1
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Orwelius L, Wilhelms S, Sjöberg F. Is comorbidity alone responsible for changes in health-related quality of life among critical care survivors? A purpose-specific review. Crit Care 2024; 28:208. [PMID: 38926875 PMCID: PMC11201873 DOI: 10.1186/s13054-024-04997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is one of the most important outcome variables for assessing the effectiveness of intensive care, together with mortality and survival, where comorbidity is suggested to have high impact. However, studies are lacking that examine to what extent HRQoL is affected after a general ICU period, beyond that of the effects that may be claimed to be due to comorbidities. DESIGN Purpose-specific literature review including literature searches in PubMed, Cinahl, Scopus, and Cochrane library between 2010 and 2021. MEASUREMENTS AND RESULTS This Purpose-specific, i.e., task focused review examines HRQoL (assessed by either SF-36 or EQ-5D, > 30 days after leaving the hospital) in adult patients (≥ 18 years) having an ICU length of stay > 24 h. Further, the HRQoL comparisons were adjusted for age or comorbidity. A total of 11 publications were found. A majority comprised observational, prospective cohort studies, except three that were either case-control, cross-sectional comparison, or retrospective cohort studies. A total of 18,566 critically ill patients were included, and the response rate ranged from 16 to 94%. In all studies, a recurrent relevant finding was that HRQoL after ICU care was affected by pre-ICU comorbidities. In three studies (n = 3), which included a comorbidity adjusted control group, there were no effect of the critical care period itself on the registered HRQoL after the critical care period. CONCLUSION Health-Related Quality of Life (HRQoL) in former ICU patients appears to be primarily influenced by comorbidity. A notable limitation in this field of research is the high heterogeneity observed in the studies reviewed, particularly in terms of the HRQoL measurement tool employed, the duration of follow-up, the methodology for comorbidity assessment, and the adjustments for age and sex. Despite these variations and the limited number of studies in the review, the findings suggest a minimal HRQoL impact beyond the effects of comorbidity. Given the significant dearth of comprehensive studies in this domain, there is an escalating call for more thorough and detailed research endeavours.
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Affiliation(s)
- Lotti Orwelius
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85, Linköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Susanne Wilhelms
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Clinical Physiology, Faculty of Medicine, Linköping University, 581 83, Linköping, Sweden
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
- Burns, Hand, and Plastic Surgery, Linköping University Hospital, 581 85, Linköping, Sweden
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2
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Sarmin M, Alam T, Shaly NJ, Jeorge DH, Afroze F, Shahrin L, Shahunja KM, Ahmed T, Shahid ASMSB, Chisti MJ. Physical Quality of Life of Sepsis Survivor Severely Malnourished Children after Hospital Discharge: Findings from a Retrospective Chart Analysis. Life (Basel) 2022; 12:379. [PMID: 35330130 PMCID: PMC8954014 DOI: 10.3390/life12030379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Quality of life (QoL) among pediatric sepsis survivors in resource-limited countries is poorly understood. We aimed to evaluate the QoL among sepsis survivors, by comparing them with non-sepsis survivors three months after hospital discharge. METHODOLOGY In this retrospective chart analysis with a case-control design, we compared children having sepsis and non-sepsis at hospital admission and during their post-hospitalization life, where the study population was derived from a hospital cohort of 405 severely malnourished children having pneumonia. RESULTS The median age (months, inter-quartile range) of the children having sepsis and non-sepsis was 10 (5, 17) and 9 (5, 18), respectively. Approximately half of the children among the sepsis survivors had new episodes of respiratory symptoms at home. Though death was significantly higher (15.8% vs. 2.7%, p ≤ 0.001) at admission among the sepsis group, deaths during post-hospitalization life (7.8% vs. 8.8%, p = 0.878) were comparable. A verbal autopsy revealed that before death, most of the children from the sepsis group had respiratory complaints, whereas gastrointestinal complaints were more common among the non-sepsis group. CONCLUSIONS Pediatric sepsis is life-threatening both during hospitalization and post-discharge. The QoL after sepsis is compromised, including re-hospitalization and the development of new episodes of respiratory symptoms especially before death.
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Affiliation(s)
- Monira Sarmin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Tahmina Alam
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Nusrat Jahan Shaly
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Didarul Haque Jeorge
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Farzana Afroze
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Lubaba Shahrin
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - K. M. Shahunja
- Institute for Social Science Research, The University of Queensland, Brisbane 4072, Australia;
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Abu Sadat Mohammad Sayeem Bin Shahid
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (M.S.); (T.A.); (N.J.S.); (D.H.J.); (F.A.); (L.S.); (T.A.); (A.S.M.S.B.S.)
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3
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Moran BL, Myburgh JA, Scott DA. The complications of opioid use during and post-intensive care admission: A narrative review. Anaesth Intensive Care 2022; 50:108-126. [PMID: 35172616 DOI: 10.1177/0310057x211070008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Opioids are a commonly administered analgesic medication in the intensive care unit, primarily to facilitate invasive mechanical ventilation. Consensus guidelines advocate for an opioid-first strategy for the management of acute pain in ventilated patients. As a result, these patients are potentially exposed to high opioid doses for prolonged periods, increasing the risk of adverse effects. Adverse effects relevant to these critically ill patients include delirium, intensive care unit-acquired infections, acute opioid tolerance, iatrogenic withdrawal syndrome, opioid-induced hyperalgesia, persistent opioid use, and chronic post-intensive care unit pain. Consequently, there is a challenge of optimising analgesia while minimising these adverse effects. This narrative review will discuss the characteristics of opioid use in the intensive care unit, outline the potential short-term and long-term adverse effects of opioid therapy in critically ill patients, and outline a multifaceted strategy for opioid minimisation.
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Affiliation(s)
- Benjamin L Moran
- Critical Care Program, The George Institute of Global Health, Sydney, Australia.,Department of Intensive Care, 90112Gosford Hospital, Gosford Hospital, Gosford, Australia.,Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - John A Myburgh
- Critical Care Program, The George Institute of Global Health, Sydney, Australia.,Faculty of Medicine, 7800University of New South Wales, University of New South Wales, Kensington, Australia.,St George Hospital, Kogarah, Australia
| | - David A Scott
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Fitzroy, Australia.,Department of Critical Care, University of Melbourne, Parkville, Australia
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4
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Apitzsch S, Larsson L, Larsson AK, Linder A. The physical and mental impact of surviving sepsis - a qualitative study of experiences and perceptions among a Swedish sample. Arch Public Health 2021; 79:66. [PMID: 33933171 PMCID: PMC8088073 DOI: 10.1186/s13690-021-00585-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sepsis is a critical illness with high morbidity and mortality rates. Each year, sepsis affects about 48.9 million people all over the world. This study aims to illuminate how sepsis survivors experience sepsis and the impact of sepsis, as well as the health-related quality of life thereafter. METHODS An interview study with eight sepsis survivors was carried out in Sweden with an inductive qualitative method. The data were analyzed with content analysis. RESULTS Four themes were identified during the analysis; The experience of health care and being a sepsis patient, New circumstances´ impact on life, Family and social interactions, and The psychological impact on life. The lack of information about how sepsis can impact the survivors' lives and what to expect can lead to prolonged agony. The long recovery time comes as an unexpected and unpleasant surprise to those affected. Initially, the sepsis survivors are almost euphoric that they have survived, which can later lead to chock and trauma when they realize that they could have died. This insight needs to be processed in order to reach reconciliation with life after sepsis. CONCLUSION Sepsis has a huge impact on both physical and mental aspects of life. Many survivors suffer from persistent residual symptoms of varying degrees, to which they have to adapt. The sepsis survivors need individually adjusted information about the sepsis recovery trajectory, and what to expect during and after the hospital stay.
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Affiliation(s)
- Sabine Apitzsch
- The Emergency Department, Skåne University Hospital, Lund, Sweden
| | - Lotta Larsson
- Faculties of humanities and theology, Centre for Languages and Literature, Lund University, Lund, Sweden
| | - Anna-Karin Larsson
- Region Skåne, Department of Quality Management and Production, Lund/Malmö, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden.
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5
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Advocating for a Loved One in the Setting of Uncertainty: A Mixed-Methods Study Among Caregivers of Sepsis Survivors at the Point of a Sepsis Readmission. Dimens Crit Care Nurs 2021; 40:36-50. [PMID: 33560634 DOI: 10.1097/dcc.0000000000000449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. OBJECTIVES To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. METHODS We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. RESULTS Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. DISCUSSION Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.
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6
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Carpenter KC, Hakenjos JM, Fry CD, Nemzek JA. The Influence of Pain and Analgesia in Rodent Models of Sepsis. Comp Med 2019; 69:546-554. [PMID: 31213216 PMCID: PMC6935706 DOI: 10.30802/aalas-cm-19-000004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/15/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Abstract
Sepsis is a multifaceted host response to infection that dramatically affects patient outcomes and the cost of health care. Animal models are necessary to replicate the complexity and heterogeneity of clinical sepsis. However, these models entail a high risk of pain and distress due to tissue trauma, inflammation, endotoxin-mediated hyperalgesia, and other mechanisms. Several recent studies and initiatives address the need to improve the welfare of animals through analgesics and standardize the models used in preclinical sepsis research. Ultimately, the goal is to provide high-fidelity, humane animal models that better replicate the clinical course of sepsis, to provide more effective translation and advance therapeutic discovery. The purpose of this review is to discuss the current understanding of the roles of pain and analgesia in rodent models of sepsis. The current definitions of sepsis along with an overview of pain in human sepsis are described. Finally, welfare concerns associated with animal models of sepsis and the most recent considerations for relief of pain and distress are reviewed.
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Affiliation(s)
- Kelsey C Carpenter
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - John M Hakenjos
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christopher D Fry
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jean A Nemzek
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Michigan;,
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7
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Gluck S, Summers MJ, Finnis ME, Andrawos A, Goddard TP, Hodgson CL, Iwashyna TJ, Deane AM. An observational study investigating the use of patient-owned technology to quantify physical activity in survivors of critical illness. Aust Crit Care 2019; 33:137-143. [PMID: 30879879 DOI: 10.1016/j.aucc.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/28/2019] [Accepted: 01/31/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Physical activity after intensive care unit (ICU) discharge is challenging to measure but could inform research and practice. A patient's smartphone may provide a novel method to quantify physical activity. OBJECTIVES We aimed to evaluate the feasibility and accuracy of using smartphone step counts among survivors of critical illness. METHODS We performed a prospective observational cohort study in 50 patients who had an ICU length of stay>48 h, owned a smartphone, were ambulatory before admission, and were likely to attend follow-up at 3 and 6 months after discharge. At follow-up, daily step counts were extracted from participants' smartphones and two FitBit pedometers, and exercise capacity (6-min walk test) and quality of life (European Quality of Life-5 Dimensions) were measured. RESULTS Thirty-nine (78%) patients returned at 3 months and 33 (66%) at 6 months, the median [interquartile range] smartphone step counts being 3372 [1688-5899] and 2716 [1717-5994], respectively. There was a strong linear relationship, with smartphone approximating 0.71 (0.58, 0.84) of FitBit step counts, P < 0.0001, R-squared = 0.87. There were weak relationships between step counts and the 6-min walk test distance. CONCLUSION Although smartphone ownership and data acquisition limit the viability of using extracted smartphone steps at this time, mean daily step counts recorded using a smartphone may act as a surrogate for a dedicated pedometer; however, the relationship between step counts and other measures of physical recovery remains unclear.
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Affiliation(s)
- Samuel Gluck
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000; Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000.
| | - Matthew James Summers
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000.
| | - Mark Edward Finnis
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000; Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000.
| | - Alice Andrawos
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000; Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000.
| | - Thomas Paul Goddard
- Intensive Care Unit, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia, SA 5000.
| | - Carol Lynette Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia, VIC 3800; Physiotherapy Department, The Alfred Hospital, 55 Commercial Rd, Melbourne, Australia, VIC 3004.
| | - Theodore John Iwashyna
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Adam Michael Deane
- Discipline of Acute Care Medicine, Adelaide Health and Medical Sciences Building, 4 North Terrace, Adelaide, South Australia, Australia, SA 5000; Intensive Care Unit, The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia, VIC 3050; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia, VIC 3050.
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8
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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: 81] [Impact Index Per Article: 16.2] [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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9
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Fontela PC, Abdala FANB, Forgiarini SGI, Luiz Jr. AF. Quality of life in survivors after a period of hospitalization in the intensive care unit: a systematic review. Rev Bras Ter Intensiva 2018; 30:496-507. [PMID: 30672974 PMCID: PMC6334481 DOI: 10.5935/0103-507x.20180071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 07/10/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the long-term, health-related quality of life of intensive care unit survivors by systematic review. METHODS The search for, and selection and analysis of, observational studies that assessed the health-related quality of life of intensive care unit survivors in the electronic databases LILACS and MEDLINE® (accessed through PubMed) was performed using the indexed MESH terms "quality of life [MeSH Terms]" AND "critically illness [MeSH Terms]". Studies on adult patients without specific prior diseases published in English in the last 5 years were included in this systematic review. The citations were independently selected by three reviewers. Data were standardly and independently retrieved by two reviewers, and the quality of the studies was assessed using the Newcastle-Ottawa scale. RESULTS In total, 19 observational cohort and 2 case-control studies of 57,712 critically ill patients were included. The follow-up time of the studies ranged from 6 months to 6 years, and most studies had a 6-month or 1-year follow up. The health-related quality of life was assessed using two generic tools, the EuroQol and the Short Form Health Survey. The overall quality of the studies was low. CONCLUSIONS Long-term, health-related quality of life is compromised among intensive care unit survivors compared with the corresponding general population. However, it is not significantly affected by the occurrence of sepsis, delirium, and acute kidney injury during intensive care unit admission when compared with that of critically ill patient control groups. High-quality studies are necessary to quantify the health-related quality of life among intensive care unit survivors.
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Affiliation(s)
- Paula Caitano Fontela
- Programa de Pós-Graduação em
Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul -
Porto Alegre (RS), Brasil
| | | | | | - Alberto Forgiarini Luiz Jr.
- Programa de Pós-Graduação em
Biociências e Reabilitação e Reabilitação e
Inclusão, Centro Universitário Metodista IPA - Porto Alegre (RS),
Brasil
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10
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Baumbach P, Götz T, Günther A, Weiss T, Meissner W. Chronic intensive care-related pain: Exploratory analysis on predictors and influence on health-related quality of life. Eur J Pain 2017; 22:402-413. [PMID: 29105897 DOI: 10.1002/ejp.1129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is growing evidence for the development of chronic pain after intensive care. Nonetheless, there is only limited knowledge about factors leading to chronic intensive care-related pain (CIRP). Thus, the primary objective was the identification of predictors of CIRP. Moreover, we aimed to assess the impact of CIRP on patients' health-related quality of Life (HRQOL). METHODS Comprehensive information on patients' pain before ICU admission and present pain was collected longitudinally by means of the German Pain Questionnaire 6 and 12 months after ICU discharge (ICUDC ). In addition, a subsample of patients underwent Quantitative Sensory Testing (QST). We used Generalized Estimating Equations to identify predictors of CIRP with logistic regression models. RESULTS In total, 204 patients (197/159 at 6/12 months after ICUDC ) were available for the analyses. In the multivariate models, moderate to severe average pain in the 4 weeks after ICUDC , lower age, female sex, increased inflammation and chronic pain conditions and increased levels of anxiety before ICU admission were predictive for CIRP. In addition, small fibre deficits and lower disease severity were associated with CIRP in the QST subsample (81 patients, 77/55 at 6/12 months after ICUDC ). Patients with CIRP reported significantly lower HRQOL than patients without CIRP. CONCLUSIONS Chronic intensive care-related pain is associated with specific decrements in HRQOL. Knowledge about the identified predictors is of clinical and scientific importance and might help to reduce the incidence of CIRP. SIGNIFICANCE Chronic intensive care-related pain is associated with specific decrements in health-related quality of life. While most of the identified predictors for CIRP can only be considered as risk factors, especially adequate (post-) acute pain management should be studied as preventive strategy.
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Affiliation(s)
- P Baumbach
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
| | - T Götz
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.,Biomagnetic Center, Hans-Berger-Klinik for Neurology, Jena University Hospital, Germany
| | - A Günther
- Biomagnetic Center, Hans-Berger-Klinik for Neurology, Jena University Hospital, Germany
| | - T Weiss
- Department of Biological and Clinical Psychology, Friedrich Schiller University of Jena, Germany
| | - W Meissner
- Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Germany.,Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Germany
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11
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Nusshag C, Weigand MA, Zeier M, Morath C, Brenner T. Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review. Int J Mol Sci 2017; 18:E1387. [PMID: 28657585 PMCID: PMC5535880 DOI: 10.3390/ijms18071387] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 12/19/2022] Open
Abstract
Acute kidney injury (AKI) has a high incidence on intensive care units around the world and is a major complication in critically ill patients suffering from sepsis or septic shock. The short- and long-term complications are thereby devastating and impair the quality of life. Especially in terms of AKI staging, the determination of kidney function and the timing of dialytic AKI management outside of life-threatening indications are ongoing matters of debate. Despite several studies, a major problem remains in distinguishing between beneficial and unnecessary "early" or even harmful renal replacement therapy (RRT). The latter might prolong disease course and renal recovery. AKI scores, however, provide an insufficient outcome-predicting ability and the related estimation of kidney function via serum creatinine or blood urea nitrogen (BUN)/urea is not reliable in AKI and critical illness. Kidney independent alterations of creatinine- and BUN/urea-levels further complicate the situation. This review critically assesses the current AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs.
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Affiliation(s)
- Christian Nusshag
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
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Prevalence and Characteristics of Chronic Intensive Care-Related Pain: The Role of Severe Sepsis and Septic Shock. Crit Care Med 2017; 44:1129-37. [PMID: 26958751 DOI: 10.1097/ccm.0000000000001635] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE There is only limited knowledge about chronic pain conditions resulting from critical care. Experimental and clinical data suggest a close relationship between inflammation and pain perception. Since sepsis is the most severe form of systemic inflammation, the primary objective was to evaluate chronic pain states and functional impairment of septic and nonseptic patients 6 months after discharge from ICU. Second, we aimed to obtain the total prevalence and characteristics of chronic ICU-related pain. DESIGN Case-control study. SETTING Observational study in long-term survivors of mixed surgical and medical ICUs. PATIENTS Septic and nonseptic survivors of critical care (n = 207) and healthy controls (n = 46). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We collected comprehensive information on patients' past and present pain 6 months after ICU discharge by means of the German pain questionnaire. Pain intensity levels and pain interference ratings were compared between septic and nonseptic patients and healthy controls. We found no differences in prevalence, severity, and interference of pain between septic and nonseptic patients. However, both patient groups differed significantly from controls. In secondary analysis, a third of all patients reported chronic clinically relevant pain associated with the ICU stay 6 months after ICU discharge. Half of these patients experienced chronic pain conditions before ICU admission and reported additional sources of pain. Most important, 16% of all patients had no preexisting pain condition and now experience chronic ICU-related pain. The majority of patients with chronic ICU-related pain reported a high degree of disabling pain, limiting daily activities. CONCLUSIONS A high percentage of former ICU patients develop chronic pain conditions associated with critical care. These patients differ significantly from control data in terms of pain intensity and show high levels of interference with pain. The presence of sepsis per se seems to play a marginal role for the development of chronic ICU-related pain.
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Brown SM, Wilson E, Presson AP, Zhang C, Dinglas VD, Greene T, Hopkins RO, Needham DM. Predictors of 6-month health utility outcomes in survivors of acute respiratory distress syndrome. Thorax 2017; 72:311-317. [PMID: 27440140 PMCID: PMC5518323 DOI: 10.1136/thoraxjnl-2016-208560] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/03/2016] [Accepted: 06/18/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND With improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding and improving quality of life (QOL) outcomes in ARDS survivors is a clinical and research priority. We sought to identify variables associated with QOL, as measured by the EQ-5D health utility score, after ARDS using contemporary data science methods. METHODS Analysis of prospectively acquired baseline variables and 6-month EQ-5D health utility scores for adults with ARDS enrolled in the ARDS Network Long-Term Outcomes Study (ALTOS). Penalised regression identified predictors of health utility, with results validated using 10-fold cross-validation. RESULTS Among 616 ARDS survivors, several predictors were associated with 6-month EQ-5D utility scores, including two lifestyle factors. Specifically, older age, female sex, Hispanic/Latino ethnicity, current smoking and higher body mass index were associated with lower EQ-5D utilities, while living at home without assistance at baseline and AIDS were associated with higher EQ-5D utilities in ARDS survivors. No acute illness variables were associated with EQ-5D utility. CONCLUSIONS Acute illness variables do not appear to be associated with postdischarge QOL among ARDS survivors. Functional independence and lifestyle factors, such as obesity and tobacco smoking, were associated with worse QOL. Future analyses of postdischarge health utility among ARDS survivors should incorporate measures of demographics and functional independence at baseline. TRIAL REGISTRATION NUMBERS NCT00719446 (ALTOS), NCT00434993 (ALTA), NCT00609180 (EDEN/OMEGA), and NCT00883948 (EDEN); Post-results.
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Affiliation(s)
- Samuel M. Brown
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT
- Pulmonary and Critical Care, University of Utah School of Medicine, Salt Lake City, UT
| | - Emily Wilson
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Angela P. Presson
- Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Chong Zhang
- Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Victor D. Dinglas
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Tom Greene
- Study Design and Biostatistics Center and Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ramona O. Hopkins
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
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Shankar-Hari M, Rubenfeld GD. Understanding Long-Term Outcomes Following Sepsis: Implications and Challenges. Curr Infect Dis Rep 2016; 18:37. [PMID: 27709504 PMCID: PMC5052282 DOI: 10.1007/s11908-016-0544-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sepsis is life-threating organ dysfunction due to infection. Incidence of sepsis is increasing and the short-term mortality is improving, generating more sepsis survivors. These sepsis survivors suffer from additional morbidities such as higher risk of readmissions, cardiovascular disease, cognitive impairment and of death, for years following index sepsis episode. In the first year following index sepsis episode, approximately 60 % of sepsis survivors have at least one rehospitalisation episode, which is most often due to infection and one in six sepsis survivors die. Sepsis survivors also have a higher risk of cognitive impairment and cardiovascular disease contributing to the reduced life expectancy seen in this population, when assessed with life table comparisons. For optimal design of interventional trials to reduce these bad outcomes in sepsis survivors, in-depth understanding of major risk factors for these morbid events, their modifiability and a causal relationship to the pathobiology of sepsis is essential. This review highlights the recent advances, clinical and methodological challenges in our understanding of these morbid events in sepsis survivors.
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Affiliation(s)
- Manu Shankar-Hari
- Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, 1st Floor, East Wing, St Thomas' Hospital, London, SE17EH, UK.
- Division of Asthma, Allergy and Lung Biology, Kings College London, London, SE1 9RT, UK.
| | - Gordon D Rubenfeld
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, D5 03, Toronto, ON, M4N 3M5, Canada
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15
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Westwood M, Ramaekers B, Whiting P, Tomini F, Joore M, Armstrong N, Ryder S, Stirk L, Severens J, Kleijnen J. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis. Health Technol Assess 2016; 19:v-xxv, 1-236. [PMID: 26569153 DOI: 10.3310/hta19960] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Determination of the presence or absence of bacterial infection is important to guide appropriate therapy and reduce antibiotic exposure. Procalcitonin (PCT) is an inflammatory marker that has been suggested as a marker for bacterial infection. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of adding PCT testing to the information used to guide antibiotic therapy in adults and children (1) with confirmed or highly suspected sepsis in intensive care and (2) presenting to the emergency department (ED) with suspected bacterial infection. METHODS Twelve databases were searched to June 2014. Randomised controlled trials were assessed for quality using the Cochrane Risk of Bias tool. Summary relative risks (RRs) and weighted mean differences (WMDs) were estimated using random-effects models. Heterogeneity was assessed visually using forest plots and statistically using the I (2) and Q statistics and investigated through subgroup analysis. The cost-effectiveness of PCT testing in addition to current clinical practice was compared with current clinical practice using a decision tree with a 6 months' time horizon. RESULTS Eighteen studies (36 reports) were included in the systematic review. PCT algorithms were associated with reduced antibiotic duration [WMD -3.19 days, 95% confidence interval (CI) -5.44 to -0.95 days, I (2) = 95.2%; four studies], hospital stay (WMD -3.85 days, 95% CI -6.78 to -0.92 days, I (2) = 75.2%; four studies) and a trend towards reduced intensive care unit (ICU) stay (WMD -2.03 days, 95% CI -4.19 to 0.13 days, I (2) = 81.0%; four studies). There were no differences for adverse clinical outcomes. PCT algorithms were associated with a reduction in the proportion of adults (RR 0.77, 95% CI 0.68 to 0.87; seven studies) and children (RR 0.86, 95% CI 0.80 to 0.93) receiving antibiotics, reduced antibiotic duration (two studies). There were no differences for adverse clinical outcomes. All but one of the studies in the ED were conducted in people presenting with respiratory symptoms. Cost-effectiveness: the base-case analyses indicated that PCT testing was cost-saving for (1) adults with confirmed or highly suspected sepsis in an ICU setting; (2) adults with suspected bacterial infection presenting to the ED; and (3) children with suspected bacterial infection presenting to the ED. Cost-savings ranged from £368 to £3268. Moreover, PCT-guided treatment resulted in a small quality-adjusted life-year (QALY) gain (ranging between < 0.001 and 0.005). Cost-effectiveness acceptability curves showed that PCT-guided treatment has a probability of ≥ 84% of being cost-effective for all settings and populations considered (at willingness-to-pay thresholds of £20,000 and £30,000 per QALY). CONCLUSIONS The limited available data suggest that PCT testing may be effective and cost-effective when used to guide discontinuation of antibiotics in adults being treated for suspected or confirmed sepsis in ICU settings and initiation of antibiotics in adults presenting to the ED with respiratory symptoms and suspected bacterial infection. However, it is not clear that observed costs and effects are directly attributable to PCT testing, are generalisable outside people presenting with respiratory symptoms (for the ED setting) and would be reproducible in the UK NHS. Further studies are needed to assess the effectiveness of adding PCT algorithms to the information used to guide antibiotic treatment in children with suspected or confirmed sepsis in ICU settings. Additional research is needed to examine whether the outcomes presented in this report are fully generalisable to the UK. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010822. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Bram Ramaekers
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Florian Tomini
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Manuela Joore
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | | | - Lisa Stirk
- Kleijnen Systematic Reviews Ltd, York, UK
| | - Johan Severens
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jos Kleijnen
- Maastricht University Medical Centre, Maastricht, The Netherlands
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16
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Baker EJ, Lee GA. A Retrospective Observational Study Examining the Effect of Thoracic Epidural and Patient Controlled Analgesia on Short-term Outcomes in Blunt Thoracic Trauma Injuries. Medicine (Baltimore) 2016; 95:e2374. [PMID: 26765412 PMCID: PMC4718238 DOI: 10.1097/md.0000000000002374] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Effective analgesia in the early stages after any major traumatic event remains pivotal to optimal trauma management. For patients with significant thoracic injuries, this is paramount to ensure ongoing efficient respiratory function. The aim of this study was to investigate the use of analgesic modes in the management of patients with a primary thoracic injury and blunt mechanism of injury. By understanding variables that influence the use of varying analgesic modes and influence the development of pulmonary complications, there should be more uniform evidence-based prescription in the future.This retrospective study considered analgesic use in patients admitted after blunt thoracic injuries at one major trauma center over a 2-year period. Pulmonary complications measured included both infective and ventilator-associated failure. Univariate and multivariate analyses were used to identify patient and injury severity characteristics and their association with respiratory complications.A total of 401 cases were reviewed and analyzed: 159 received Patient Controlled Analgesia (PCA), 32 received PCA and epidural analgesia (EA), 6 received EA alone, and 204 received interval-administered analgesia. There were no significant differences in the rates of complication when compared between analgesic modes. Patients who developed pneumonia had significantly increased number of thoracic fractures and underlying organ injury (P < 0.05). Logistic regression analysis highlighted duration of intercostal drain insertion (OR 1.377, P = 0.001) and premorbid cardiac disease (OR 2.624, P = 0.042) and ICU length of stay (OR: 1.146, P < 0.001) as significant predictors of developing pneumonia in this patient group.Examining the different analgesic modes, this study failed to identify a particular analgesic mode that was more effective in preventing pulmonary complications in blunt thoracic injuries. However, variables that may influence usage of different analgesic modes and high-risk groups for the development of pneumonia were identified. Further work is warranted to consider the long-term benefits of analgesia in patients post-blunt thoracic injuries.
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Affiliation(s)
- Edward James Baker
- From the Emergency Department, Kings College Hospital, London, UK (EJB); Florence Nightingale Faculty of Nursing & Midwifery, Kings College London, London, UK (EJB); and Florence Nightingale Faculty of Nursing & Midwifery, Kings College London, London, UK (GAL)
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17
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Oeyen S, De Corte W, Benoit D, Annemans L, Dhondt A, Vanholder R, Decruyenaere J, Hoste E. Long-term quality of life in critically ill patients with acute kidney injury treated with renal replacement therapy: a matched cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:289. [PMID: 26250830 PMCID: PMC4527359 DOI: 10.1186/s13054-015-1004-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022]
Abstract
Introduction Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients and is associated with increased morbidity and mortality. We compared long-term outcome and quality of life (QOL) in ICU patients with AKI treated with renal replacement therapy (RRT) with matched non-AKI-RRT patients. Methods Over 1 year, consecutive adult ICU patients were included in a prospective cohort study. AKI-RRT patients alive at 1 year and 4 years were matched with non-AKI-RRT survivors from the same cohort in a 1:2 (1 year) and 1:1 (4 years) ratio based on gender, age, Acute Physiology and Chronic Health Evaluation II score, and admission category. QOL was assessed by the EuroQoL-5D and the Short Form-36 survey before ICU admission and at 3 months, 1 and 4 years after ICU discharge. Results Of 1953 patients, 121 (6.2 %) had AKI-RRT. AKI-RRT hospital survivors (44.6 %; N = 54) had a 1-year and 4-year survival rate of 87.0 % (N = 47) and 64.8 % (N = 35), respectively. Forty-seven 1-year AKI-RRT patients were matched with 94 1-year non-AKI-RRT patients. Of 35 4-year survivors, three refused further cooperation, three were lost to follow-up, and one had no control. Finally, 28 4-year AKI-RRT patients were matched with 28 non-AKI-RRT patients. During ICU stay, 1-year and 4-year AKI-RRT patients had more organ dysfunction compared to their respective matches (Sequential Organ Failure Assessment scores 7 versus 5, P < 0.001, and 7 versus 4, P < 0.001). Long-term QOL was, however, comparable between both groups but lower than in the general population. QOL decreased at 3 months, improved after 1 and 4 years but remained under baseline level. One and 4 years after ICU discharge, 19.1 % and 28.6 % of AKI-RRT survivors remained RRT-dependent, respectively, and 81.8 % and 71 % of them were willing to undergo ICU admission again if needed. Conclusion In long-term critically ill AKI-RRT survivors, QOL was comparable to matched long-term critically ill non-AKI-RRT survivors, but lower than in the general population. The majority of AKI-RRT patients wanted to be readmitted to the ICU when needed, despite a higher severity of illness compared to matched non-AKI-RRT patients, and despite the fact that one quarter had persistent dialysis dependency. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1004-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Oeyen
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Wouter De Corte
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Anaesthesia and Intensive Care Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Courtray, Belgium.
| | - Dominique Benoit
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Research Foundation - Flanders (FWO), Brussels, Belgium.
| | - Lieven Annemans
- I-CHER, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Annemieke Dhondt
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Raymond Vanholder
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Nephrology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Johan Decruyenaere
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Eric Hoste
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Intensive Care, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Research Foundation - Flanders (FWO), Brussels, Belgium.
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18
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Honselmann KC, Buthut F, Heuwer B, Karadag S, Sayk F, Kurowski V, Thiele H, Droemann D, Wolfrum S. Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis: Predictors of mortality and quality of life in patients with sepsis/pneumonia. J Crit Care 2015; 30:721-6. [PMID: 25818842 DOI: 10.1016/j.jcrc.2015.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/16/2015] [Accepted: 03/06/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study is to evaluate long-term mortality and quality of life (QoL) of intensive care patients with pneumonia and/or sepsis 1 year after discharge and to identify potential predictors for these outcome measures. METHODS This retrospective cohort study analyzed all patients admitted to the intensive care unit (ICU) of a German university hospital with diagnosis of pneumonia and/or sepsis between 2008 and 2009. Quality of life was assessed by telephone interview or mail using the standardized EuroQol 5-dimension questionaire. RESULTS Of 1406 patients treated in the ICU within the observational period, 217 met the inclusion criteria. Whereas in-hospital mortality differed significantly between pneumonia (17%) and sepsis (46%) (P < .001), 1-year mortality was not statistically significant (51% and 65%, P = .057). A high Simplified Acute Physiology Score (SAPS) II value was associated with high in-hospital mortality but failed to predict 1-year mortality. Quality of life, measured 1 year after discharge by visual analog scale (VAS), was 50% ± 25%, which was significantly lower than in a matched control group (70% ± 20%; P < .001). A high SAPS II score on admission did not correlate with VAS but was an independent predictor of a low EuroQol 5-dimension index. CONCLUSIONS The high post-ICU mortality of patients with pneumonia and sepsis emphasizes the need to focus on long-term follow-up in ICU studies and demonstrates that even when sepsis signs are missing, critically ill patients due to pneumonia have high 1-year mortality. Simplified Acute Physiology Score II does not predict long-term mortality, but a low SAPS II on admission might be useful to identify patients with good physical status after 1 year. TAKE HOME MESSAGE Hospital mortality of patients treated for pneumonia and/or sepsis is high and increases significantly within the first year after discharge. The SAPS II predicts in-hospital mortality and the physical components of QoL but not long-term mortality. TWEET One-year mortality of ICU pneumonia patients is equally high as in sepsis patients. Simplified Acute Physiology Score II cannot predict long-term mortality but can predict QoL.
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Affiliation(s)
- Kim C Honselmann
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Franziska Buthut
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Bjoern Heuwer
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Sevin Karadag
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Friedhelm Sayk
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Volkhardt Kurowski
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Holger Thiele
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Daniel Droemann
- Medical Clinic III, Pulmonology/Infectious Diseases, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany
| | - Sebastian Wolfrum
- Medical Clinic II, Cardiology/Angiology/Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany; Department of Emergency Medicine, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23552 Luebeck, Germany.
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Anderson ST, Commins S, Moynagh PN, Coogan AN. Lipopolysaccharide-induced sepsis induces long-lasting affective changes in the mouse. Brain Behav Immun 2015; 43:98-109. [PMID: 25063709 DOI: 10.1016/j.bbi.2014.07.007] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/04/2014] [Accepted: 07/10/2014] [Indexed: 12/27/2022] Open
Abstract
Post-septic encephalopathy is a poorly understood condition in survivors of sepsis that is characterised by cognitive and affective impairments. In this study we have sought to better understand this condition by undertaking a comprehensive behavioural and cognitive assessment of mice who had previously survived sepsis. Mice were treated with lipopolysaccharide (LPS; 5mg/kg) and one month after this assessed on a battery of tests. Post-septic animals were found to display significantly more immobility in the tail suspension test and show a significantly decreased sucrose preference. Acute fluoxetine treatment reversed the increase in immobility in the tail suspension test in post-septic animals. Post-septic animals also showed less overall exploratory behaviour in the novel object recognition task and also showed increased anxiety-like behaviour in the elevated plus maze. Post-septic mice did not show signs of cognitive impairment, as assessed in the Morris watermaze, the 8-arm radial maze or on preference for the novel object in the novel object recognition task. Immunohistochemical analysis revealed significant upregulation of the microglial marker CD-11b, F4/80 and IBA-1 in the hippocampus of post-septic animals, as well as significant downregulation of the plasticity-related immediate early gene products ARC and EGR1. We also observed a decrease in neural stem cell proliferation in the dentate gyrus of post-septic animals as judged by BrdU incorporation. Co-treatment with the NF-κB pathway inhibitor PDTC attenuated the long-lasting effects of LPS on most of the affected parameters, but not on neural stem cell proliferation. These results show that LPS-induced sepsis in the mouse is followed by long-lasting increases in depressive- and anxiety-like behaviours, as well as by changes in neuroinflammatory- and neural plasticity-associated factors, and that attenuation of the severity of sepsis by PDTC attenuates many of these effects.
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Affiliation(s)
- Seán T Anderson
- Department of Psychology, National University of Ireland Maynooth, County Kildare, Ireland
| | - Seán Commins
- Department of Psychology, National University of Ireland Maynooth, County Kildare, Ireland
| | - Paul N Moynagh
- Institute of Immunology, National University of Ireland Maynooth, County Kildare, Ireland
| | - Andrew N Coogan
- Department of Psychology, National University of Ireland Maynooth, County Kildare, Ireland.
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