for resuscitation of patients in intensive care: long-term outcomes and cost-effectiveness analysis of a cohort from CHEST. THE LANCET RESPIRATORY MEDICINE 2016; 4:818-825. [DOI: 10.1016/s2213-2600(16)30120-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022]
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The conceptualisation of health-related quality of life in decision-making by intensive care physicians: A qualitative inquiry. Aust Crit Care 2016; 30:152-159. [PMID: 27595412 DOI: 10.1016/j.aucc.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To explore how intensive care physicians conceptualise and prioritise patient health-related quality of life in their decision-making. RESEARCH METHODOLOGY/DESIGN General qualitative inquiry using elements of Grounded Theory. Six ICU physicians participated. SETTING A large, closed, mixed ICU at a university-affiliated hospital, Australia. RESULTS Three themes emerged: (1) Multi-dimensionality of HRQoL-HRQoL was described as difficult to understand; the patient was viewed as the best informant. Proxy information on HRQoL and health preferences was used to direct clinical care, despite not always being trusted. (2) Prioritisation of HRQoL within decision-making-this varied across the patient's health care trajectory. Premorbid HRQoL was prioritised when making admission decisions and used to predict future HRQoL. (3) Role of physician in decision-making-the physicians described their role as representing society with peers influencing their decision-making. All participants considered their practice to be similar to their peers, referring to their practice as the "middle of the road". This is a novel finding, emphasising other important influences in high-stakes decision-making. CONCLUSION Critical care physicians conceptualised HRQoL as a multi-dimensional subjective construct. Patient (or proxy) voice was integral in establishing patient HRQoL and future health preferences. HRQoL was important in high stakes decision-making including initiating invasive and burdensome therapies or in redirecting therapeutic goals.
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Farley KJ, Eastwood GM, Bellomo R. A feasibility study of functional status and follow-up clinic preferences of patients at high risk of post intensive care syndrome. Anaesth Intensive Care 2016; 44:413-9. [PMID: 27246943 DOI: 10.1177/0310057x1604400310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
After prolonged mechanical ventilation patients may experience the 'post intensive care syndrome' (PICS) and may be candidates for post-discharge follow-up clinics. We aimed to ascertain the incidence and severity of PICS symptoms in patients surviving prolonged mechanical ventilation and to describe their views regarding follow-up clinics. In a teaching hospital, we conducted a cohort study of all adult patients discharged alive after ventilation in ICU for ≥7 days during 2013. We administered the EuroQol-5D (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) via telephone interview and asked patients their views about the possible utility of a follow-up clinic. We studied 48 patients. At follow-up (average 19.5 months), seven (15%) patients had died and 14 (29%) did not participate (eight declined; two were non-English speakers; four were non-contactable). Among the 27 responders, 16 (59%) reported at least moderate problems in ≥1 EQ-5D dimension; 10 (37%) in ≥2 dimensions, and 8 (30%) in ≥3 dimensions. Moreover, 10 (37%) patients reported marked psychological symptoms; six (22%) scored borderline or abnormal on the HADS for both anxiety and depression; and four (15%) scored borderline or abnormal for one component. Finally, 21/26 (81%) patients stated that an ICU follow-up clinic would have been beneficial. At long-term follow-up, the majority of survivors of prolonged mechanical ventilation reported impaired quality of life and significant psychological symptoms. Most believed that a follow-up clinic would have been beneficial.
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Affiliation(s)
- K J Farley
- Intensive Care Specialist, Western Health, Melbourne, Victoria
| | - G M Eastwood
- Adjunct Senior Research Fellow, Faculty of MN&HS, Monash University, Research Manager, Department of Intensive Care, Austin Hospital, Victoria, Melbourne, Victoria
| | - R Bellomo
- Director of Intensive Care Research & Intensive Care Specialist, Austin Hospital, Melbourne, Victoria
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Nickels M, Aitken LM, Walsham J, Watson L, McPhail S. Clinicians' perceptions of rationales for rehabilitative exercise in a critical care setting: A cross-sectional study. Aust Crit Care 2016; 30:79-84. [PMID: 27105830 DOI: 10.1016/j.aucc.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. OBJECTIVE To identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent across nursing, medical and physiotherapy clinicians. METHODS A cross-sectional study was undertaken among clinicians (nursing, medical, physiotherapy) working in a mixed medical surgical ICU in an Australian metropolitan tertiary hospital. Participants completed a customised web-based questionnaire developed by a clinician working-group. The questionnaire consisted of 11 plausible rationales for commencing rehabilitative exercise in ICUs based on prior literature and their own clinical experiences grouped into 4 over-arching categories (musculoskeletal, respiratory, psychological and facilitation of discharge). Participants rated their perceived importance for each potential rationale on a 5-point Likert scale. RESULTS Participants (n=76) with a median (interquartile range) 4.8 (1.5, 15.5) years of experience working in ICUs completed the questionnaire. Responses were consistent across professional disciplines. Clinicians rated rehabilitative exercise as either 'very much' or 'somewhat' important for facilitating discharge (n=76, 100%), reducing muscle atrophy (n=76, 100%), increasing muscle strength (n=76, 100%), prevention of contractures (n=73, 96%), reducing the incidence of ICU acquired weakness (n=62, 82%), increasing oxygenation (n=71, 93%), facilitating weaning (n=72, 97%), reducing anxiety (n=60, 80%), reducing depression (n=64, 84%), reducing delirium (n=53, 70%), and increasing mental alertness (n=65, 87%). CONCLUSIONS Any shortcoming in implementation of rehabilitation exercise is unlikely attributable to a lack of perceived importance by nursing, medical or physiotherapy clinicians who are the most likely clinicians to influence rehabilitation practices in ICUs. It is noteworthy that this study examined self-reported perceptions, not physiological or scientific legitimacy of rationales, or clinician behaviours in practice.
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Affiliation(s)
- Marc Nickels
- Intensive Care Unit and Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia; School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Leanne M Aitken
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Health Sciences, City University London, London, United Kingdom
| | - James Walsham
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Lisa Watson
- Intensive Care Unit and Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Steven McPhail
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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Reassuring Long-Term Outcomes for Australian and New Zealand Survivors of Severe Influenza A (H1N1) Infection. A Case Study in Methodological Complexity? Ann Am Thorac Soc 2016; 12:794-5. [PMID: 26075552 DOI: 10.1513/annalsats.201503-171ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Freeman-Sanderson AL, Togher L, Elkins MR, Phipps PR. Quality of life improves with return of voice in tracheostomy patients in intensive care: An observational study. J Crit Care 2016; 33:186-91. [PMID: 26971032 DOI: 10.1016/j.jcrc.2016.01.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To measure patient-reported change of mood, communication-related quality of life, and general health status with return of voice among mechanically ventilated tracheostomy patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS A prospective observational study in a tertiary ICU was conducted. Communication-related quality of life was measured daily using the Visual Analogue Self-Esteem Scale. General health status was measured weekly using the EuroQol-5D. RESULTS Aspects of communication self-esteem that significantly improved with the return of voice were ability to be understood by others (P = .006) and cheerfulness (P = .04), both with a median difference from before to after return of voice of 1 on the 5-point scale. Return of voice was not associated with a significant improvement in confidence, sense of outgoingness, anger, sense of being trapped, optimism, or frustration. Reported general health status did not significantly improve. CONCLUSIONS Return of voice was associated with significant improvement in patient reported self-esteem, particularly in being understood by others and in cheerfulness. Improved self-esteem may also improve quality of life; however, further research is needed to confirm this relationship. Early restoration of voice should be investigated as a way to improve the experience of ICU for tracheostomy patients.
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Affiliation(s)
- Amy L Freeman-Sanderson
- Speech Pathology Department, Royal Prince Alfred Hospital, Camperdown, Australia; Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
| | - Leanne Togher
- Speech Pathology, Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Mark R Elkins
- Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Education & Workforce Development, Sydney Local Health District, Sydney, Australia
| | - Paul R Phipps
- Department of Intensive Care Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
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McKinley S, Fien M, Elliott R, Elliott D. Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge. Am J Crit Care 2016; 25:52-8. [PMID: 26724295 DOI: 10.4037/ajcc2016995] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Intensive care unit survivors often have diminished health-related quality of life. OBJECTIVES To describe health-related quality of life of former intensive care patients and identify associated factors 6 months after hospital discharge. METHODS Six months after discharge, 193 patients from an intensive care unit completed the Short Form-36 Health Survey; measures of sleep; Intensive Care Experience Questionnaire; Depression, Anxiety and Stress Scales; and Posttraumatic Stress Disorder Checklist. Norm-based scores were calculated for the Short Form-36. Bivariate associations with Short Form-36 scores were tested by using the Pearson correlation. Multiple linear regression was used to identify independent associations with health-related quality of life. RESULTS All scores on the Short Form-36 (physical component summary, 41.8; mental component summary, 48.2) were less than population norms. Bivariate associations with health-related quality of life (P < .05) were scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, awareness of surroundings and frightening experiences, depression, anxiety, stress, posttraumatic symptoms, and sleep quality at 2 and 6 months. In linear regression, scores on the Acute Physiology and Chronic Health Evaluation II, hospital length of stay, and sleep quality at 6 months were independently associated with Short Form-36 physical summary scores (P < .001); depression and stress were independently associated with mental summary scores (P < .001). CONCLUSION Sleep, depression, and stress are potential targets for interventions to improve health-related quality of life and improve recovery.
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Affiliation(s)
- Sharon McKinley
- Sharon McKinley is a nurse researcher in the intensive care unit at Royal North Shore Hospital, Sydney, Australia. Mary Fien is a business analyst, eHealth NSW, Sydney, Australia. Rosalind Elliott and Doug Elliott are members of the faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Mary Fien
- Sharon McKinley is a nurse researcher in the intensive care unit at Royal North Shore Hospital, Sydney, Australia. Mary Fien is a business analyst, eHealth NSW, Sydney, Australia. Rosalind Elliott and Doug Elliott are members of the faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosalind Elliott
- Sharon McKinley is a nurse researcher in the intensive care unit at Royal North Shore Hospital, Sydney, Australia. Mary Fien is a business analyst, eHealth NSW, Sydney, Australia. Rosalind Elliott and Doug Elliott are members of the faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Doug Elliott
- Sharon McKinley is a nurse researcher in the intensive care unit at Royal North Shore Hospital, Sydney, Australia. Mary Fien is a business analyst, eHealth NSW, Sydney, Australia. Rosalind Elliott and Doug Elliott are members of the faculty of Health, University of Technology Sydney, Sydney, Australia
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Key Measurement and Feasibility Characteristics When Selecting Outcome Measures. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0099-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Health-Related Quality of Life in Australasian Survivors of H1N1 Influenza Undergoing Mechanical Ventilation. A Multicenter Cohort Study. Ann Am Thorac Soc 2015; 12:895-903. [DOI: 10.1513/annalsats.201412-568oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Skinner E, Warrillow S, Denehy L. Organisation and resource management in the intensive care unit: A critical review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2015. [DOI: 10.12968/ijtr.2015.22.4.187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Linda Denehy
- Professor in physiotherapy, The University of Melbourne, Australia
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Mehrholz J, Pohl M, Kugler J, Burridge J, Mückel S, Elsner B. Physical rehabilitation for critical illness myopathy and neuropathy. Cochrane Database Syst Rev 2015; 2015:CD010942. [PMID: 25737049 PMCID: PMC11026869 DOI: 10.1002/14651858.cd010942.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. OBJECTIVES Our primary objective was to assess the effects of physical rehabilitation therapies and interventions for people with CIP and CIM in improving activities of daily living such as walking, bathing, dressing and eating. Secondary objectives were to assess effects on muscle strength and quality of life, and to assess adverse effects of physical rehabilitation. SEARCH METHODS On 16 July 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register and on 14 July 2014 we searched CENTRAL, MEDLINE, EMBASE and CINAHL Plus. In July 2014, we searched the Physiotherapy Evidence Database (PEDro, http://www.pedro.org.au/) and three trials registries for ongoing trials and further data about included studies. There were no language restrictions. We also handsearched relevant conference proceedings and screened reference lists to identify further trials. SELECTION CRITERIA We planned to include randomised controlled trials (RCTs), quasi-RCTs and randomised controlled cross-over trials of any rehabilitation intervention in people with acquired weakness syndrome due to CIP/CIM. DATA COLLECTION AND ANALYSIS We would have extracted data, assessed the risk of bias and classified the quality of evidence for outcomes in duplicate, according to the standard procedures of The Cochrane Collaboration. Outcome data collection would have been for activities of daily living (for example, mobility, walking, transfers and self care). Secondary outcomes included muscle strength, quality of life and adverse events. MAIN RESULTS The search strategy retrieved 3587 references. After examination of titles and abstracts, we retrieved the full text of 24 potentially relevant studies. None of these studies met the inclusion criteria of our review. No data were suitable to be included in a meta-analysis. AUTHORS' CONCLUSIONS There are no published RCTs or quasi-RCTs that examine whether physical rehabilitation interventions improve activities of daily living for people with CIP and CIM. Large RCTs, which are feasible, need to be conducted to explore the role of physical rehabilitation interventions for people with CIP and CIM.
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Affiliation(s)
- Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Marcus Pohl
- Klinik Bavaria KreischaAbteilung Neurologie und Fachübergreifende RehabilitationAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Jane Burridge
- University of SouthamptonResearch Group, Faculty of Health SciencesBuilding 45, University of SouthamptonSouthamptonUKSO17 1BJ
| | - Simone Mückel
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Bernhard Elsner
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
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Hofhuis JGM, van Stel HF, Schrijvers AJP, Rommes JH, Spronk PE. ICU survivors show no decline in health-related quality of life after 5 years. Intensive Care Med 2015; 41:495-504. [PMID: 25672277 DOI: 10.1007/s00134-015-3669-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/15/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Severe critical illness requiring treatment in the intensive care unit (ICU) may have a serious impact on patients and their families. However, optimal follow-up periods are not defined and data on health-related quality of life (HRQOL) before ICU admission as well as those beyond 2 years follow-up are limited. The aim of our study was to assess the impact of ICU stay up to 5 years after ICU discharge. METHODS We performed a long-term prospective cohort study in patients admitted for longer than 48 h in a medical-surgical ICU. The Short-Form 36 was used to evaluate HRQOL before admission (by proxy within 48 h after admission of the patient), at ICU discharge, and at 1, 2, and 5 years following ICU discharge (all by patients). Changes in HRQOL were assessed using linear mixed modeling. RESULTS We included a total of 749 patients (from 2000 to 2007). At 5 years after ICU discharge 234 patients could be evaluated. After correction for natural decline in HRQOL, the mean scores of four dimensions-physical functioning (p < 0.001), role-physical (p < 0.001), general health (p < 0.001), and social functioning (p = 0.003)-were still significantly lower 5 years after ICU discharge compared with their pre-admission levels, although effect sizes were small (<0.5). CONCLUSIONS After correction for natural decline, the effect sizes of decreases in HRQOL were small, suggesting that patients regain their age-specific HRQOL 5 years after their ICU stay.
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Affiliation(s)
- José G M Hofhuis
- Department of Intensive Care, Gelre Ziekenhuizen Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands,
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Our paper 20 years later: 1-year survival and 6-month quality of life after intensive care. Intensive Care Med 2015; 41:605-14. [PMID: 25605472 DOI: 10.1007/s00134-015-3654-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In the early 1990s, the in-hospital mortality rate of intensive care unit (ICU) patients dropped, and interest in the quality of life (QOL) of ICU survivors increased. In 1996, we published a study to investigate 1-year survival after hospital discharge and 6-month QOL after intensive care. Now, we compare our previous results with those reported in the recent literature to appraise any changes, and new knowledge in the area. RESULTS The 1-year survival of ICU patients after hospital discharge is substantial, lower than in the general population, and different among subgroups. Some studies showed a reduction in QOL at 6 months, as in our study, while others showed an improvement. Different results seem to be related mainly to the case mix. Studies on different types of patients found long-term cognitive impairment in ICU survivors, possibly not disease specific. The proportions of patients with neuropsychological morbidities such as posttraumatic stress disorder, anxiety, and depression, described after our study, did not show any change over time. CONCLUSIONS Differences between studies on long-term survival and QOL do not allow conclusions to be drawn about change over time. No change was found in neuropsychological morbidities. However, a lack of change may not be viewed negatively, because critically ill patients who survive ICU today may be at higher risk for poor long-term outcome than in the past due to the higher severity of their illness and the more aggressive treatments received. Future studies may provide understanding of the relationships between psychiatric symptoms, cognitive impairment, functional disability, and QOL.
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Quasim T, Brown J, Kinsella J. Employment, social dependency and return to work after intensive care. J Intensive Care Soc 2014; 16:31-36. [PMID: 28979372 DOI: 10.1177/1751143714556238] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Quality of life is an important measure of outcome in intensive care survivors. As return to employment is a key determinant of quality of life, we performed a prospective observational, cohort study of 75 intensive care unit patients who survived to hospital discharge. Approximately 2 years after intensive care unit discharge, 64% (18/28) of those employed before intensive care unit had returned to work. Of the rest, 10 were not working, two were unemployed, one was temporarily sick and seven were permanently sick. When health utility scores were assessed in the various employment categories, quality of life was particularly poor in the unemployed and permanently sick with median (interquartile range) scores of 0.082(-0.045-0.665) and 0.053(-0.160-0.769) respectively. Of the retired population, 95% returned to their own home with 50% requiring a family member to act as their carer. This study has demonstrated that patients who returned to work after a critical illness had a better quality of life at follow up, compared to the unemployed and permanently sick. In addition, there may be a burden on family members who act as carers for their relatives on discharge from hospital after a critical illness. Further work is required in this important area.
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Affiliation(s)
- Tara Quasim
- Academic Unit of Anaesthesia, Pain & Critical Care Medicine, School of Medicine, University of Glasgow, Glasgow, UK
| | - Judith Brown
- Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - John Kinsella
- Academic Unit of Anaesthesia, Pain & Critical Care Medicine, School of Medicine, University of Glasgow, Glasgow, UK
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Ewens BA, Hendricks JM, Sundin D. Never ending stories: visual diarizing to recreate autobiographical memory of intensive care unit survivors. Nurs Crit Care 2014; 22:8-18. [PMID: 25294316 DOI: 10.1111/nicc.12093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/22/2014] [Accepted: 02/25/2014] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to explore the potential use of visual diarizing to enable intensive care unit (ICU) survivors to create their story of recovery. BACKGROUND An ICU experience can have deleterious psychological and physical effects on survivors leading to reductions in quality of life which for some may be of significant duration. Although there has been exploration of many interventions to support recovery in this group, service provision for survivors remains inconsistent and inadequate. DESIGN AND PARTICIPANTS A qualitative interpretive biographical exploration of the ICU experience and recovery phase of ICU survivors using visual diarizing as method. This paper is a component of a larger study and presents an analyses of one participant's visual diary in detail. METHODS Data collection was twofold. The participant was supplied with visual diary materials at 2 months post-hospital discharge and depicted his story in words and pictures for a 3-month period, after which he was interviewed. The interview enabled the participant and researcher to interpret the visual diary and create a biographical account of his ICU stay and recovery journey. FINDINGS The analysis of one participant's visual diary yielded a wealth of information about his recovery trajectory articulated through the images he chose to symbolize his story. The participant confirmed feelings of persecution whilst in ICU and was unprepared for the physical and psychological disability which ensued following his discharge from hospital. However, his story was one of hope for the future and a determination that good would come out of his experience. He considered using the visual diary enhanced his recovery. CONCLUSIONS The participant perceived that visual diarizing enhanced his recovery trajectory by enabling him to recreate his story using visual imagery in a prospective diary. RELEVANCE TO CLINICAL PRACTICE Prospective visual diarizing with ICU survivors may have potential as an aid to recovery.
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Affiliation(s)
- Beverley A Ewens
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Joyce M Hendricks
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
| | - Deb Sundin
- Nursing and Midwifery, Edith Cowan University, Perth, WA 6027, Australia
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Wang YT, Haines TP, Ritchie P, Walker C, Ansell TA, Ryan DT, Lim PS, Vij S, Acs R, Fealy N, Skinner EH. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R161. [PMID: 25069952 PMCID: PMC4262200 DOI: 10.1186/cc14001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/30/2014] [Indexed: 02/07/2023]
Abstract
Introduction Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population. Methods A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured. Results No episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads between the intervention shift and the following shift were similar. Conclusions Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011) Electronic supplementary material The online version of this article (doi:10.1186/cc14001) contains supplementary material, which is available to authorized users.
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Castillo MI, Aitken LM, Cooke ML. Adverse outcomes of critical illness from a dyadic perspective. Aust Crit Care 2014; 27:195-7. [PMID: 24947896 DOI: 10.1016/j.aucc.2014.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/06/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Maria I Castillo
- NHMRC Centre of Research Excellence, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
| | - Leanne M Aitken
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marie L Cooke
- NHMRC Centre of Research Excellence, Research Centre for Clinical and Community Practice Innovation, Griffith Health Institute, Griffith University, Nathan, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study. Aust Crit Care 2014; 27:28-35. [DOI: 10.1016/j.aucc.2013.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 04/29/2013] [Accepted: 07/02/2013] [Indexed: 12/26/2022] Open
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Mehrholz J, Pohl M, Kugler J, Burridge J, Mückel S. Physical rehabilitation for critical illness myopathy and neuropathy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd010942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Impaired long-term quality of life in survivors of severe sepsis. Anaesthesist 2013; 62:995-1002. [DOI: 10.1007/s00101-013-2257-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 09/06/2013] [Accepted: 10/08/2013] [Indexed: 11/25/2022]
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Orwelius L, Fredrikson M, Kristenson M, Walther S, Sjöberg F. Health-related quality of life scores after intensive care are almost equal to those of the normal population: a multicenter observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R236. [PMID: 24119915 PMCID: PMC4056627 DOI: 10.1186/cc13059] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 09/11/2013] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) in patients treated in intensive care has been reported to be lower compared with age- and sex-adjusted control groups. Our aim was to test whether stratifying for coexisting conditions would reduce observed differences in HRQoL between patients treated in the ICU and a control group from the normal population. We also wanted to characterize the ICU patients with the lowest HRQoL within these strata. METHODS We did a cross-sectional comparison of scores of the short-form health survey (SF-36) questionnaire in a multicenter study of patients treated in the ICU (n = 780) and those from a local public health survey (n = 6,093). Analyses were in both groups adjusted for age and sex, and data stratified for coexisting conditions. Within each stratum, patients with low scores (below -2 SD of the control group) were identified and characterized. RESULTS After adjustment, there were minor and insignificant differences in mean SF-36 scores between patients and controls. Eight (n = 18) and 22% (n = 51) of the patients had low scores (-2 SD of the control group) in the physical and mental dimensions of SF-36, respectively. Patients with low scores were usually male, single, on sick leave before admission to critical care, and survived a shorter time after being in ICU. CONCLUSIONS After adjusting for age, sex, and coexisting conditions, mean HRQoL scores were almost equal in patients and controls. Up to 22% (n = 51) of the patients had, however, a poor quality of life as compared with the controls (-2 SD). This group, which more often consisted of single men, individuals who were on sick leave before admission to the ICU, had an increased mortality after ICU. This group should be a target for future support.
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Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor-Partner Interdependence Model. Crit Care Med 2013; 41:69-75. [PMID: 23222259 DOI: 10.1097/ccm.0b013e31826766b0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the physical and mental long-term consequences of intensive care treatment for severe sepsis in patients and their spouses under consideration of a dyadic perspective using the Actor-Partner Interdependence Model. DESIGN Prospective study. SETTING Patients and spouses who had requested advice from the German Sepsis Aid's National Helpline were invited to participate. SUBJECTS We included 55 patients who survived severe sepsis and their spouses an average of 55 months after ICU discharge. MEASUREMENTS AND MAIN RESULTS The Hospital Anxiety and Depression Scale, the Short Form-12 Health Survey, the Posttraumatic Stress Scale-10, and the Giessen Subjective Complaints List-24 were used. The Actor-Partner Interdependence Model was tested using multilevel modeling with the actor effect representing the impact of a person's posttraumatic stress symptoms on his or her own mental health-related quality of life and the partner effect characterized by the impact of a person's posttraumatic stress symptoms on his or her partner's mental health-related quality of life. A significant proportion of patients and spouses (26%-42%) showed clinically relevant scores of anxiety and depression; approximately two thirds of both, patients and spouses, reported posttraumatic stress symptoms defined as clinically relevant. Compared with normative samples, patients reported greater anxiety, poorer mental and physical health-related quality of life, and greater exhaustion; spouses had an impaired mental health-related quality of life and increased anxiety. Testing the Actor-Partner Interdependence Model revealed that posttraumatic stress symptoms were related to patients' (β = -0.71, 95% confidence interval -0.88 to -0.54) and spouses' (β = -0.62, 95% confidence interval -0.79 to -0.46) own mental health-related quality of life. Posttraumatic stress symptoms further influenced the mental health-related quality of life of the respective other (β = -0.18, 95% confidence interval -0.35 to -0.003 for patients; β = -0.15, 95% confidence interval -0.32 to 0.02 for spouses). CONCLUSIONS Interventions to treat posttraumatic stress symptoms after critical illness to improve mental health-related quality of life should not only include patients, but also consider spouses.
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Abstract
OBJECTIVE To compare patients' retrospectively reported baseline quality of life before intensive care hospitalization with population norms and proxy reports. DESIGN Prospective cohort study. SETTING Thirteen ICUs at four teaching hospitals in Baltimore, MD. PATIENTS One hundred forty acute lung injury survivors and their designated proxies. INTERVENTIONS Around the time of hospital discharge, both patients and proxies were asked to retrospectively estimate patients' baseline quality of life before hospital admission using the EQ-5D quality-of-life instrument. MEASUREMENTS AND MAIN RESULTS Mean patient-rated EQ-5D visual analog scale scores and utility scores were significantly lower than population norms but were significantly higher than proxy ratings. However, the magnitude of difference in average utility scores between patients and either population norms or proxies was not clinically important. For the five individual EQ-5D domains, κ statistics revealed slight to fair agreement between patients and proxies. Bland-Altman plots demonstrated that for both the visual analog scale and utility scores, proxies underestimated scores when patients reported high ratings and overestimated scores for low patient ratings. CONCLUSIONS Patients retrospectively reported worse baseline health status before acute lung injury than population norms and better status than proxy reports; however, the magnitude of these differences in health status may not be clinically important. Proxies had only slight to fair agreement with patients in all five EQ-5D domains, attenuating patients' more extreme ratings toward moderate scores. Caution is required when interpreting proxy retrospective reports of baseline health status for survivors of acute lung injury.
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Abstract
Patients admitted to the intensive care unit (ICU) can develop a condition referred to as "ICU-acquired weakness." This condition is characterized by profound weakness that is greater than might be expected to result from prolonged bed rest. Intensive care unit-acquired weakness often is accompanied by dysfunction of multiple organ systems. Individuals with ICU-acquired weakness typically have significant activity limitations, often requiring physical assistance for even the most basic activities associated with bed mobility. Many of these individuals have activity limitations months to years after hospitalization. The purpose of this article is to review evidence that guides physical rehabilitation of people with ICU-acquired weakness. Included are diagnostic criteria, medical management, and prognostic indicators, as well as criteria for beginning physical rehabilitation, with an emphasis on patient safety. Data are presented indicating that rehabilitation can be implemented with very few adverse effects. Evidence is provided for appropriate measurement approaches and for physical intervention strategies. Finally, some of the key issues are summarized that should be investigated to determine the best intervention guidelines for individuals with ICU-acquired weakness.
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Hodgson CL, Hayes K, Everard T, Nichol A, Davies AR, Bailey MJ, Tuxen DV, Cooper DJ, Pellegrino V. Long-term quality of life in patients with acute respiratory distress syndrome requiring extracorporeal membrane oxygenation for refractory hypoxaemia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R202. [PMID: 23082772 PMCID: PMC3682304 DOI: 10.1186/cc11811] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/28/2012] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The purpose of the study was to assess the long term outcome and quality of life of patients with acute respiratory distress syndrome (ARDS) receiving extracorporeal membrane oxygenation (ECMO) for refractory hypoxemia. METHODS A retrospective observational study with prospective health related quality of life (HRQoL) assessment was conducted in ARDS patients who had ECMO as a rescue therapy for reversible refractory hypoxemia from January 2009 until April 2011 in a tertiary Australian centre. Survival and long-term quality of life assessment, using the Short-Form 36 (SF-36) and the EuroQol health related quality of life questionnaire (EQ5D) were assessed and compared to international data from other research groups. RESULTS Twenty-one patients (mean age 36.3 years) with ARDS receiving ECMO for refractory hypoxemia were studied. Eighteen (86%) patients were retrieved from external intensive care units (ICUs) by a dedicated ECMO retrieval team. Eleven (55%) had H1N1 influenza A-associated pneumonitis. Eighteen (86%) patients survived to hospital discharge. Of the 18 survivors, ten (56%) were discharged to other hospitals and 8 (44%) were discharged directly home. Sequelae and health related quality of life were evaluated for 15 of the 18 (71%) long-term survivors (assessment at median 8 months). Mean SF-36 scores were significantly lower across all domains compared to age and sex matched Australian norms. Mean SF-36 scores were lower (minimum important difference at least 5 points) than previously described ARDS survivors in the domains of general health, mental health, vitality and social function. One patient had long-term disability as a result of ICU acquired weakness. Only 26% of survivors had returned to previous work levels at the time of follow-up. CONCLUSIONS This ARDS cohort had a high survival rate (86%) after use of ECMO support for reversible refractory hypoxemia. Long term survivors had similar physical health but decreased mental health, general health, vitality and social function compared to other ARDS survivors and an unexpectedly poor return to work.
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Intensive care unit survivorship: varying outcomes dependent on patient characteristics. Crit Care Med 2011; 39:2002-4. [PMID: 21768807 DOI: 10.1097/ccm.0b013e318224994b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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