1
|
Lobo-Valbuena B, Molina R, Castañeda-Vozmediano R, Lopez de la Oliva Calvo L, Abella A, Garcia-Arias MM, Salinas Gabiña I, Gordo F. Functional independence, frailty and perceived quality of life in patients who developed delirium during ICU stay: a prospective cohort study. Eur J Med Res 2023; 28:560. [PMID: 38049839 PMCID: PMC10696684 DOI: 10.1186/s40001-023-01530-8] [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: 03/28/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Survivors of critical illness are frequently left with a long-lasting disability. We hypothesised that patients who developed delirium during ICU stay, compared with patients who did not, would have worse health-related quality of life following a critical illness. METHODS Prospective longitudinal observational and analytical study assessing functional independence, frailty and perceived quality of life measured with the Barthel Index, the Clinical Frailty Scale, and the SF-36, comparing patients who developed delirium during ICU stay and patients who did not. The questionnaires were used at different times during the follow-up (upon ICU admission, at ICU discharge, at hospital discharge and 2 years after hospital discharge). RESULTS In a cohort of 1462 patients, we matched 93 patients who developed delirium (delirium group) with 93 patients who did not develop delirium (no-delirium group). Of 156 completed questionnaires (84.7%), we observed that (a) in each of the two groups of patients, the scores related to functional independence (Barthel Index) and frailty (Clinical Frailty Scale) tended to improve over time (p < 0.001), being consistently less favourable in the delirium group compared to the no-delirium group (p < 0.001); (b) the patients who developed delirium also presented lower scores on the SF-36 scale, these differences being statistically significant, and therefore evidencing a worse quality of life, with impact on both the psychological and social spheres (p < 0.001). CONCLUSIONS Patients who developed delirium had significantly lower scores 2 years after hospital discharge on the three used questionnaires, displaying a clear negative impact on the physical, psychological, and social dimensions. The study's results reinforce the need to support and strengthen the care of ICU survivors.
Collapse
Affiliation(s)
- Beatriz Lobo-Valbuena
- Intensivist - Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain.
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de La Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - Rosario Molina
- Intensivist - Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de La Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Raúl Castañeda-Vozmediano
- Research Support Unit, Faculty of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - Ana Abella
- Intensivist - Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de La Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - María-Mercedes Garcia-Arias
- Intensivist - Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de La Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Irene Salinas Gabiña
- Intensivist - Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de La Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Federico Gordo
- Intensivist - Intensive Care Unit, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Grupo de Investigación en Patología Crítica, Facultad de Ciencias de La Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| |
Collapse
|
2
|
Objective assessment of metabolism and guidance of ICU rehabilitation with cardiopulmonary exercise testing. Curr Opin Crit Care 2021; 27:390-398. [PMID: 33973897 DOI: 10.1097/mcc.0000000000000843] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Addressing the reduced quality of life that affects ICU survivors is the most pressing challenge in critical care medicine. In order to meet this challenge, we must translate lessons learnt from assessing and training athletes to the clinical population, utilizing measurable and targeted parameters obtained during cardiopulmonary exercise testing (CPET). RECENT FINDINGS Critical illness survivors demonstrate a persistent reduction in their physical and metabolic function. This manifests in reduced aerobic exercise capacity and metabolic inflexibility. CPET-guided targeted metabolic conditioning has proved beneficial in several clinical populations, including those undergoing high-risk surgery, and could be successfully applied to the rehabilitation of ICU survivors. SUMMARY CPET shows great promise in the guidance of rehabilitation in functionally limited ICU survivors. Parallels in the physiological response to exercise in athletes and clinical populations with the stress and consequences of critical illness must be investigated and ultimately applied to the burgeoning population of ICU survivors in order to treat the consequences of survival from critical illness.
Collapse
|