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Xiao S, Zhuang Q, Li Y, Xue Z. Longitudinal Vasoactive Inotrope Score Trajectories and Their Prognostic Significance in Critically Ill Sepsis Patients: A Retrospective Cohort Analysis. Clin Ther 2024; 46:711-716. [PMID: 39153910 DOI: 10.1016/j.clinthera.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 08/19/2024]
Abstract
PURPOSE Sepsis continues to be a critical issue in intensive care, characterized by significant morbidity and mortality. This study explores the association between Vasoactive Inotrope Score (VIS) trajectories and 28-day mortality in ICU patients with sepsis, employing VIS trajectories as a marker for assessing severity and guiding therapy. METHODS We conducted a retrospective analysis of the MIMIC-IV database, which included sepsis patients admitted to the ICU between 2008 and 2019. VIS calculations were performed bi-hourly during the first 72 hours of ICU admission. Using latent growth mixture modeling, we identified distinct VIS trajectory patterns, and multivariate Cox proportional hazards models were employed to evaluate their association with 28-day mortality. FINDINGS Among 6,802 sepsis patients who met the inclusion criteria, four distinct VIS trajectory patterns were identified: "Low-Decreasing" (52.1%), "Mild-Ascending" (13.2%), "Moderate-Decreasing" (23.0%), and "High-Stable" (11.6%). The 28-day survival analysis demonstrated that, compared to the "Low-Decreasing" group, the "Mild-Ascending" group had a hazard ratio (HR) for mortality of 2.55 (95% CI: 2.19-2.97, P < 0.001), the "Moderate-Decreasing" group had an HR of 1.20 (95% CI: 1.03-1.41, P = 0.021), and the "High-Stable" group presented the highest risk with an HR of 4.19 (95% CI: 3.43-5.12, P < 0.001). IMPLICATIONS This study offers significant insights into the prognostic value of VIS trajectories in sepsis patients. The identification of distinct trajectory patterns not only underscores the heterogeneity in sepsis but also emphasizes the importance of personalized management strategies. The findings underscore the potential of VIS trajectory monitoring in predicting 28-day outcomes and in guiding clinical decision-making in ICU settings.
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Affiliation(s)
- Shiji Xiao
- Department of Pediatrics intensive care unit, The Affiliated Hospital of Putian University, Putian, Fujian, PR China
| | - Qiufeng Zhuang
- Department of General practice, The Affiliated Hospital of Putian University, Putian, Fujian, PR China.
| | - Yinling Li
- Department of Pediatrics intensive care unit, The Affiliated Hospital of Putian University, Putian, Fujian, PR China
| | - Zhibin Xue
- Department of Pediatrics intensive care unit, The Affiliated Hospital of Putian University, Putian, Fujian, PR China
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Fernández-Gonzalo S, Navarra-Ventura G, Gomà G, Godoy-González M, Oliveras L, Ridao Sais N, Espinal C, Fortià C, De Haro C, Ochagavía A, Jodar M, Forné C, Santos-Pulpon V, Sarlabous L, Bacardit N, Subirà C, Fernández R, Palao D, Roca O, Blanch L, López-Aguilar J. Characterization of postintensive care syndrome in a prospective cohort of survivors of COVID-19 critical illness: a 12-month follow-up study. Can J Anaesth 2024; 71:1282-1301. [PMID: 39251486 PMCID: PMC11408405 DOI: 10.1007/s12630-024-02811-4] [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: 06/01/2023] [Revised: 02/14/2024] [Accepted: 03/05/2024] [Indexed: 09/11/2024] Open
Abstract
PURPOSE Studies integrating an exhaustive longitudinal long-term follow-up of postintensive care syndrome (PICS) in critically ill COVID-19 survivors are scarce. We aimed to 1) describe PICS-related sequelae over a 12-month period after intensive care unit (ICU) discharge, 2) identify relevant demographic and clinical factors related to PICS, and 3) explore how PICS-related sequelae may influence health-related quality of life (HRQoL) in critically ill COVID-19 survivors. METHODS We conducted a prospective cohort study in adult critically ill survivors of SARS-CoV-2 infection that did or did not need invasive mechanical ventilation (IMV) during the COVID-19 pandemic in Spain (March 2020 to January 2021). We performed a telemedicine follow-up of PICS-related sequelae (physical/functional, cognitive, and mental health) and HRQoL with five data collection points. We retrospectively collected demographic and clinical data. We used multivariable mixed-effects models for data analysis. RESULTS We included 142 study participants in the final analysis, with a median [interquartile range] age of 61 [53-68] yr; 35% were female and 59% needed IMV. Fatigue/dyspnea, pain, impaired muscle function, psychiatric symptomatology and reduced physical HRQoL were prominent sequelae early after ICU discharge. Over the 12-month follow-up, functionality and fatigue/dyspnea improved progressively, while pain remained stable. We observed slight fluctuations in anxiety symptoms and perception of cognitive deficit, whereas posttraumatic stress disorder (PTSD) and depressive symptoms improved, with a mild rebound at the end of the follow-up. Female sex, younger age, and the need for IMV were risk factors for PICS, while having higher cognitive reserve was a potential protective factor. Physical HRQoL scores showed a general improvement over time, whereas mental HRQoL remained stable. Shorter ICU stay, better functionality, and lower scores for fatigue/dyspnea and pain were associated with better physical HRQoL, while lower scores for anxiety, depression, and PTSD were associated with better mental HRQoL. CONCLUSIONS Postintensive care syndrome was common in COVID-19 critical illness survivors and persisted in a significant proportion of patients one year after ICU discharge, impacting HRQoL. The presence of risk factors for PICS may identify patients who are more likely to develop the condition and who would benefit from more specific and closer follow-up after ICU admission. STUDY REGISTRATION ClinicalTrials.gov ( NCT04422444 ); first submitted 9 June 2020.
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Affiliation(s)
- Sol Fernández-Gonzalo
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical and Health Psychology, International Excellence Campus, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Guillem Navarra-Ventura
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
- Department of Medicine, University of the Balearic Islands, IUNICS, IdISBa, Palma, Mallorca, Spain.
| | - Gemma Gomà
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Godoy-González
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Department of Clinical and Health Psychology, International Excellence Campus, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Laia Oliveras
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Natalia Ridao Sais
- Physical and Rehabilitation Medicine Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Cristina Espinal
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Cristina Fortià
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Candelaria De Haro
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Ochagavía
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Merce Jodar
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical and Health Psychology, International Excellence Campus, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
- Neurology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Carles Forné
- Heorfy Consulting, Lleida, Spain
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
| | - Verónica Santos-Pulpon
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Leonardo Sarlabous
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Neus Bacardit
- Mental Health Department, Althaia Xarxa Assistencial Universitària de Manresa, IRIS Research Institute, Manresa, Spain
| | - Carles Subirà
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Critical Care Department, Althaia Xarxa Assistencial Universitària de Manresa, IRIS Research Institute, Manresa, Spain
| | - Rafael Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Critical Care Department, Althaia Xarxa Assistencial Universitària de Manresa, IRIS Research Institute, Manresa, Spain
| | - Diego Palao
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Mental Health Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, Sabadell, Spain
- Department of Psychiatry and Forensic Medicine, International Excellence Campus, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Oriol Roca
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, International Excellence Campus, Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Lluís Blanch
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina López-Aguilar
- Critical Care Department, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Praça APA, Nassar Junior AP, Ferreira AM, Caruso P. Decreased Long-Term Survival of Patients With Newly Diagnosed Cancer Discharged Home After Unplanned ICU Admission: A Prospective Observational Study. Crit Care Explor 2024; 6:e1136. [PMID: 39092843 PMCID: PMC11299991 DOI: 10.1097/cce.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
IMPORTANCE AND OBJECTIVES To compare the 18-month survival between patients with newly diagnosed cancer discharged home after early unplanned ICU admission and those without early unplanned ICU admission; we also evaluated the frequency and risk factors for early unplanned ICU admission. DESIGN Observational study with prospectively collected data from September 2019 to June 2021 and 18 months follow-up. SETTING Single dedicated cancer center in São Paulo, Brazil. PARTICIPANTS We screened consecutive adults with suspected cancer and included those with histologically proven cancer from among 20 highly prevalent cancers. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The exposure was early unplanned ICU admission, defined as admission for medical reasons or urgent surgery during the first 6 months after cancer diagnosis. The main outcome was 18-month survival after cancer diagnosis, and the main analysis was Cox's proportional hazards model adjusted for confounders and immortal time bias. Propensity score matching was used in the sensitivity analysis. We screened 4738 consecutive adults with suspected cancer and included 3348 patients. Three hundred twelve (9.3%) had early unplanned ICU admission, which was associated with decreased 18-month survival both in the unadjusted (hazard ratio, 4.03; 95% CI, 2.89-5.62) and adjusted (hazard ratio, 1.84; 95% CI, 1.29-2.64) models. The sensitivity analysis confirmed the results because the groups were balanced after matching, and the 18-month survival of patients with early ICU admission was lower compared with patients without early ICU admission (87.0% vs. 93.9%; p = 0.01 log-rank test). Risk factors for early unplanned ICU admission were advanced age, comorbidities, worse performance status, socioeconomic deprivation, metastatic tumors, and hematologic malignancies. CONCLUSIONS Patients with newly diagnosed cancer discharged home after early unplanned ICU admission have decreased 18-month survival compared with patients without early unplanned ICU admission.
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Affiliation(s)
| | | | | | - Pedro Caruso
- Intensive Care Unit, A.C.Camargo Cancer Center, São Paulo, Brazil
- Pulmonary Department, Heart Institute (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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You H, Docherty SL, Ashana DC, Oyesanya TO. Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care. AACN Adv Crit Care 2024; 35:97-108. [PMID: 38848572 DOI: 10.4037/aacnacc2024982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another location or level of care. Transitions theory is a middle-range nursing theory that aims to provide guidance for safe and effective nursing care and research while an individual experiences a transition. Intensive care unit nurses are well positioned to provide ICU transitional care planning early. This article applies the transitions theory as a theoretical model to guide the study of the transition to home after acute hospital care for ICU patients and their families. This theory application can help ICU nurses provide holistic patient- and family-centered transitional care to achieve optimal outcomes by addressing the predischarge and postdischarge needs of patients and families.
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Affiliation(s)
- HyunBin You
- HyunBin You is a PhD candidate, School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham, NC 27710
| | - Sharron L Docherty
- Sharron L. Docherty is Associate Professor, School of Nursing, and Associate Professor, Department of Medicine, Duke University, Durham, North Carolina
| | - Deepshikha C Ashana
- Deepshikha C. Ashana is Assistant Professor, Department of Medicine; Core Faculty Member, Duke-Margolis Center for Health Policy; and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Tolu O Oyesanya
- Tolu O. Oyesanya is Associate Professor, School of Nursing, Duke University, Durham, North Carolina
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Sauvage A, Laurent E, Gaborit C, Guillon A, Grammatico-Guillon L. Herpes simplex encephalitis in France: incidence, 6-month rehospitalizations and mortality. Infection 2024:10.1007/s15010-024-02272-3. [PMID: 38678152 DOI: 10.1007/s15010-024-02272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Herpes simplex encephalitis (HSE) is a disease with unfavorable vital and functional prognoses. There are no recent epidemiological data on HSE at a national level using real-life databases, especially in France. This study aimed to report the incidence, the clinical characteristics and outcomes of the patients with HSE. METHODS We conducted a comprehensive retrospective cohort study on all patients hospitalized for HSE in France between 2015 and 2022 using national hospital discharge databases. Incidence, socio-demographic and clinical characteristics (including comorbidities, seizure, stays' features, intensive care supports) were described. The short- (first stay) and long-term (6-month) outcomes were reported, in terms of mortality and rehospitalizations. RESULTS 1425 HSE patients were included (median age 67 [54-77] years old, M/F sex ratio 1.07), giving a mean yearly hospital incidence of 2.3 [2.1-2.5] per 1,000,000 inhabitants. 51.2% of the patients were admitted in ICU (n = 730), of whom 59.0% were mechanically ventilated. The overall mortality during the first stay was 14.3% (n = 204), up to 17.9% for ICU patients. Within 6 months, among the survivors, 10.1% had at least one rehospitalization related to HSE. At 6 months, 16.5% of all patients had died (n = 235), 20.8% for ICU patients. CONCLUSION In France, the incidence of hospitalizations for HSE was 2.3 per 1,000,000 inhabitants with more than half of the patients admitted in ICU and a 6-month in-hospital mortality about 16.5%. This real-life update on the characteristics and severe outcomes of the disease raises awareness among care practitioners, of the serious nature of the disease, and thus can lead to higher vigilance.
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Affiliation(s)
- Ambre Sauvage
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
- University of Tours, Tours, France
| | - Emeline Laurent
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
- Research Team EA 7505 "Education, Ethics, Health", University of Tours, Tours, France
| | - Christophe Gaborit
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France
| | - Antoine Guillon
- Intensive Care Unit, Tours University Hospital, Tours, France
- Research Center for Respiratory Diseases, INSERM U1100, Tours, France
| | - Leslie Grammatico-Guillon
- Clinical Data Epidemiology Unit in Centre-Val de Loire (EpiDcliC), Tours University Hospital, Tours, France.
- University of Tours, Tours, France.
- MAVIVH, INSERM U1259, Tours, France.
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Stewart J, Bradley J, Smith S, McPeake J, Walsh T, Haines K, Leggett N, Hart N, McAuley D. Do critical illness survivors with multimorbidity need a different model of care? Crit Care 2023; 27:485. [PMID: 38066562 PMCID: PMC10709866 DOI: 10.1186/s13054-023-04770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.
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Affiliation(s)
- Jonathan Stewart
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Judy Bradley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timothy Walsh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nina Leggett
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
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Grammatico-Guillon L, Laurent E, Fuhrman J, Gaborit C, Vallée M, Dinh A, Sotto A, Bruyere F. Factors associated with urinary diversion and fatality of hospitalised acute pyelonephritis patients in France: a national cross-sectional study (FUrTIHF-2). Epidemiol Infect 2023; 151:e161. [PMID: 37721009 PMCID: PMC10600899 DOI: 10.1017/s0950268823001504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014-2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% Escherichia coli), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33.1 [32.3-34.0]), sepsis (1.73 [1.69-1.77]) and a Charlson index ≥3 (1.32 [1.29-1.35]) were significantly associated with urinary diversion, whereas E. coli (0.75 [0.74-0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32-2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.
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Affiliation(s)
- Leslie Grammatico-Guillon
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
| | - Emeline Laurent
- Public Health and Prevention Center, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Research Team “Education, Ethics and Health”, University of Tours, Tours, France
| | - Joseph Fuhrman
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
| | - Christophe Gaborit
- Public Health and Prevention Department, Unit of Regional Clinical Epidemiology, Teaching Hospital of Tours, Tours, France
| | - Maxime Vallée
- Service of Urology, Teaching Hospital of Poitiers, Medical School, University of Poitiers, Poitiers, France
| | - Aurélien Dinh
- Service of Infectious Diseases, AP-HP, Medical School, University of Paris, Paris, France
| | - Albert Sotto
- Service of Infectious Diseases, Teaching Hospital of Nimes, Medical School, University of Nimes, Nimes, France
| | - Franck Bruyere
- Service of Urology, Teaching Hospital of Tours, Medical School, University of Tours, Tours, France
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Jaworska N, Soo A, Stelfox HT, Burry LD, Fiest KM. Impacts of antipsychotic medication prescribing practices in critically ill adult patients on health resource utilization and new psychoactive medication prescriptions. PLoS One 2023; 18:e0287929. [PMID: 37384760 PMCID: PMC10310007 DOI: 10.1371/journal.pone.0287929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic medications are commonly prescribed to critically ill adult patients and initiation of new antipsychotic prescriptions in the intensive care unit (ICU) increases the proportion of patients discharged home on antipsychotics. Critically ill adult patients are also frequently exposed to multiple psychoactive medications during ICU admission and hospitalization including benzodiazepines and opioid medications which may increase the risk of psychoactive polypharmacy following hospital discharge. The associated impact on health resource utilization and risk of new benzodiazepine and opioid prescriptions is unknown. RESEARCH QUESTION What is the burden of health resource utilization and odds of new prescriptions of benzodiazepines and opioids up to 1-year post-hospital discharge in critically ill patients with new antipsychotic prescriptions at hospital discharge? STUDY DESIGN & METHODS We completed a multi-center, propensity-score matched retrospective cohort study of critically ill adult patients. The primary exposure was administration of ≥1 dose of an antipsychotic while the patient was admitted in the ICU and ward with continuation at hospital discharge and a filled outpatient prescription within 1-year following hospital discharge. The control group was defined as no doses of antipsychotics administered in the ICU and hospital ward and no filled outpatient prescriptions for antipsychotics within 1-year following hospital discharge. The primary outcome was health resource utilization (72-hour ICU readmission, 30-day hospital readmission, 30-day emergency room visitation, 30-day mortality). Secondary outcomes were administration of benzodiazepines and/or opioids in-hospital and following hospital discharge in patients receiving antipsychotics. RESULTS 1,388 propensity-score matched patients were included who did and did not receive antipsychotics in ICU and survived to hospital discharge. New antipsychotic prescriptions were not associated with increased health resource utilization or 30-day mortality following hospital discharge. There was increased odds of new prescriptions of benzodiazepines (adjusted odds ratio [aOR] 1.61 [95%CI 1.19-2.19]) and opioids (aOR 1.82 [95%CI 1.38-2.40]) up to 1-year following hospital discharge in patients continuing antipsychotics at hospital discharge. INTERPRETATION New antipsychotic prescriptions at hospital discharge are significantly associated with additional prescriptions of benzodiazepines and opioids in-hospital and up to 1-year following hospital discharge.
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Affiliation(s)
- Natalia Jaworska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Leslie Dan Faculty of Pharmacy, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa D. Burry
- Departments of Pharmacy and Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Leslie Dan Faculty of Pharmacy, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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9
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Patterns of Healthcare Resource Utilisation of Critical Care Survivors between 2006 and 2017 in Wales: A Population-Based Study. J Clin Med 2023; 12:jcm12030872. [PMID: 36769519 PMCID: PMC9917699 DOI: 10.3390/jcm12030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
In this retrospective cohort study, we used the Secure Anonymised Information Linkage (SAIL) Databank to characterise and identify predictors of the one-year post-discharge healthcare resource utilisation (HRU) of adults who were admitted to critical care units in Wales between 1 April 2006 and 31 December 2017. We modelled one-year post-critical-care HRU using negative binomial models and used linear models for the difference from one-year pre-critical-care HRU. We estimated the association between critical illness and post-hospitalisation HRU using multilevel negative binomial models among people hospitalised in 2015. We studied 55,151 patients. Post-critical-care HRU was 11-87% greater than pre-critical-care levels, whereas emergency department (ED) attendances decreased by 30%. Age ≥50 years was generally associated with greater post-critical-care HRU; those over 80 had three times longer hospital readmissions than those younger than 50 (incidence rate ratio (IRR): 2.96, 95% CI: 2.84, 3.09). However, ED attendances were higher in those younger than 50. High comorbidity was associated with 22-62% greater post-critical-care HRU than no or low comorbidity. The most socioeconomically deprived quintile was associated with 24% more ED attendances (IRR: 1.24 [1.16, 1.32]) and 13% longer hospital stays (IRR: 1.13 [1.09, 1.17]) than the least deprived quintile. Critical care survivors had greater 1-year post-discharge HRU than non-critical inpatients, including 68% longer hospital stays (IRR: 1.68 [1.63, 1.74]). Critical care survivors, particularly those with older ages, high comorbidity, and socioeconomic deprivation, used significantly more primary and secondary care resources after discharge compared with their baseline and non-critical inpatients. Interventions are needed to ensure that key subgroups are identified and adequately supported.
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10
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Post-Intensive Care Syndrome in Non-COVID-19 ICU Survivors during the COVID-19 Pandemic in South Korea: A Multicenter Prospective Cohort Study. J Clin Med 2022; 11:jcm11226653. [PMID: 36431130 PMCID: PMC9699493 DOI: 10.3390/jcm11226653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
A prospective observational cohort study investigated the prevalence of post-intensive care syndrome (PICS) among non-COVID-19 ICU survivors during the COVID-19 pandemic. Adults who had been admitted to the ICU for more than 24 h were enrolled, and followed-up at 3, 6, and 12 months post-discharge. PICS (mental health, cognitive, and physical domains) was measured using the Hospital Anxiety and Depression Scale, Posttraumatic Diagnosis Scale, Montreal Cognitive Assessment, and Korean Activities of Daily Living (ADL) scale. Data were analyzed from 237 participants who completed all three follow-up surveys. The prevalence of PICS was 44.7%, 38.4%, and 47.3%, at 3, 6, and 12 months of discharge, respectively. The prevalence of PICS in the mental health and cognitive domains decreased at 6 and increased at 12 months. The prevalence of PICS in the physical domain declined over time. Changes in PICS scores other than ADL differed significantly according to whether participants completed follow-up before or after December 2020, when COVID-19 rapidly spread in South Korea. In the recent group, anxiety, depression, post-traumatic stress disorder, and cognition scores were significantly worse at 12 months than at 6 months post-discharge. The COVID-19 pandemic may have adversely affected the recovery of non-COVID-19 ICU survivors.
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11
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Martin GL, Atramont A, Mazars M, Tajahmady A, Agamaliyev E, Singer M, Leone M, Legrand M. Days Spent at Home and Mortality After Critical Illness: A Cluster Analysis Using Nationwide Data. Chest 2022; 163:826-842. [PMID: 36257472 PMCID: PMC10107061 DOI: 10.1016/j.chest.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. RESEARCH QUESTION What are the days spent at home and health care trajectories during the year after surviving critical illness? STUDY DESIGN AND METHODS Data were extracted on adult survivors spending at least 2 nights in a French ICU during 2018 who were treated with invasive mechanical ventilation or vasopressors or inotropes. Trauma, burn, organ transplant, stroke, and neurosurgical patients were excluded. Stays at home, death, and hospitalizations were reported before and after ICU stay, using state sequence analysis. An unsupervised clustering method was performed to identify cohorts based on post-ICU trajectories. RESULTS Of 77,132 ICU survivors, 89% returned home. In the year after discharge, these patients spent a median of 330 (interquartile range [IQR], 283-349) days at home. At 1 year, 77% of patients were still at home and 17% had died. Fifty-one percent had been re-hospitalized, and 10% required a further ICU admission. Forty-eight percent used rehabilitation facilities, and 5.7%, hospital at home. Three clusters of patients with distinct post-ICU trajectories were identified. Patients in cluster 1 (68% of total) survived and spent most of the year at home (338 [323-354] days). Patients in cluster 2 (18%) had more complex trajectories, but most could return home (91%), spending 242 (174-277) days at home. Patients in cluster 3 (14%) died, with only 37% returning home for 45 (15-90) days. INTERPRETATION Many patients had complex health care trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge were observed between clusters, which represents an important patient-centered outcome.
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Affiliation(s)
| | | | | | | | | | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Marc Leone
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesia and Intensive Care Unit, Hospital Nord, Marseille, France; Société Française d'Anesthésie et de Réanimation (SFAR), Paris, France
| | - Matthieu Legrand
- Société Française d'Anesthésie et de Réanimation (SFAR), Paris, France; Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF, San Francisco, CA; INI-CRCT network, Nancy, France.
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12
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Griffiths R, Herbert L, Akbari A, Bailey R, Hollinghurst J, Pugh R, Szakmany T, Torabi F, Lyons RA. A methodology to facilitate critical care research using multiple linked electronic, clinical and administrative health records at population scale. Int J Popul Data Sci 2022; 7:1724. [PMID: 37650027 PMCID: PMC10464871 DOI: 10.23889/ijpds.v7i1.1724] [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: 10/17/2022] Open
Abstract
Introduction Critical Care is a specialty in medicine providing a service for severely ill and high-risk patients who, due to the nature of their condition, may require long periods recovering after discharge. Consequently, focus on the routine data collection carried out in Intensive Care Units (ICUs) leads to reporting that is confined to the critical care episode and is typically insensitive to variation in individual patient pathways through critical care to recovery.A resource which facilitates efficient research into interactions with healthcare services surrounding critical admissions, capturing the complete patient's healthcare trajectory from primary care to non-acute hospital care prior to ICU, would provide an important longer-term perspective for critical care research. Objective To describe and apply a reproducible methodology that demonstrates how both routine administrative and clinically rich critical care data sources can be integrated with primary and secondary healthcare data to create a single dataset that captures a broader view of patient care. Method To demonstrate the INTEGRATE methodology, it was applied to routine administrative and clinical healthcare data sources in the Secure Anonymised Data Linking (SAIL) Databank to create a dataset of patients' complete healthcare trajectory prior to critical care admission. SAIL is a national, data safe haven of anonymised linkable datasets about the population of Wales. Results When applying the INTEGRATE methodology in SAIL, between 2010 and 2019 we observed 91,582 critical admissions for 76,019 patients. Of these, 90,632 (99%) had an associated non-acute hospital admission, 48,979 (53%) had an emergency admission, and 64,832 (71%) a primary care interaction in the week prior to the critical care admission. Conclusion This methodology, at population scale, integrates two critical care data sources into a single dataset together with data sources on healthcare prior to critical admission, thus providing a key research asset to study critical care pathways.
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Affiliation(s)
- Rowena Griffiths
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
| | - Laura Herbert
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
| | - Rowena Bailey
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
| | - Joe Hollinghurst
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
| | - Richard Pugh
- Department of Anaesthetics, Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - Tamas Szakmany
- Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK
- Critical Care Directorate, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Fatemeh Torabi
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
| | - Ronan A. Lyons
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Wales, UK
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13
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Dynamic Delirium Severity Trajectories and Their Association With 2-Year Healthcare Utilization and Mortality Outcomes. Crit Care Explor 2021; 3:e0524. [PMID: 34589712 PMCID: PMC8437216 DOI: 10.1097/cce.0000000000000524] [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] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Delirium severity has been associated with a higher risk of mortality and an increasing morbidity burden. Recently defined delirium severity trajectories were predictive of 30-day mortality in a critically ill patient population. No studies to date have examined associations between delirium severity trajectories and 2-year mortality and healthcare utilization outcomes.
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14
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Langeland H, Bergum D, Nordseth T, Løberg M, Skaug T, Bjørnstad K, Gundersen Ø, Skjærvold NK, Klepstad P. Circulatory trajectories after out-of-hospital cardiac arrest: a prospective cohort study. BMC Anesthesiol 2021; 21:219. [PMID: 34496748 PMCID: PMC8424149 DOI: 10.1186/s12871-021-01434-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of post-cardiac arrest syndrome (PCAS). The aim of this study was to investigate circulatory disturbances in PCAS by assessing the circulatory trajectory during treatment in the intensive care unit (ICU). METHODS This was a prospective single-center observational cohort study of patients after OHCA. Circulation was continuously and invasively monitored from the time of admission through the following five days. Every hour, patients were classified into one of three predefined circulatory states, yielding a longitudinal sequence of states for each patient. We used sequence analysis to describe the overall circulatory development and to identify clusters of patients with similar circulatory trajectories. We used ordered logistic regression to identify predictors for cluster membership. RESULTS Among 71 patients admitted to the ICU after OHCA during the study period, 50 were included in the study. The overall circulatory development after OHCA was two-phased. Low cardiac output (CO) and high systemic vascular resistance (SVR) characterized the initial phase, whereas high CO and low SVR characterized the later phase. Most patients were stabilized with respect to circulatory state within 72 h after cardiac arrest. We identified four clusters of circulatory trajectories. Initial shockable cardiac rhythm was associated with a favorable circulatory trajectory, whereas low base excess at admission was associated with an unfavorable circulatory trajectory. CONCLUSION Circulatory failure after OHCA exhibits time-dependent characteristics. We identified four distinct circulatory trajectories and their characteristics. These findings may guide clinical support for circulatory failure after OHCA. TRIAL REGISTRATION ClinicalTrials.gov: NCT02648061.
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Affiliation(s)
- Halvor Langeland
- Department of Anesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
- Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- St. Olavs Hospital HF, Avdeling for Thoraxanestesi Og Intensivmedisin, Postboks 3250, 7006, Trondheim, Torgarden, Norway.
| | - Daniel Bergum
- Department of Anesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Trond Nordseth
- Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Anesthesia, Molde Hospital, Molde, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olav's University Hospital, Trondheim, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Thomas Skaug
- Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway
| | - Knut Bjørnstad
- Department of Cardiology, St. Olav's University Hospital, Trondheim, Norway
| | - Ørjan Gundersen
- Department of Anesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Nils-Kristian Skjærvold
- Department of Anesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Pål Klepstad
- Department of Anesthesiology and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Institute of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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15
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[Post-intensive care syndrome]. Rev Med Interne 2021; 42:855-861. [PMID: 34088516 DOI: 10.1016/j.revmed.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022]
Abstract
Post-intensive care syndrome is an entity defined in 2010 and covering any sequelae following an extended hospitalization in intensive care unit. It comprises psychological, cognitive and physical disorders (neuromyopathy, respiratory dysfunction, joint stiffness, among others). These sequelae have important consequences on autonomy and quality of life of these patients, as well as on their healthcare consumption and on mortality. Psychological sequelae can also be seen in hospitalized patients' relatives. Screening and management of these disorders is more and more frequent but no method has formally proven effective. The number of patients surviving an intensive care unit hospitalization is increasing, and management of post-intensive care syndrome is a major issue. It seems important that the internist be aware of this syndrome, given his pivotal role in global management of patients and frequent implication into care after the intensive care unit.
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16
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Mobilization During Critical Illness: A Higher Level of Mobilization Improves Health Status at 6 Months, a Secondary Analysis of a Prospective Cohort Study. Crit Care Med 2021; 49:e860-e869. [PMID: 33967203 DOI: 10.1097/ccm.0000000000005058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the influence of active mobilization during critical illness on health status in survivors 6 months post ICU admission. DESIGN Post hoc secondary analysis of a prospective cohort study conducted between November 2013 and March 2015. SETTING Two tertiary hospital ICU's in Victoria, Australia. PATIENTS Of 194 eligible patients admitted, mobility data for 186 patients were obtained. Inclusion and exclusion criteria were as per the original trial. INTERVENTIONS The dosage of mobilization in ICU was measured by 1) the Intensive Care Mobility Scale where a higher Intensive Care Mobility Scale level was considered a higher intensity of mobilization or 2) the number of active mobilization sessions performed during the ICU stay. The data were extracted from medical records and analyzed against Euro-quality of life-5D-5 Level version answers obtained from phone interviews with survivors 6 months following ICU admission. The primary outcome was change in health status measured by the Euro-quality of life-5D-5 Level utility score, with change in Euro-quality of life-5D-5 Level mobility domain a secondary outcome. MEASUREMENTS AND MAIN RESULTS Achieving higher levels of mobilization (as per the Intensive Care Mobility Scale) was independently associated with improved outcomes at 6 months (Euro-quality of life-5D-5 Level utility score unstandardized regression coefficient [β] 0.022 [95% CI, 0.002-0.042]; p = 0.033; Euro-quality of life-5D-5 Level mobility domain β = 0.127 [CI, 0.049-0.205]; p = 0.001). Increasing the number of active mobilization sessions was not found to independently influence health status. Illness severity, total comorbidities, and admission diagnosis also independently influenced health status. CONCLUSIONS In critically ill survivors, achieving higher levels of mobilization, but not increasing the number of active mobilization sessions, improved health status 6 months after ICU admission.
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17
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Guillon A, Mizgerd JP, Grammatico-Guillon L. 2-year survival among elderly hospitalised for acute respiratory infection versus hip fracture: a useful comparison to raise awareness. Eur Respir Rev 2020; 29:29/158/200156. [PMID: 33268438 PMCID: PMC9488726 DOI: 10.1183/16000617.0156-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/28/2020] [Indexed: 01/14/2023] Open
Abstract
We read with great interest the article by Cillónizet al. [1]. The authors nicely reported and discussed recent literature showing that pneumonia is a common lung infection that can be life-threatening, with particular concern for the elderly. Indeed, the annual incidences of hospitalisation for respiratory infections increase with age from 0.2% (for patients aged <75 years) to 1.9% (for age 80–84 years), 3.2% (for age 85–89 years) and 5.0% (for age ≥90 years) [2]. For the elderly, pneumonia has the greatest risk of death among the common causes of hospitalisation [3]. We do agree with the authors when they concluded that preventive interventions are of pivotal importance to improve outcomes and reduce the occurrence of adverse consequences [1]. However, we would like to emphasise that there is a mismatch between the high morbidity and mortality caused by respiratory infection and the low public awareness of this disease. A large pneumonia awareness survey involving over 9000 adults aged ≥50 years highlighted that most fail to accurately gauge their own pneumonia risk, leading to inadequate pneumonia prevention efforts including low uptake of existing vaccines [4]. The low public awareness of respiratory infection risk and severity in the elderly is a barrier to healthcare delivery and a driver of unhealthy ageing [5]. It is critical to raise awareness of this disease among the general public to improve the management of this largely preventable infectious disease [5]. If breaking a hip feels like a concern for the elderly, then getting pneumonia should be twice as concerning: patients hospitalised for lung infection had 3.3-fold greater in-hospital mortality and 1.8-fold increased risk of death at 2 yearshttps://bit.ly/2Xqsrf6
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Affiliation(s)
- Antoine Guillon
- CHRU de Tours, Service de médecine intensive réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, Université de Tours, Tours, France
| | - Joseph P Mizgerd
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Leslie Grammatico-Guillon
- CHRU de Tours, Unité d'épidémiologie des données cliniques régionales, Service d'information médicale, d'épidémiologie et d'économie de la santé, EA EES, Université de Tours, Tours, France
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18
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Abstract
PURPOSE OF REVIEW Critical illness survivorship is associated with new and worsening physical, cognitive, and emotional status. Survivors are vulnerable to further health set-backs, most commonly because of infection and exacerbation of chronic medical conditions. Awareness of survivors' challenges are important given the anticipated rise in critical illness survivors because of SARS-CoV-2 viral sepsis. RECENT FINDINGS Studies continue to document challenges of critical illness survivorship. Beyond the cognitive, physical, and mental health sequelae encompassed by postintensive case syndrome, patients commonly experience persistent immunosuppression, re-hospitalization, inability to resume prior employment, and reduced quality of life. Although recommended practices for enhancing recovery from sepsis are associated with better outcomes, only a minority of patients receive all recommended practices. ICU follow-up programs or peer support groups remain important interventions to learn about and address the multifaceted challenges of critical illness survivorship, but there is little evidence of benefit to date. SUMMARY Survivors of sepsis and critical illness commonly experience impaired health status, reduced quality of life, and inability to return to prior employment. Although the challenges of critical illness survivorship are increasingly well documented, there are relatively few studies on enhancing recovery. Future studies must focus on identifying best practices for optimizing recovery and strategies to promote their implementation.
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Affiliation(s)
- Hallie C Prescott
- Department of Internal Medicine, University of Michigan.,VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Jeremy B Sussman
- Department of Internal Medicine, University of Michigan.,VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - W Joost Wiersinga
- Department of Medicine, Division of Infectious Diseases.,Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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19
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Guillon A, Hermetet C, Barker KA, Jouan Y, Gaborit C, Ehrmann S, Le Manach Y, Dequin PF, Grammatico-Guillon L. Long-term survival of elderly patients after intensive care unit admission for acute respiratory infection: a population-based, propensity score-matched cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:384. [PMID: 32600392 PMCID: PMC7325055 DOI: 10.1186/s13054-020-03100-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
Background Intensive care unit (ICU) hospitalisations of elderly patients with acute respiratory infection have increased, yet the long-term effects of ICU admission among elderly individuals remain unknown. We examined differences over the 2 years after discharge in mortality, healthcare utilisation and frailty score between elderly survivors of ARI in the ICU and an elderly control population. Methods We used 2009–2017 data from 39 hospital discharge databases. Patients ≥ 80 years old discharged alive from ICU hospitalisation for acute respiratory infection were propensity score-matched with controls (cataract surgery) discharged from the hospital at the same time and adjusted for age, sex and comorbidities present before hospitalisation. We reported 2-year mortality and compared healthcare utilisation and frailty scores in the 2-year periods before and after ICU hospitalisation. Results One thousand two hundred and twenty elderly survivors of acute respiratory infection in the ICU were discharged, and 988 were successfully matched with controls. After discharge, patients had a 10.1-fold [95% CI, 6.1–17.3] higher risk of death at 6 months and 3.6-fold [95% CI, 2.9–4.6] higher risk of death at 2 years compared with controls. They also had a 2-fold increase in both healthcare utilisation and frailty score in the 2 years after hospital discharge, whereas healthcare utilisation and frailty scores among controls were stable before and after hospitalisation. Conclusions We observed a substantially increased rate of death in the years following ICU hospitalisation for elderly patients along with elevated healthcare resource use and accelerated age-associated decline as assessed by frailty score. These findings provide data for better informed goals-of-care discussions and may help target post-ICU discharge services.
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Affiliation(s)
- Antoine Guillon
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France.
| | - Coralie Hermetet
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France.,EA EES, Université de Tours, Tours, France
| | - Kimberly A Barker
- Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Department of Microbiology, Boston University School of Medicine, Boston, MA, USA
| | - Youenn Jouan
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France
| | - Christophe Gaborit
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France.,EA EES, Université de Tours, Tours, France
| | - Stephan Ehrmann
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France.,CIC INSERM 1415, Tours, France
| | - Yannick Le Manach
- Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, Michael DeGroote School of Medicine, McMaster University and the Perioperative Research Group, Population Health Research Institute, Hamilton, ON, Canada
| | - Pierre-François Dequin
- CHRU de Tours, Service de Médecine Intensive Réanimation, INSERM U1100, Centre d'Etude des Pathologies Respiratoires, CRICS-TriggerSEP Research Network, Université de Tours, 2 Bd Tonnellé, F-37044, Tours Cedex 9, France
| | - Leslie Grammatico-Guillon
- CHRU de Tours, Epidémiologie des Données Cliniques (EpiDcliC), Service d'Information Médicale, d'Épidémiologie et d'Économie de la Santé, Université de Tours, Tours, France
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