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Szymczak H, Brandstetter S, Blecha S, Dodoo-Schittko F, Rohr M, Bein T, Apfelbacher C. Potential risk factors for reduced quality of life and increased health care utilization in ARDS survivors: results from the multicenter cohort study DACAPO. Crit Care 2024; 28:201. [PMID: 38898469 PMCID: PMC11188221 DOI: 10.1186/s13054-024-04992-2] [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: 03/13/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To analyze the association of individual pre-ICU risk factors (obesity, physical and mental comorbidity, smoking status) on the long-term recovery process in survivors of the acute respiratory distress syndrome (ARDS; outcomes: health related quality of life, health care utilization; measured at 12, 24, and 36 months after ICU discharge). FINDINGS Results show a possible causal link between pre-ICU risk factors and subsequent recovery of survivors of ARDS, especially with regard to mental health related quality of life. PURPOSE Identifying relevant pre-existing risk factors, such as mental health problems, will enable the identification of at-risk patients, thus aiding in the improvement of long-term healthcare for survivors of critical illness.
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Affiliation(s)
- Hermann Szymczak
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Susanne Brandstetter
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Hospital St. Hedwig of the Order of St. John, Steinmetzstrasse 1-3, 93051, Regensburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sebastian Blecha
- Department for Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Frank Dodoo-Schittko
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Magdalena Rohr
- University Children's Hospital Regensburg (KUNO), University of Regensburg, Hospital St. Hedwig of the Order of St. John, Steinmetzstrasse 1-3, 93051, Regensburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Thomas Bein
- Medical Faculty, University of Regensburg, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Apfelbacher
- Medical Faculty, Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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Xiao Z, Zeng L, Chen S, Wu J, Huang H. Development and validation of early prediction models for new-onset functional impairment in patients after being transferred from the ICU. Sci Rep 2024; 14:11902. [PMID: 38789502 PMCID: PMC11126674 DOI: 10.1038/s41598-024-62447-8] [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: 12/22/2023] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
A significant number of intensive care unit (ICU) survivors experience new-onset functional impairments that impede their activities of daily living (ADL). Currently, no effective assessment tools are available to identify these high-risk patients. This study aims to develop an interpretable machine learning (ML) model for predicting the onset of functional impairment in critically ill patients. Data for this study were sourced from a comprehensive hospital in China, focusing on adult patients admitted to the ICU from August 2022 to August 2023 without prior functional impairments. A least absolute shrinkage and selection operator (LASSO) model was utilized to select predictors for inclusion in the model. Four models, logistic regression, support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost), were constructed and validated. Model performance was assessed using the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Additionally, the DALEX package was employed to enhance the interpretability of the final models. The study ultimately included 1,380 patients, with 684 (49.6%) exhibiting new-onset functional impairment on the seventh day after leaving the ICU. Among the four models evaluated, the SVM model demonstrated the best performance, with an AUC of 0.909, accuracy of 0.838, sensitivity of 0.902, specificity of 0.772, PPV of 0.802, and NPV of 0.886. ML models are reliable tools for predicting new-onset functional impairments in critically ill patients. Notably, the SVM model emerged as the most effective, enabling early identification of patients at high risk and facilitating the implementation of timely interventions to improve ADL.
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Affiliation(s)
- Zewei Xiao
- Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Limei Zeng
- Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Suiping Chen
- Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Jinhua Wu
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Haixing Huang
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China.
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van Sleeuwen D, Zegers M, Ramjith J, Cruijsberg JK, Simons KS, van Bommel D, Burgers-Bonthuis D, Koeter J, Bisschops LLA, Janssen I, Rettig TCD, van der Hoeven JG, van de Laar FA, van den Boogaard M. Prediction of Long-Term Physical, Mental, and Cognitive Problems Following Critical Illness: Development and External Validation of the PROSPECT Prediction Model. Crit Care Med 2024; 52:200-209. [PMID: 38099732 PMCID: PMC10793772 DOI: 10.1097/ccm.0000000000006073] [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] [Indexed: 01/19/2024]
Abstract
OBJECTIVES ICU survivors often suffer from long-lasting physical, mental, and cognitive health problems after hospital discharge. As several interventions that treat or prevent these problems already start during ICU stay, patients at high risk should be identified early. This study aimed to develop a model for early prediction of post-ICU health problems within 48 hours after ICU admission. DESIGN Prospective cohort study in seven Dutch ICUs. SETTING/PATIENTS ICU patients older than 16 years and admitted for greater than or equal to 12 hours between July 2016 and March 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Outcomes were physical problems (fatigue or ≥ 3 new physical symptoms), mental problems (anxiety, depression, or post-traumatic stress disorder), and cognitive impairment. Patient record data and questionnaire data were collected at ICU admission, and after 3 and 12 months, of 2,476 patients. Several models predicting physical, mental, or cognitive problems and a composite score at 3 and 12 months were developed using variables collected within 48 hours after ICU admission. Based on performance and clinical feasibility, a model, PROSPECT, predicting post-ICU health problems at 3 months was chosen, including the predictors of chronic obstructive pulmonary disease, admission type, expected length of ICU stay greater than or equal to 2 days, and preadmission anxiety and fatigue. Internal validation using bootstrapping on data of the largest hospital ( n = 1,244) yielded a C -statistic of 0.73 (95% CI, 0.70-0.76). External validation was performed on data ( n = 864) from the other six hospitals with a C -statistic of 0.77 (95% CI, 0.73-0.80). CONCLUSIONS The developed and externally validated PROSPECT model can be used within 48 hours after ICU admission for identifying patients with an increased risk of post-ICU problems 3 months after ICU admission. Timely preventive interventions starting during ICU admission and follow-up care can prevent or mitigate post-ICU problems in these high-risk patients.
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Affiliation(s)
- Dries van Sleeuwen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke Zegers
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Koen S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Daniëlle van Bommel
- Department of Intensive Care Medicine, Bernhoven Hospital, Uden, The Netherlands
| | | | - Julia Koeter
- Department of Intensive Care Medicine, CWZ, Nijmegen, The Netherlands
| | - Laurens L A Bisschops
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge Janssen
- Department of Intensive Care Medicine, Maasziekenhuis, Boxmeer, The Netherlands
| | - Thijs C D Rettig
- Department of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Amphia Hospital, Breda, The Netherlands
| | | | - Floris A van de Laar
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Uehara H, Harada R, Ogawa M, Komaki K, Makiura D, Fujii Y, Onishi H, Matsumoto T, Yoshikawa R, Sakai Y. Activity of Daily Living and Walking Ability of Patients with Severe COVID-19 at Discharge from an Acute Care Hospital. Prog Rehabil Med 2024; 9:20240003. [PMID: 38264291 PMCID: PMC10800290 DOI: 10.2490/prm.20240003] [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: 10/01/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
Objectives The effectiveness of acute rehabilitation treatment for severe coronavirus disease 2019 (COVID-19) has not yet been established. This study examined the efficacy of treatment provided to patients with severe COVID-19 in an acute care facility. Methods A total of 98 patients with severe COVID-19 requiring inpatient management in our intensive care unit (ICU) were included between December 2020 and October 2021. They were divided into two groups: those who received physiotherapy (PT group; n=44) and those who did not receive physiotherapy (non-PT group; n=54). Their backgrounds, clinical characteristics, and activities of daily life (ADL) at discharge were compared to examine factors that influenced the need for physiotherapy (PT). We also evaluated the effect of PT on ADL by comparing the Barthel Index (BI) before PT and at discharge. Results The PT group patients were significantly older, had longer hospital and ICU stays, and used invasive mechanical ventilators (IMV) more frequently than those in the non-PT group. More patients in the non-PT group were able to walk at discharge than in the PT group. The PT group patients showed significant improvement in BI and ADL at discharge when compared with BI at the start of PT, regardless of whether an IMV was used. Conclusions Older patients with severe COVID-19 with prolonged hospitalization or ICU stay or on an IMV are prone to a decline in ADL and may need to be considered for early PT.
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Affiliation(s)
- Hiroe Uehara
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Risa Harada
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Masato Ogawa
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Kodai Komaki
- Department of Rehabilitation Medicine, Kobe University
Hospital, Kobe, Japan
| | - Daisuke Makiura
- Department of Rehabilitation Medicine, Kobe University
Hospital, Kobe, Japan
| | - Yasumitsu Fujii
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Hirokazu Onishi
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Tsuyoshi Matsumoto
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Ryo Yoshikawa
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University
Graduate School of Medicine, Kobe, Japan
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Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
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Tejero-Aranguren J, Martin RGDM, Poyatos-Aguilera ME, Morales-Galindo I, Cobos-Vargas A, Colmenero M. Incidence and risk factors for postintensive care syndrome in a cohort of critically ill patients. Rev Bras Ter Intensiva 2022; 34:380-385. [PMID: 36351069 PMCID: PMC9749097 DOI: 10.5935/0103-507x.20220224-en] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/23/2022] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE To determine the incidence of postintensive care syndrome in a cohort of critically ill patients admitted to the intensive care unit and to identify risk factors related to its development in the physical, cognitive and mental health areas. METHODS This was a prospective observational cohort study developed in the intensive care unit of a university hospital. Patients with intensive care unit stays equal to or longer than one week and the need for mechanical ventilation for more than 3 days, shock or delirium were included in the study. Demographic variables, reasons for admission, diagnoses, sedation, type of mechanical ventilation used, complications and length of stay were recorded. A univariate analysis was performed to identify risk factors related to postintensive care syndrome. The scales used for the assessment of the different spheres were Barthel, Pfeiffer, Hospital Anxiety and Depression Scale and Impact of Event Scale-6. The main variables of interest were postintensive care syndrome incidence overall and by domains. Risk factors were examined in each of the health domains (physical, cognitive and mental health). RESULTS Eighty-seven patients were included. The mean Acute Physiology and Chronic Health Evaluation II score was 16.5. The mean number of intensive care unit days was 17. The incidence of global postintensive care syndrome was 56.3% (n = 49, 95%CI 45.8 - 66.2%). The incidence of postintensive care syndrome in each of the spheres was 32.1% (physical), 11.5% (cognitive), and 36.6% (mental health). CONCLUSIONS The incidence of postintensive care syndrome is 56.3%. The mental health sphere is the most frequently involved. The risk factors are different depending on the area considered.
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Affiliation(s)
- Julia Tejero-Aranguren
- Intensive Care Department, Hospital Universitario Clínico San
Cecilio, POD Medicina Clínica y Salud Pública, Universidad de Granada - Granada,
Spain
| | - Raimundo García-del Moral Martin
- Intensive Care Department, Hospital Universitario Clínico San
Cecilio, POD Medicina Clínica y Salud Pública, Universidad de Granada - Granada,
Spain
| | - Maria Eugenia Poyatos-Aguilera
- Intensive Care Department, Hospital Universitario Clínico San
Cecilio, POD Medicina Clínica y Salud Pública, Universidad de Granada - Granada,
Spain
| | - Ildaura Morales-Galindo
- Intensive Care Department, Hospital Universitario Clínico San
Cecilio, POD Medicina Clínica y Salud Pública, Universidad de Granada - Granada,
Spain
| | - Angel Cobos-Vargas
- Intensive Care Department, Hospital Universitario Clínico San
Cecilio, POD Medicina Clínica y Salud Pública, Universidad de Granada - Granada,
Spain
| | - Manuel Colmenero
- Intensive Care Department, Hospital Universitario Clínico San
Cecilio, POD Medicina Clínica y Salud Pública, Universidad de Granada - Granada,
Spain
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Prabu R N. Long-term Survival after Critical Illness: Are We There Yet? Indian J Crit Care Med 2022; 26:1065-1066. [PMID: 36876211 PMCID: PMC9983670 DOI: 10.5005/jp-journals-10071-24343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Prabu RN. Long-term Survival after Critical Illness: Are We There Yet? Indian J Crit Care Med 2022;26(10):1065-1066.
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Affiliation(s)
- Natesh Prabu R
- Department of Critical Care Medicine, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Moayed MS, Vahedian-Azimi A, Gohari-Moghadam K, Asghari-Jafarabadi M, Reiner Ž, Sahebkar A. A Modified Physical Disability Screening Model after Treatment in the Intensive Care Unit: A Nationwide Derivation-Validation Study. J Clin Med 2022; 11:jcm11123251. [PMID: 35743325 PMCID: PMC9224861 DOI: 10.3390/jcm11123251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Many of the survivors of critical illnesses in the intensive care unit (ICU) suffer from physical disability for months after the treatment in the ICU. Identifying patients who are susceptible to disability is essential. The purpose of the study was to modify a model for early in-ICU prediction of the patient’s risk for physical disability two months after the treatment in the ICU. Methods: A prospective multicenter derivation–validation study was conducted from 1 July 2015, to 31 August 2016. We modified a model consisting of three risk factors in the derivation group and tested the modified model in the validation group. They were asked for their physical abilities before being admitted, two months after discharge from the ICU by a binary ADL staircases questionnaire. The univariate and multivariate logistic regression was used to modify physical disability components in the derivation data set. Receiver operating characteristic curves were used to determine the sensitivity and specificity of the threshold values in the validation group. Results: Five-hundred nineteen survivors were enrolled in the derivation group, and 271 in the validation. In multivariable analysis, the odds ratio (OR) of physical disability significantly increased with educational level ≤ elementary school (OR: 36.96, 95%CI: 18.14–75.29), inability to sit without support (OR: 15.16, 95%CI: 7.98–28.80), and having a fracture (OR: 12.74, 95%CI: 4.47–36.30). The multivariable validation model indicated that education level, inability to sit without support, and having a fracture simultaneously had sensitivity 71.3%, specificity 88.2%, LR+ 6.0, LR− 0.33, PPV 90.9, and NPV 64.9 to predict physical disability. Applying the coefficients derived from the multivariable logistic regression fitted on the derivation dataset in the validation dataset and computing diagnostic index sensitivity 100%, specificity 60.5%, LR+ 2.5, LR− 0.003, PPV 80.8, and NPV 100. The modified model had an excellent prediction ability for physical disability (AUC ± SE = 0.881 ± 0.016). Conclusions: Low education level, inability to sit without support, and having a fracture in a modified model were associated with the development of physical disability after discharge from ICU. Therefore, these clinical variables should be considered when organizing follow-up care for ICU survivors.
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Affiliation(s)
- Malihe Sadat Moayed
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran 1435916471, Iran;
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran 1435916471, Iran;
- Correspondence: (A.V.-A.); or (Ž.R.); or (A.S.)
| | - Keivan Gohari-Moghadam
- Medical ICU and Pulmonary Unit, Tehran University of Medical Sciences, Tehran 1419733141, Iran;
| | - Mohammad Asghari-Jafarabadi
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz 5165665811, Iran;
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Correspondence: (A.V.-A.); or (Ž.R.); or (A.S.)
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
- Department of Medical Biotechnology and Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Correspondence: (A.V.-A.); or (Ž.R.); or (A.S.)
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Development and validation of early prediction models for new-onset functional impairment at hospital discharge of ICU admission. Intensive Care Med 2022; 48:679-689. [PMID: 35362765 DOI: 10.1007/s00134-022-06688-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/21/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE We aimed to develop and validate models for predicting new-onset functional impairment after intensive care unit (ICU) admission with predictors routinely collected within 2 days of admission. METHODS In this multi-center retrospective cohort study of acute care hospitals in Japan, we identified adult patients who were admitted to the ICU with independent activities of daily living before hospitalization and survived for at least 2 days from April 2014 to October 2020. The primary outcome was functional impairment defined as Barthel Index ≤ 60 at hospital discharge. In the internal validation dataset (April 2014 to March 2019), using routinely collected 94 candidate predictors within 2 days of ICU admission, we trained and tuned the six conventional and machine-learning models with repeated random sub-sampling cross-validation. We computed the variable importance of each predictor to the models. In the temporal validation dataset (April 2019 to October 2020), we measured the performance of these models. RESULTS We identified 19,846 eligible patients. Functional impairment at discharge was developed in 33% of patients (n = 6488/19,846). In the temporal validation dataset, all six models showed good discrimination ability with areas under the curve above 0.86, and the differences among the six models were negligible. Variable importance revealed newly detected early predictors, including worsened neurologic conditions and catabolism biomarkers such as decreased serum albumin and increased blood urea nitrogen. CONCLUSION We successfully developed early prediction models of new-onset functional impairment after ICU admission that achieved high performance using only data routinely collected within 2 days of ICU admission.
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Mayer KP, Ortiz-Soriano VM, Kalantar A, Lambert J, Morris PE, Neyra JA. Acute kidney injury contributes to worse physical and quality of life outcomes in survivors of critical illness. BMC Nephrol 2022; 23:137. [PMID: 35392844 PMCID: PMC8991933 DOI: 10.1186/s12882-022-02749-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/18/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives Survivors of critical illness and acute kidney injury (AKI) are at risk of increased morbidity. The purpose of this study was to compare physical, emotional, and cognitive health in survivors of critical illness with and without AKI. Methods Retrospective cohort study of adult (≥ 18 years old) survivors of critical illness due to sepsis and/or acute respiratory failure who attended follow-up in a specialized ICU Recovery Clinic. Outcomes were evaluated during 3-month visit and comprised validated tests for evaluation of physical function, muscle strength, cognitive and emotional health, and self-reported health-related quality of life (HRQOL). Descriptive statistics and group comparisons were performed. Results A total of 104 patients with median age of 55 [49-64] years, 54% male, and median SOFA score of 10 [8-12] were analyzed. Incidence of AKI during ICU admission was 61 and 19.2% of patients required renal replacement therapy (RRT). Patients with AKI stage 2 or 3 (vs. those with AKI stage 1 or no AKI) walked less on the 6-min walk test (223 ± 132 vs. 295 ± 153 m, p = 0.059) and achieved lower of the predicted walk distance (38% vs. 58%, p = 0.041). Similar patterns of worse physical function and more significant muscle weakness were observed in multiple tests, with overall worse metrics in patients that required RRT. Patients with AKI stage 2 or 3 also reported lower HRQOL scores when compared to their counterparts, including less ability to return to work or hobby, or reengage in driving. There were no significant differences in cognitive function or emotional health between groups. Conclusions Survivors of critical illness and AKI stage 2 or 3 have increased physical debility and overall lower quality of life, with more impairment in return to work, hobby, and driving when compared to their counterparts without AKI or AKI stage 1 at 3 months post-discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02749-z.
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Affiliation(s)
- Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose Street, Lexington, KY, 40536, USA. .,Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY, USA. .,Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, KY, USA.
| | - Victor M Ortiz-Soriano
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, KY, 40536, USA
| | - Alborz Kalantar
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, KY, 40536, USA
| | - Joshua Lambert
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Peter E Morris
- Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, KY, USA.,College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Javier A Neyra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
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11
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Turnbull AE, Ji H, Dinglas VD, Wu AW, Mendez-Tellez PA, Himmelfarb CD, Shanholtz CB, Hosey MM, Hopkins RO, Needham DM. Understanding Patients' Perceived Health After Critical Illness: Analysis of Two Prospective, Longitudinal Studies of ARDS Survivors. Chest 2022; 161:407-417. [PMID: 34419426 PMCID: PMC8941599 DOI: 10.1016/j.chest.2021.07.2177] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Perceived health is one of the strongest determinants of subjective well-being, but it has received little attention among survivors of ARDS. RESEARCH QUESTION How well do self-reported measures of physical, emotional, and social functioning predict perceived overall health (measured using the EQ-5D visual analog scale [EQ-5D-VAS]) among adult survivors of ARDS? Are demographic features, comorbidity, or severity of illness correlated with perceived health after controlling for self-reported functioning? STUDY DESIGN AND METHODS We analyzed the ARDSNet Long Term Outcomes Study (ALTOS) and Improving Care of Acute Lung Injury Patients (ICAP) Study, two longitudinal cohorts with a total of 823 survivors from 44 US hospitals, which prospectively assessed survivors at 6 and 12 months after ARDS. Perceived health, evaluated using the EQ-5D-VAS, was predicted using ridge regression and self-reported measures of physical, emotional, and social functioning. The difference between observed and predicted perceived health was termed perspective deviation (PD). Correlations between PD and demographics, comorbidities, and severity of illness were explored. RESULTS The correlation between observed and predicted EQ-5D-VAS scores ranged from 0.68 to 0.73 across the two cohorts and time points. PD ranged from -80 to +34 and was more than the minimum clinically important difference for 52% to 55% of survivors. Neither demographic features, comorbidity, nor severity of illness were correlated strongly with PD, with |r| < 0.25 for all continuous variables in both cohorts and time points. The correlation between PD at 6- and 12-month assessments was weak (ALTOS: r = 0.22, P < .001; ICAP: r = 0.20, P = .02). INTERPRETATION About half of survivors of ARDS showed clinically important differences in actual perceived health vs predicted perceived health based on self-reported measures of functioning. Survivors of ARDS demographic features, comorbidities, and severity of illness were correlated only weakly with perceived health after controlling for measures of perceived functioning, highlighting the challenge of predicting how individual patients will respond psychologically to new impairments after critical illness.
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Affiliation(s)
- Alison E Turnbull
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Hongkai Ji
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Albert W Wu
- Center for Health Services and Outcomes Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Pedro A Mendez-Tellez
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Cheryl Dennison Himmelfarb
- Office for Science and Innovation, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Carl B Shanholtz
- Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD
| | - Megan M Hosey
- Outcomes After Critical Illness and Surgery (OACIS) 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
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT; Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) 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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12
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Thiolliere F, Allaouchiche B, Boyer H, Marie M, Friggeri A, Vacheron CH. Association between out-of-bed mobilization during the ICU stay of elderly patients and long-term autonomy: A cohort study. J Crit Care 2021; 68:10-15. [PMID: 34844035 DOI: 10.1016/j.jcrc.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Our objective was to estimate the impact of the absence of Out-of-Bed (OoB) mobilization during intensive care unit (ICU) stay among patients ≥70 years on their long-term autonomy. METHODS We conducted an ancillary study of the multicenter FRAGIREA study, including patients aged over 70 years, admitted to ICU for more than 48 h. We excluded the patients who died before day 180, who were lost to follow-up, and for whom the baseline autonomy (ADL) score was not available. Patients were classified into the OoB or non-OoB-mobilization group, and the impact of OoB mobilization on the decreased 6-month autonomy was estimated. RESULTS Among the 548 patients of the FRAGIREA cohort, 276 were included in the present study. Among them, 226 had OoB mobilization and 50 did not. 220/276 (80%) patients experienced the transfer to chair as rehabilitation therapy, passive mobilization and transfer to upright sitting were also frequently performed. A decrease in the 6-month autonomy was observed for 63 (23%) patients. After the elimination of potential confounders, non-OoB-mobilization patients had a greater risk of 6-month decreased autonomy (aOR 2.43 [1.18; 4.98]). CONCLUSIONS Mobilization during the ICU stay of elderly ICU patient survivors was associated with a lower decreased autonomy at 6 months.
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Affiliation(s)
- Fabrice Thiolliere
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
| | - Bernard Allaouchiche
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard, Lyon1, France; Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Pulmonary and Cardiovascular Aggression in Sepsis, F-69280 Marcy l'Étoile, France.
| | - Hélène Boyer
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France.
| | - Manon Marie
- CHU Edouard Heriot, AZUREA Study Group, France.
| | - Arnaud Friggeri
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard, Lyon1, France; CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France.
| | - Charles-Hervé Vacheron
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard, Lyon1, France; CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France; Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Hospices Civils de Lyon, Lyon, France.
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13
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Thackeray M, Mohebbi M, Orford N, Kotowicz MA, Pasco JA. Lean mass as a risk factor for intensive care unit admission: an observational study. Crit Care 2021; 25:364. [PMID: 34663393 PMCID: PMC8525013 DOI: 10.1186/s13054-021-03788-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Intensive care unit (ICU) survivors have reduced physical function likely due to skeletal muscle wasting and weakness acquired during critical illness. However, the contribution of pre-morbid muscle mass has not been elucidated. We aimed to examine the association between pre-ICU muscle mass and ICU admission risk. Secondary outcomes include the relationship between muscle mass and ICU outcomes. Methods ICU admissions between June 1, 1998, and February 1, 2019, were identified among participants of Geelong Osteoporosis Study (GOS), a population-based cohort study. Cox proportional hazard regression models estimated hazard ratios (HR) for ICU admission across T-score strata and continuous values of DXA-derived lean mass measures of skeletal mass index (SMI, lean mass/body mass %) and appendicular lean mass corrected for height (ALM/h2, kg/m2). Multivariable regression was used to determine the relationship between lean mass and ICU outcomes. Results One hundred and eighty-six of 3126 participants enrolled in GOS were admitted to the ICU during the follow-up period. In adjusted models, lean mass was not predictive of ICU admission (SMI: HR 0.99 95%CI 0.97–1.01, p = 0.32; ALM/h2: HR 1.11 95%CI 0.94–1.31, p = 0.23), while greater appendicular lean mass was related to reduced 28-day mortality (ALM/h2 adjOR: 0.25, 95%CI 0.10–0.63, p = 0.003, SMI adjOR: 0.91, 95%CI 0.82–1.02, p = 0.09). Conclusion Lean mass was not associated with ICU admission in this population-based cohort study; however, greater appendicular lean mass was associated with reduced mortality. This suggests pre-ICU muscle status may not predict development of critical illness but is associated with better survival after critical illness occurs. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03788-y.
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Affiliation(s)
- Matthew Thackeray
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia. .,Barwon Health, Geelong, Australia.
| | - Mohammadreza Mohebbi
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia.,Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Australia
| | - Neil Orford
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia.,Barwon Health, Geelong, Australia.,Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, Australia
| | - Mark A Kotowicz
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia.,Barwon Health, Geelong, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- IMPACT (Institute of Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Australia.,Barwon Health, Geelong, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.,Department of Epidemiology and Preventive Medicine (DEPM), Monash University, Melbourne, Australia
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14
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Anna S, Catharina F, Ann-Charlotte F. The core of patient-participation in the Intensive Care Unit: The patient's views. Intensive Crit Care Nurs 2021; 68:103119. [PMID: 34391629 DOI: 10.1016/j.iccn.2021.103119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Patient participation is an established concept in public welfare. However, reports of the phenomenon of patient participation during intensive care from the patient's point of view are scarce. Therefore, the aim of this study was to explore the meaning of patient participation in the intensive care unit from the patient's perspective. RESEARCH DESIGN A qualitative design was used for the purpose of the study with a purposive convenient sample of nine adult patients with memories from their intensive care stay. METHOD Data was collected through individual interviews and analysed using a phenomenological hermeneutical method. FINDINGS The results of our study show a variety of meanings and degrees of participation that continuously move on a sliding scale from acting as a captain to feelings of being on an isolated island. Patient participation varied due to individual cognitive abilities and individual preferences, and the caregiver's attention altered between the body and the person through the continuum of care. CONCLUSION Patient participation during ICU care is more than participation in decision-making processes or direct patient care decisions. An understanding of the concept participation from the individual patient is necessary to support person centred care and the patient's relatives play an important role in during the entire care process.
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Affiliation(s)
- Slettmyr Anna
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institute, SE-141 52 Stockholm, Sweden.
| | - Frank Catharina
- School of Health and Caring Sciences, Linnaeus University, SE-351 95 Växjö, Sweden.
| | - Falk Ann-Charlotte
- Department for Health Promoting Science, Sophiahemmet University, SE-114 86 Stockholm, Sweden.
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15
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Prediction Models for Physical, Cognitive, and Mental Health Impairments After Critical Illness: A Systematic Review and Critical Appraisal. Crit Care Med 2021; 48:1871-1880. [PMID: 33060502 PMCID: PMC7673641 DOI: 10.1097/ccm.0000000000004659] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Objectives: Improved ability to predict impairments after critical illness could guide clinical decision-making, inform trial enrollment, and facilitate comprehensive patient recovery. A systematic review of the literature was conducted to investigate whether physical, cognitive, and mental health impairments could be predicted in adult survivors of critical illness. Data Sources: A systematic search of PubMed and the Cochrane Library (Prospective Register of Systematic Reviews ID: CRD42018117255) was undertaken on December 8, 2018, and the final searches updated on January 20, 2019. Study Selection: Four independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were eligible if a prediction model was developed, validated, or updated for impairments after critical illness in adult patients. Discrepancies were resolved by consensus or an independent adjudicator. Data Extraction: Data on study characteristics, timing of outcome measurement, candidate predictors, and analytic strategies used were extracted. Risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool. Data Synthesis: Of 8,549 screened studies, three studies met inclusion. All three studies focused on the development of a prediction model to predict (1) a mental health composite outcome at 3 months post discharge, (2) return-to-pre-ICU functioning and residence at 6 months post discharge, and (3) physical function 2 months post discharge. Only one model had been externally validated. All studies had a high risk of bias, primarily due to the sample size, and statistical methods used to develop and select the predictors for the prediction published model. Conclusions: We only found three studies that developed a prediction model of any post-ICU impairment. There are several opportunities for improvement for future prediction model development, including the use of standardized outcomes and time horizons, and improved study design and statistical methodology.
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16
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National Trends and Variation of Functional Status Deterioration in the Medically Critically Ill. Crit Care Med 2021; 48:1556-1564. [PMID: 32886469 DOI: 10.1097/ccm.0000000000004524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Physical and psychologic deficits after an ICU admission are associated with lower quality of life, higher mortality, and resource utilization. This study aimed to examine the prevalence and secular changes of functional status deterioration during hospitalization among nonsurgical critical illness survivors over the past decade. DESIGN We performed a retrospective longitudinal cohort analysis. SETTING Analysis performed using the Cerner Acute Physiology and Chronic Health Evaluation outcomes database which included manually abstracted data from 236 U.S. hospitals from 2008 to 2016. PATIENTS We included nonsurgical adult ICU patients who survived their hospitalization and had a functional status documented at ICU admission and hospital discharge. Physical functional status was categorized as fully independent, partially dependent, or fully dependent. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Functional status deterioration occurred in 38,116 patients (29.3%). During the past decade, functional status deterioration increased in each disease category, as well as overall (prevalence rate ratio, 1.15; 95% CI, 1.13-1.17; p < 0.001). Magnitude of functional status deterioration also increased over time (odds ratio, 1.03; 95% CI, 1.03-1.03; p < 0.001) with hematological, sepsis, neurologic, and pulmonary disease categories having the highest odds of severe functional status deterioration. CONCLUSIONS Following nonsurgical critical illness, the prevalence of functional status deterioration and magnitude increased in a nationally representative cohort, despite efforts to reduce ICU dysfunction over the past decade. Identifying the prevalence of functional status deterioration and primary etiologies associated with functional status deterioration will elucidate vital areas for further research and targeted interventions. Reducing ICU debilitation for key disease processes may improve ICU survivor mortality, enhance quality of life, and decrease healthcare utilization.
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17
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Hartman ME, Williams CN, Hall TA, Bosworth CC, Piantino JA. Post-Intensive-Care Syndrome for the Pediatric Neurologist. Pediatr Neurol 2020; 108:47-53. [PMID: 32299742 PMCID: PMC7306429 DOI: 10.1016/j.pediatrneurol.2020.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/06/2020] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
Abstract
The number of children who survive critical illness has steadily increased. However, lower mortality rates have resulted in a proportional increase in post-intensive-care morbidity. Critical illness in childhood affects a child's development, cognition, and family functioning. The constellation of physical, emotional, cognitive, and psychosocial symptoms that begin in the intensive care unit and continue after discharge has recently been termed post-intensive-care syndrome. A conceptual model of the post-intensive-care syndrome experienced by children who survive critical illness, their siblings, and parents has been coined post-intensive-care syndrome in pediatrics. Owing to their prolonged hospitalizations, the use of sedative medications, and the nature of their illness, children with primary neurological injury are among those at the highest risk for post-intensive-care syndrome in pediatrics. The pediatric neurologist participates in the care of children with acute brain injury throughout their hospitalization and remains involved after the patient leaves the hospital. Hence it is important for pediatric neurologists to become versed in the early recognition and management of post-intensive-care syndrome in pediatrics. In this review, we discuss the current knowledge regarding post-intensive-care syndrome in pediatrics and its risk factors. We also discuss our experience establishing Pediatric Neurocritical Care Recovery Programs at two large academic centers. Last, we provide a battery of validated tests to identify and manage the different aspects of post-intensive-care syndrome in pediatrics, which have been successfully implemented at our institutions. Dissemination of this "road map" may assist others interested in establishing recovery programs, therefore mitigating the burden of post-intensive-care morbidity in children.
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Affiliation(s)
- Mary E. Hartman
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University in St. Louis, St. Louis, MO
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Critical care, Oregon Health & Science University
| | - Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Christopher C. Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO
| | - Juan A. Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University,Department of Pediatrics, Division of Pediatric Neurology, Oregon Health & Science University
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18
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Milton A, Schandl A, Soliman I, Joelsson‐Alm E, Boogaard M, Wallin E, Brorsson C, Östberg U, Latocha K, Savilampi J, Paskins S, Bottai M, Sackey P. ICU discharge screening for prediction of new-onset physical disability-A multinational cohort study. Acta Anaesthesiol Scand 2020; 64:789-797. [PMID: 32083323 DOI: 10.1111/aas.13563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/02/2020] [Accepted: 02/07/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge. METHODS Multinational prospective cohort study in 10 general ICUs in Sweden, Denmark, and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability 3 months post-ICU, defined as a ≥10 score reduction in the Barthel Index (BI) compared to baseline. RESULTS Of the 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea critical care physical assessment tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81-0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61-0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, and positive predictive value for a high-risk group (CPAx score ≤18) was 0.32. CONCLUSION The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.
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Affiliation(s)
- Anna Milton
- Department of Physiology and Pharmacology Karolinska Institutet Solna Sweden
- Department of Perioperative Medicine and Intensive care Karolinska University Hospital Stockholm Sweden
| | - Anna Schandl
- Department of Molecular Medicine and Surgery Karolinska Institutet Solna Sweden
| | - Iwo Soliman
- Department of Intensive Care Medicine University Medical Center Utrecht Utrecht University Utrecht the Netherlands
| | - Eva Joelsson‐Alm
- Department of Clinical Science and Education Karolinska Institutet Solna Sweden
- Unit of Anaesthesiology and Intensive Care Södersjukhuset Stockholm Sweden
| | - Mark Boogaard
- Department of Intensive Care Medicine Radboud University Nijmegen Medical Center Nijmegen the Netherlands
| | - Ewa Wallin
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden
| | - Camilla Brorsson
- Department of Surgical and Perioperative Sciences Umeå University Umea Sweden
| | - Ulrika Östberg
- Department of Anaesthesiology and Intensive Care Östersund Hospital Östersund Sweden
| | - Kristine Latocha
- Department of Intensive Care Rigshospitalet Copenhagen Copenhagen Denmark
| | - Johanna Savilampi
- School of medical sciences Örebro University Örebro Sweden
- Department of Anaesthesiology and Intensive care Örebro University Hospital Örebro Sweden
| | - Stinne Paskins
- Department of Intensive Care Odense University Hospital Odense Denmark
| | - Matteo Bottai
- Institute of Environmental Medicine Karolinska Institutet Solna Sweden
| | - Peter Sackey
- Department of Physiology and Pharmacology Karolinska Institutet Solna Sweden
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19
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Survivor But Not Fully Recovered: The Lived Experience After 1 Year of Surviving Sepsis. Dimens Crit Care Nurs 2020; 38:317-327. [PMID: 31593071 DOI: 10.1097/dcc.0000000000000381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Hospital mortality rates related to sepsis have decreased over the last decade, increasing the number of survivors of sepsis who may experience long-term consequences. Yet, little is known about how they perceive their illness experience and its aftermath. OBJECTIVE This study explores the experiences of sepsis survivors after 1 year of their index intensive care unit (ICU) stay. METHODS This phenomenological study was guided by Merleau-Ponty's philosophy. Participants were adult patients admitted directly to the medical ICU with sepsis who had an ICU stay of at least 48 hours and had been discharged from their index ICU stay for at least 1 year. Participants were invited by letter to participate in face-to-face or telephone interviews and a brief survey. Interviews were audio recorded, transcribed verbatim, and verified. An interpretive group read transcripts aloud to increase rigor of identifying meaning units, existential grounds, and thematic structure. RESULTS Eight participants were recruited over 20 months. Participants were primarily white (87.5%) females (75%) with an age range of 37 to 74 years who were interviewed between 1 and 2 years following an index sepsis ICU stay. Five major themes emerged from the transcripts: (1) how they survived, (2) blurring of time versus counting time by events, (3) helpful help versus unhelpful help, (4) powerless versus striving for control, and (5) survivor but not fully recovered. DISCUSSION Findings reflected a long trajectory of chronic illness in which the index episode of sepsis was not necessarily what stood out as figural to participants. The meaning of participant experiences must be considered in the context of a health care system that offers little to no systematic follow-up care after sepsis and little prevention. Participants expressed a need for advocacy and follow-up support.
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20
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Milton A, Schandl A, Soliman IW, Meijers K, van den Boogaard M, Larsson IM, Brorsson C, Östberg U, Oxenbøll-Collet M, Savilampi J, Paskins S, Bottai M, Sackey PV. Development of an ICU discharge instrument predicting psychological morbidity: a multinational study. Intensive Care Med 2018; 44:2038-2047. [PMID: 30467678 PMCID: PMC6280826 DOI: 10.1007/s00134-018-5467-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022]
Abstract
Purpose To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors. Methods Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥ 12 h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3 months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score ≥ 11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score > 45. Results A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10–1.50], traumatic memories (OR 1.44, 95% CI 1.13–1.82), lack of social support (OR 3.28, 95% CI 1.47–7.32) and age (age-dependent OR, peak risk at age 49–65 years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70–0.81). Conclusions We developed an instrument to predict individual patients’ risk for psychological problems 3 months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up. Trial registration The study was registered at clinicaltrials.gov, NCT02679157. Electronic supplementary material The online version of this article (10.1007/s00134-018-5467-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Milton
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. .,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - A Schandl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - I W Soliman
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Meijers
- Department of Anaesthesiology and Intensive Care, Sodersjukhuset, Stockholm, Sweden
| | - M van den Boogaard
- Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - I M Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - C Brorsson
- Department of Surgery and Perioperative Science, Umeå University, Umeå, Sweden
| | - U Östberg
- Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden
| | - M Oxenbøll-Collet
- Department of Intensive Care, Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - J Savilampi
- Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden
| | - S Paskins
- Department of Intensive Care, Odense University Hospital, Odense, Denmark
| | - M Bottai
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - P V Sackey
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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21
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Abstract
Older ICU survivors are often challenged with clusters of geriatric syndromes and functional decline. The purpose of this study was (a) to assess patterns of geriatric syndromes and functional status from admission to 6 months post discharge and (b) to examine the predictors of longitudinal functional status. This is a prospective cohort study. Demographic information, clinical variables, geriatric syndromes, and functional status were collected longitudinally. A total of 192 medical ICU older adult survivors were included in the analysis. Factors associated with reductions in functional status over 6 months were (a) institutionalized prior to hospitalization, (b) pressure sore before admission, (c) existing delirium, (d) impaired mobility at baseline, (e) increased APACHE II score upon ICU admission, and (f) use of mechanical ventilation during the ICU stay. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.
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Affiliation(s)
- Hsin-Ju Tang
- National Cheng Kung University, Tainan, Taiwan, Republic of China
- Chi-Mei Medical Center, Tainan, Taiwan, Republic of China
| | | | - Chia-Ming Chang
- National Cheng Kung University, Tainan, Taiwan, Republic of China
- National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
| | - Pei-Fang Su
- National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - Ching-Huey Chen
- Chang Jung Christian University, Tainan City, Taiwan, Republic of China
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22
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Kjaer MN, Mortensen CB, Hjortrup PB, Rygård SL, Andersen I, Perner A. Factors associated with non-response at health-related quality of life follow-up in a septic shock trial. Acta Anaesthesiol Scand 2018; 62:357-366. [PMID: 29282713 DOI: 10.1111/aas.13056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 11/06/2017] [Accepted: 11/22/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Follow-up of intensive care unit (ICU) patients often includes health-related quality of life (HRQoL) surveying, but non-responders hamper the interpretation. Our aim was to assess factors for non-response to HRQoL survey in ICU patients with septic shock at follow-up in a clinical trial. METHODS In a post hoc follow-up registry study, we assessed all the Danish survivors in the Transfusion-Requirements in Septic Shock trial patients, who were mailed the Short Form 36-item Survey (SF-36) 1-year after randomization. We used covariates from the trial database merged with covariates from nation-wide registries using the unique national identification number to explore possible factors for not responding. Five covariates were pre-specified to be included in the primary multivariate analysis: age, number of days in hospital from randomization to follow-up, level of education, cohabitation and employment status at follow-up. We compared the mortality from 1-year survival (2012-2014) till end of final follow-up (January 2016) between non-responders and responders. RESULTS We assessed 308 survivors of whom 108 (35%) were non-responders. In the primary analysis lower age (odds ratio 1.03, 95% CI [1.01-1.05]), more admission days in hospital (1.006 [1.001-1.011]) and living alone (4.33 [2.46-7.63]) were associated with non-responding, whereas the level of education and employment status were not. Non-responders had a hazard ratio of 1.63 [0.97-2.72] for mortality from 1-year follow-up to final follow-up as compared to the responders. CONCLUSION Being younger, spending more days in hospital and living alone were all associated with non-response at 1-year HRQoL follow-up among ICU patients with septic shock.
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Affiliation(s)
- M. N. Kjaer
- Department of Intensive Care; COPENHAGEN University Hospital, Rigshospitalet; Copenhagen Denmark
| | - C. B. Mortensen
- Department of Intensive Care; Zealand University Hospital; Køge Denmark
- Department of Intensive Care; Copenhagen University Hospital, Herlev Hospital; Copenhagen Denmark
| | - P. B. Hjortrup
- Department of Intensive Care; COPENHAGEN University Hospital, Rigshospitalet; Copenhagen Denmark
| | - S. L. Rygård
- Department of Intensive Care; COPENHAGEN University Hospital, Rigshospitalet; Copenhagen Denmark
| | - I. Andersen
- Department of Public Health, Section of Social Medicine; University of Copenhagen; Copenhagen Denmark
| | - A. Perner
- Department of Intensive Care; COPENHAGEN University Hospital, Rigshospitalet; Copenhagen Denmark
- Centre for Research in Intensive Care; Copenhagen Denmark
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23
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Soliman IW, Cremer OL, de Lange DW, Slooter AJC, van Delden JHJM, van Dijk D, Peelen LM. The ability of intensive care unit physicians to estimate long-term prognosis in survivors of critical illness. J Crit Care 2017; 43:148-155. [PMID: 28898744 DOI: 10.1016/j.jcrc.2017.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE To assess the reliability of physicians' prognoses for intensive care unit (ICU) survivors with respect to long-term survival and health related quality of life (HRQoL). METHODS We performed an observational cohort-study in a single mixed tertiary ICU in The Netherlands. ICU survivors with a length of stay >48h were included. At ICU discharge, one-year prognosis was estimated by physicians using the four-option Sabadell score to record their expectations. The outcome of interest was poor outcome, which was defined as dying within one-year follow-up, or surviving with an EuroQoL5D-3L index <0.4. RESULTS Among 1399 ICU survivors, 1068 (76%) subjects were expected to have a good outcome; 243 (18%) a poor long-term prognosis; 43 (3%) a poor short-term prognosis, and 45 (3%) to die in hospital (i.e. Sabadell score levels). Poor outcome was observed in 38%, 55%, 86%, and 100% of these groups respectively (concomitant c-index: 0.61). The expected prognosis did not match observed outcome in 365 (36%) patients. This was almost exclusively (99%) due to overoptimism. Physician experience did not affect results. CONCLUSIONS Prognoses estimated by physicians incorrectly predicted long-term survival and HRQoL in one-third of ICU survivors. Moreover, inaccurate prognoses were generally the result of overoptimistic expectations of outcome.
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Affiliation(s)
- Ivo W Soliman
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Johannes Hans J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | - Linda M Peelen
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht University, The Netherlands.
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24
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Abstract
OBJECTIVES There is growing evidence for increased levels of pain and reduced health-related quality of life in survivors of critical illness. Recent studies showed marked small nerve fiber pathology in critically ill patients, which may contribute to chronic pain states and reduced physical recovery after ICU discharge. Primary objective of this study was the comparison of somatosensory functions between survivors of critical illness 6 months after ICU discharge and controls. In post hoc analyses, we aimed to identify associations between small fiber deficits, pain, health-related quality of life, and clinical data. DESIGN Cross-sectional study. SETTING Study in critical illness survivors. PATIENTS Critical illness survivors (n = 84) and controls (n = 44). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Somatosensory functions were assessed with validated quantitative sensory testing. Pain and pain-related disability were assessed with the chronic pain grade questionnaire. Health-related quality of life was assessed by means of the Short Form-36. Compared with controls, former patients showed significantly increased thermal detection thresholds and more abnormal values in thermal testing, indicating reduced small fiber functioning. In addition, compared to patients without significant small fiber deficits (n = 46, 54.8%), patients with significant small fiber deficits (n = 38, 45.2%) reported higher average pain intensity, pain-related disability, and reduced physical health-related quality of life in the SF-36. CONCLUSIONS A large portion of former critically ill patients show small fiber deficits which seem to be associated with increased pain and reduced physical health-related quality of life. Screening of somatosensory functions in the (post-) acute setting could possibly help to identify patients at risk of long-term impairments.
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25
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Major ME, Kwakman R, Kho ME, Connolly B, McWilliams D, Denehy L, Hanekom S, Patman S, Gosselink R, Jones C, Nollet F, Needham DM, Engelbert RHH, van der Schaaf M. Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge. Crit Care 2016; 20:354. [PMID: 27793165 PMCID: PMC5086052 DOI: 10.1186/s13054-016-1508-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/26/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The study objective was to obtain consensus on physical therapy (PT) in the rehabilitation of critical illness survivors after hospital discharge. Research questions were: what are PT goals, what are recommended measurement tools, and what constitutes an optimal PT intervention for survivors of critical illness? METHODS A Delphi consensus study was conducted. Panelists were included based on relevant fields of expertise, years of clinical experience, and publication record. A literature review determined five themes, forming the basis for Delphi round one, which was aimed at generating ideas. Statements were drafted and ranked on a 5-point Likert scale in two additional rounds with the objective to reach consensus. Results were expressed as median and semi-interquartile range, with the consensus threshold set at ≤0.5. RESULTS Ten internationally established researchers and clinicians participated in this Delphi panel, with a response rate of 80 %, 100 %, and 100 % across three rounds. Consensus was reached on 88.5 % of the statements, resulting in a framework for PT after hospital discharge. Essential handover information should include information on 15 parameters. A core set of outcomes should test exercise capacity, skeletal muscle strength, function in activities of daily living, mobility, quality of life, and pain. PT interventions should include functional exercises, circuit and endurance training, strengthening exercises for limb and respiratory muscles, education on recovery, and a nutritional component. Screening tools to identify impairments in other health domains and referral to specialists are proposed. CONCLUSIONS A consensus-based framework for optimal PT after hospital discharge is proposed. Future research should focus on feasibility testing of this framework, developing risk stratification tools and validating core outcome measures for ICU survivors.
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Affiliation(s)
- M. E. Major
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- European School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - R. Kwakman
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - M. E. Kho
- McMaster University, School of Rehabilitation Science, Hamilton, Canada
| | - B. Connolly
- Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, Lane Fox Clinical Respiratory Physiology Research Unit, London, UK
| | - D. McWilliams
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Therapy Services, Birmingham, UK
| | - L. Denehy
- The University of Melbourne, Department of Physiotherapy, Melbourne, Australia
| | - S. Hanekom
- Stellenbosch University, Physiotherapy Division, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - S. Patman
- The University of Notre Dame Australia, School of Physiotherapy, Fremantle, Australia
| | - R. Gosselink
- KU Leuven – University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - C. Jones
- University of Liverpool, Musculoskeletal Biology, Institute of Ageing & Chronic Disease, Liverpool, UK
| | - F. Nollet
- Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD Amsterdam, The Netherlands
| | - D. M. Needham
- Johns Hopkins University Baltimore, Outcomes after Critical Illness and Surgery Group, Baltimore, USA
- Johns Hopkins University School of Medicine Division of Pulmonary and Critical Care Medicine, Baltimore, USA
- Johns Hopkins University School of Medicine Baltimore, Department of Physical Medicine and Rehabilitation, Baltimore, USA
| | - R. H. H. Engelbert
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD Amsterdam, The Netherlands
| | - M. van der Schaaf
- ACHIEVE—Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Department of rehabilitation medicine, PO Box 22660, 1100DD Amsterdam, The Netherlands
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26
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Huang M, Parker AM, Bienvenu OJ, Dinglas VD, Colantuoni E, Hopkins RO, Needham DM. Psychiatric Symptoms in Acute Respiratory Distress Syndrome Survivors: A 1-Year National Multicenter Study. Crit Care Med 2016; 44:954-65. [PMID: 26807686 PMCID: PMC4833555 DOI: 10.1097/ccm.0000000000001621] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate prevalence, severity, and co-occurrence of and risk factors for depression, anxiety, and posttraumatic stress disorder symptoms over the first year after acute respiratory distress syndrome. DESIGN Prospective longitudinal cohort study. SETTINGS Forty-one Acute Respiratory Distress Syndrome Network hospitals across the United States. PATIENTS Six hundred ninety-eight acute respiratory distress syndrome survivors. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Psychiatric symptoms were evaluated by using the Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised at 6 and 12 months. Adjusted prevalence ratios for substantial symptoms (binary outcome) and severity scores were calculated by using Poisson and linear regression, respectively. During 12 months, a total of 416 of 629 patients (66%) with at least one psychiatric outcome measure had substantial symptoms in at least one domain. There was a high and almost identical prevalence of substantial symptoms (36%, 42%, and 24% for depression, anxiety, and posttraumatic stress disorder) at 6 and 12 months. The most common pattern of co-occurrence was having symptoms of all three psychiatric domains simultaneously. Younger age, female sex, unemployment, alcohol misuse, and greater opioid use in the ICU were significantly associated with psychiatric symptoms, whereas greater severity of illness and ICU length of stay were not associated. CONCLUSIONS Psychiatric symptoms occurred in two thirds of acute respiratory distress syndrome survivors with frequent co-occurrence. Sociodemographic characteristics and in-ICU opioid administration, rather than traditional measures of critical illness severity, should be considered in identifying the patients at highest risk for psychiatric symptoms during recovery. Given high co-occurrence, acute respiratory distress syndrome survivors should be simultaneously evaluated for a full spectrum of psychiatric sequelae to maximize recovery.
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Affiliation(s)
- Minxuan Huang
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ann M. Parker
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - O. Joseph Bienvenu
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victor D. Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Ramona O. Hopkins
- Pulmonary and Critical Care Division, Intermountain Medical Center Department of Medicine, Murray, UT
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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27
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Strengthening Our Understanding of Weakness: A Step in the Right Direction. Pediatr Crit Care Med 2016; 17:92-3. [PMID: 26731325 DOI: 10.1097/pcc.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Corner EJ, Brett SJ. Early identification of patients at risk of long-term critical illness-associated physical disability: is it possible? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:629. [PMID: 25672518 PMCID: PMC4331459 DOI: 10.1186/s13054-014-0629-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
ICU-acquired weakness can hinder and determine the course of recovery from critical illness, leading to life-changing disability. Risk factors include multiorgan failure and prolonged bed rest; however, no prognostic model or screening tool for new-onset disability has been established to date. With no way of targeting the at-risk population, it is difficult to demonstrate the benefit of rehabilitation interventions in research and prioritize resources clinically. In a recent issue of Critical Care, Schandl and colleagues aimed to establish a predictive screening tool for new-onset disability using 23 possible predictors. They found that using the following risk factors – low educational level, fractures, reduced core stability and length of ICU stay over 2 days – they were able to develop a risk score predictive of disability at 2 months after hospital discharge. These investigators propose that this will help to identify patients requiring follow-up and may increase the power to detect change in interventional studies. Whilst this is promising work, further validation is essential: firstly, to make it a clinically workable tool in terms of appropriate ‘cut offs’; secondly, to ensure that it is transferable in different socio-economic environments; and finally, to make sure that those identified as ‘at risk’ are those that would benefit the most from targeted intervention.
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