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Orwelius L, Wilhelms S, Sjöberg F. Is comorbidity alone responsible for changes in health-related quality of life among critical care survivors? A purpose-specific review. Crit Care 2024; 28:208. [PMID: 38926875 PMCID: PMC11201873 DOI: 10.1186/s13054-024-04997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is one of the most important outcome variables for assessing the effectiveness of intensive care, together with mortality and survival, where comorbidity is suggested to have high impact. However, studies are lacking that examine to what extent HRQoL is affected after a general ICU period, beyond that of the effects that may be claimed to be due to comorbidities. DESIGN Purpose-specific literature review including literature searches in PubMed, Cinahl, Scopus, and Cochrane library between 2010 and 2021. MEASUREMENTS AND RESULTS This Purpose-specific, i.e., task focused review examines HRQoL (assessed by either SF-36 or EQ-5D, > 30 days after leaving the hospital) in adult patients (≥ 18 years) having an ICU length of stay > 24 h. Further, the HRQoL comparisons were adjusted for age or comorbidity. A total of 11 publications were found. A majority comprised observational, prospective cohort studies, except three that were either case-control, cross-sectional comparison, or retrospective cohort studies. A total of 18,566 critically ill patients were included, and the response rate ranged from 16 to 94%. In all studies, a recurrent relevant finding was that HRQoL after ICU care was affected by pre-ICU comorbidities. In three studies (n = 3), which included a comorbidity adjusted control group, there were no effect of the critical care period itself on the registered HRQoL after the critical care period. CONCLUSION Health-Related Quality of Life (HRQoL) in former ICU patients appears to be primarily influenced by comorbidity. A notable limitation in this field of research is the high heterogeneity observed in the studies reviewed, particularly in terms of the HRQoL measurement tool employed, the duration of follow-up, the methodology for comorbidity assessment, and the adjustments for age and sex. Despite these variations and the limited number of studies in the review, the findings suggest a minimal HRQoL impact beyond the effects of comorbidity. Given the significant dearth of comprehensive studies in this domain, there is an escalating call for more thorough and detailed research endeavours.
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Affiliation(s)
- Lotti Orwelius
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85, Linköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Susanne Wilhelms
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, 581 83, Linköping, Sweden
- Department of Clinical Physiology, Faculty of Medicine, Linköping University, 581 83, Linköping, Sweden
| | - Folke Sjöberg
- Department of Anaesthesia and Intensive Care, Linköping University Hospital, 581 85, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83, Linköping, Sweden
- Burns, Hand, and Plastic Surgery, Linköping University Hospital, 581 85, Linköping, Sweden
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Paton M, Le Maitre C, Berkovic D, Lane R, Hodgson CL. The impact of critical illness on patients' physical function and recovery: An explanatory mixed-methods analysis. Intensive Crit Care Nurs 2024; 81:103583. [PMID: 38042106 DOI: 10.1016/j.iccn.2023.103583] [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: 06/17/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES To determine how the perception of physical function 6-months following critical illness compares to objectively measured function, and to identify key concerns for patients during recovery from critical illness. RESEARCH METHODOLOGY AND DESIGN A nested convergent parallel mixed methods study assessed physical function during a home visit 6-months following critical illness, with semi-structured interviews conducted at the same time. SETTING Participants were recruited from two hospitals at one healthcare network in Melbourne, Australia from September 2017 to October 2018 with follow-up data completed in April 2019. MAIN OUTCOME MEASURES Physical function was assessed through four objective outcomes: the functional independence measure, six-minute walk test, functional reach test, and grip strength. Semi structured interviews focused on participants function, memories of the intensive care and hospital stay, assistance required on discharge, ongoing limitations, and the recovery process. FINDINGS Although many participants (12/20, 60%) stated they had recovered from their critical illness, 14 (70%) had function below expected population norms. Decreased function on returning home was commonly reported, although eleven participants were described as independent and safe for discharge from hospital-based staff. The importance of family and social networks to facilitate discharge was highlighted, however participants often described wanting more support and issues accessing services. The effect of critical illness on the financial well-being of the family network was confirmed, with difficulties accessing financial support identified. CONCLUSION Survivors of critical illness perceived a better functional state than measured, but many report new limitations 6-months after critical illness. Family and friends play a crucial role in facilitating transition home and providing financial support. IMPLICATIONS FOR CLINICAL PRACTICE Implementation of specific discharge liaison personnel to provide education, support and assist the transition from hospital-based care to home, particularly in those without stable social supports, may improve the recovery process for survivors of critical illness.
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Affiliation(s)
- Michelle Paton
- Australian and New Zeland Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Department of Physiotherapy, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia.
| | - Caitlin Le Maitre
- Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, VIC 3004, Australia.
| | - Danielle Berkovic
- School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia.
| | - Rebecca Lane
- School of Health Sciences, Swinburne University, John St, Hawthorn, VIC 3122, Australia.
| | - Carol L Hodgson
- Australian and New Zeland Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Department of Physiotherapy, The Alfred, 55 Commercial Road, Melbourne, VIC 3004, Australia; Department of Critical Care, University of Melbourne, 780 Elizabeth St, Melbourne, VIC 3004, Australia; Critical Care Division, The George Institute for Global Health, 1 King St, Newtown, NSW 2042, Australia.
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3
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review. Aust Crit Care 2024; 37:354-368. [PMID: 37684157 DOI: 10.1016/j.aucc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
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Affiliation(s)
- Lynsey Sutton
- Clinical Nurse Specialist, Wellington Intensive Care Unit, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Riddiford Street, Newtown, Wellington 6021, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
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Bosco V, Froio A, Mercuri C, Sansone V, Garofalo E, Bruni A, Guillari A, Bruno D, Talarico M, Mastrangelo H, Longhini F, Doldo P, Simeone S. The Impact of an Intensive Care Diary on the Psychological Well-Being of Patients and Their Family Members: Longitudinal Study Protocol. Healthcare (Basel) 2023; 11:2583. [PMID: 37761780 PMCID: PMC10531207 DOI: 10.3390/healthcare11182583] [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: 08/09/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Thanks to medical and technological advancements, an increasing number of individuals survive admission to intensive care units. However, survivors often experience negative outcomes, including physical impairments and alterations in mental health. Anxiety, depression, cognitive impairments, post-traumatic stress disorders, and functional disorders are known collectively as post-intensive care syndrome (PICS). Among the key triggering factors of this syndrome, memory impairment appears to play a significant role. AIMS This study aims to evaluate the impact of an intensive care diary on the psychological well-being of patients and their relatives after discharge from the ICU. DESIGN Prospective observational study. EXPECTED RESULTS The results of this study evaluate the impact of an ICU diary on the quality of life of ICU survivors and their family members.
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Affiliation(s)
- Vincenzo Bosco
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Annamaria Froio
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Caterina Mercuri
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Vincenza Sansone
- Department of Experimental Medicine, Luigi Vanvitelli University, 80131 Naples, Italy;
| | - Eugenio Garofalo
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Andrea Bruni
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Assunta Guillari
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Daniela Bruno
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | - Michaela Talarico
- School of Medicine and Surgery, Magna Graecia University, 88100 Catanzaro, Italy; (C.M.); (M.T.)
| | | | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, 88100 Catanzaro, Italy; (V.B.); (A.F.); (E.G.); (A.B.); (F.L.)
| | - Patrizia Doldo
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
| | - Silvio Simeone
- Clinical and Experimental Medicine Department, Magna Graecia University, 88100 Catanzaro, Italy; (P.D.); (S.S.)
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Clarissa C. Recovery after intensive care—A critical commentary on
Dear ICU Survivor
by Mark Hudson. Nurs Crit Care 2023. [PMID: 37379005 DOI: 10.1111/nicc.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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6
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Mejía Vanegas D, Arias Díaz JA, Leyton Toro L, Ayala Grajales KY, Becerra Londoño AM, Vallejo Ospina JI, Rincón Hurtado ÁM. Calidad de vida y funcionalidad en sobrevivientes de cuidados intensivos: Una revisión exploratoria. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introducción: La calidad de vida en pacientes críticos que sobreviven al tratamiento en unidades de cuidados intensivos es inferior al de la población general. La condición de salud basal y la severidad de la condición clínica al ingreso a terapia intensiva son factores de riesgo para la calidad de vida y la funcionalidad. Objetivo: Analizar el nivel de conocimiento en la calidad de vida y la funcionalidad de los sobrevivientes de cuidados intensivos. Materiales y métodos: Se realizó una revisión exploratoria en las bases de datos: Scielo, PubMed, Science Direct, ProQuest, Redalyc, Dialnet, OVID, Scopus, publicados entre enero del año 2010 y mayo del año 2020. El estudio se desarrolló según la estructura de la Metodología PRISMA. Se revisaron y analizaron los textos completos que cumplían los criterios de inclusión para la selección final de los artículos. Resultados: De 1814 artículo seleccionados, se eligieron 65 artículos que describen la calidad de vida y la funcionalidad en pacientes después de cuidados intensivos, y finalmente, 16 artículos son incluidos, donde se analizaron las características de los artículos, las características de la población estudiada, y las variables de análisis sobre la evaluación de la calidad de vida y la funcionalidad en los sobrevivientes después cuidados intensivos. Conclusión: Los estudios sobre calidad de vida y funcionalidad en sobrevivientes de cuidados intensivos se realizaron en mayor proporción en Europa en los años 2010 a 2016. Con estudios observacionales prospectivos que correlacionan los factores que determinan la salud mental y física después del egreso de cuidados intensivos. Se aplicaron múltiples escalas siendo las más utilizadas SF-36 y el EQ-5D para evaluar la calidad de vida y del índice de Barthel para determinar el estado de funcionalidad en los egresados de cuidados intensivos. El SF-36 y el índice de Barthel reportaron una afectación en la calidad de vida y en la funcionalidad en la población sobreviviente de cuidados intensivos.
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Paton M, Lane R, Paul E, Linke N, Shehabi Y, Hodgson CL. Correlation of patient-reported outcome measures to performance-based function in critical care survivors: PREDICTABLE. Aust Crit Care 2022:S1036-7314(22)00070-4. [PMID: 35810078 DOI: 10.1016/j.aucc.2022.05.006] [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: 02/13/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Establishing sequela following critical illness is a public health priority; however, recruitment and retention of this cohort make assessing functional outcomes difficult. Completing patient-reported outcome measures (PROMs) via telephone may improve participant and researcher involvement; however, there is little evidence regarding the correlation of PROMs to performance-based outcome measures in critical care survivors. OBJECTIVES The objective of this study was to assess the relationship between self-reported and performance-based measures of function in survivors of critical illness. METHODS This was a nested cohort study of patients enrolled within a previously published study determining predictors of disability-free survival. Spearman's correlation (rs) was calculated between four performance-based outcomes (the Functional Independence Measure [FIM], 6-min walk distance [6MWD], Functional Reach Test [FRT], and grip strength) that were collected during a home visit 6 months following their intensive care unit admission, with two commonly used PROMs (World Health Organization Disability Assessment Scale 2.0 12 Level [WHODAS 2.0] and EuroQol-5 Dimension-5 Level [EQ-5D-5L]) obtained via phone interview (via the PREDICT study) at the same time point. RESULTS There were 38 PROMs obtained from 40 recruited patients (mean age = 59.8 ± 16 yrs, M:F = 24:16). All 40 completed the FIM and grip strength, 37 the 6MWD, and 39 the FRT. A strong correlation was found between the primary outcome of the WHODAS 2.0 with all performance-based outcomes apart from grip strength where a moderate correlation was identified. Although strong correlations were also established between the EQ-5D-5L utility score and the FIM, 6MWD, and FRT, it only correlated weakly with grip strength. The EQ-5D overall global health rating only had very weak to moderate correlations with the performance-based outcomes. CONCLUSION The WHODAS 2.0 correlated stronger across multiple performance-based outcome measures of functional recovery and is recommended for use in survivors of critical illness.
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Affiliation(s)
- Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia; Department of Physiotherapy, Monash Health, Clayton, VIC, 3168, Australia
| | - Rebecca Lane
- College of Health and Biomedicine, Victoria University, Footscray, VIC, 3011, Australia
| | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Natalie Linke
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yahya Shehabi
- Department of Intensive Care, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, 3004, Australia; Department of Physiotherapy, Alfred Hospital, Melbourne, VIC, 3004, Australia.
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8
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Young DL, Fritz JM, Kean J, Thackeray A, Johnson JK, Dummer D, Passek S, Stilphen M, Beck D, Havrilla S, Hoyer EH, Friedman M, Daley K, Marcus RL. Key Data Elements for Longitudinal Tracking of Physical Function: A Modified Delphi Consensus Study. Phys Ther 2022; 102:6497841. [PMID: 35079819 DOI: 10.1093/ptj/pzab279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/02/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. METHODS A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. RESULTS Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are "administrative" and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. CONCLUSION A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. IMPACT Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research.
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Affiliation(s)
- Daniel L Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Julie M Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Jacob Kean
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anne Thackeray
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA.,Department of Population Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Joshua K Johnson
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio, USA.,Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - Danica Dummer
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Sandra Passek
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mary Stilphen
- Cleveland Clinic Rehabilitation and Sports Therapy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donna Beck
- Johns Hopkins Home Health Services, Baltimore, Maryland, USA
| | | | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kelly Daley
- Johns Hopkins Health System, Baltimore, Maryland, USA
| | - Robin L Marcus
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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9
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Brown SM, Dinglas VD, Akhlaghi N, Bose S, Banner-Goodspeed V, Beesley S, Groat D, Greene T, Hopkins RO, Mir-Kasimov M, Sevin CM, Turnbull AE, Jackson JC, Needham DM. Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study. Crit Care 2022; 26:6. [PMID: 34991660 PMCID: PMC8738999 DOI: 10.1186/s13054-021-03848-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Survivors of acute respiratory failure (ARF) commonly experience long-lasting physical, cognitive, and/or mental health impairments. Unmet medication needs occurring immediately after hospital discharge may have an important effect on subsequent recovery. Methods and analysis In this multicenter prospective cohort study, we enrolled ARF survivors who were discharged directly home from their acute care hospitalization. The primary exposure was unmet medication needs. The primary outcome was hospital readmission or death within 3 months after discharge. We performed a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the exposure–outcome association, with an a priori sample size of 200 ARF survivors. Results We enrolled 200 ARF survivors, of whom 107 (53%) were female and 77 (39%) were people of color. Median (IQR) age was 55 (43–66) years, APACHE II score 20 (15–26) points, and hospital length of stay 14 (9–21) days. Of the 200 participants, 195 (98%) were in the analytic cohort. One hundred fourteen (57%) patients had at least one unmet medication need; the proportion of medication needs that were unmet was 6% (0–15%). Fifty-six (29%) patients were readmitted or died by 3 months; 10 (5%) died within 3 months. Unmet needs were not associated (risk ratio 1.25; 95% CI 0.75–2.1) with hospital readmission or death, although a higher proportion of unmet needs may have been associated with increased hospital readmission (risk ratio 1.7; 95% CI 0.96–3.1) and decreased mortality (risk ratio 0.13; 95% CI 0.02–0.99). Discussion Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Study registration number: NCT03738774. The study was prospectively registered before enrollment of the first patient. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03848-3.
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Affiliation(s)
- Samuel M Brown
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA. .,Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA. .,Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA. .,Shock Trauma ICU, Intermountain Medical Center, 5121 S. Cottonwood Street, Murray, UT, 84107, USA.
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Narjes Akhlaghi
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Somnath Bose
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Sarah Beesley
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.,Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Danielle Groat
- Pulmonary and Critical Care Medicine, Intermountain Medical Center, Salt Lake City, UT, USA.,Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA
| | - Tom Greene
- Biostatistics and Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mustafa Mir-Kasimov
- Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT, USA.,Salt Lake City Veterans Administration, Salt Lake City, UT, USA
| | - Carla M Sevin
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alison E Turnbull
- Outcomes After Critical Illness and Surgery (OACIS) Group and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group and Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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10
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. SPLIT ENZ: Survivorship of Patients post Long Intensive care stay, Exploration/Experience in a New Zealand cohort (A mixed methods study protocol) (Preprint). JMIR Res Protoc 2021; 11:e35936. [PMID: 35297773 PMCID: PMC8972103 DOI: 10.2196/35936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment–BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/35936
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Affiliation(s)
- Lynsey Sutton
- Intensive Care Unit, Level 3, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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11
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Rosa RG, Dietrich C, Valle ELTD, Souza D, Tagliari L, Mattioni M, Tonietto TF, Rosa RD, Barbosa MG, Lovatel GA, Lago PD, Oliveira ES, Sganzerla D, Andrade JMS, Berto P, Cardoso PR, Sanchez EC, Falavigna M, Maccari JG, Rech G, Robinson C, Schneider D, Leon PD, Biason L, Teixeira C. The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study. Rev Bras Ter Intensiva 2021; 33:374-383. [PMID: 35107548 PMCID: PMC8555392 DOI: 10.5935/0103-507x.20210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a
melhora do estado funcional físico em longo prazo de pacientes
sobreviventes à unidade de terapia intensiva. Métodos Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de
2018, em um ambulatório pós-unidade de terapia intensiva, 32
sobreviventes à unidade de terapia intensiva. Foram inscritos
consecutivamente os pacientes com permanência na unidade de terapia
intensiva acima de 72 horas (para admissões emergenciais) ou acima de
120 horas (para admissões eletivas) que compareceram ao
ambulatório pós-unidade de terapia intensiva 4 meses
após receberem alta da unidade de terapia intensiva. A
associação entre a distância percorrida no Teste de
Caminhada de 6 Minutos realizado na avaliação inicial e a
evolução do estado funcional físico foi avaliada
durante 8 meses, com utilização do Índice de Barthel. Resultados A distância média percorrida no Teste de Caminhada de 6 Minutos
foi significantemente mais baixa nos sobreviventes à unidade de
terapia intensiva do que na população geral (405m
versus 557m; p < 0,001). A idade (β = -4,0; p
< 0,001) e a fraqueza muscular (β = -99,7; p = 0,02) se associaram
com a distância percorrida no Teste de Caminhada de 6 Minutos. A
distância percorrida no Teste de Caminhada de 6 Minutos se associou
com melhora do estado funcional físico no período de 8 meses
de acompanhamento desses pacientes (razão de chance para cada 10m:
1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva
Característica de Operação do Receptor para
predição da melhora funcional física pelo Teste de
Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88). Conclusão O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da
unidade de terapia intensiva, predisse com precisão moderada a
melhora do estado funcional físico de sobreviventes à unidade
de terapia intensiva.
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Affiliation(s)
| | - Camila Dietrich
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Denise Souza
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | - Rosa da Rosa
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | - Pedro Dal Lago
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | | | - Paula Berto
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Paulo Ricardo Cardoso
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | | | | | - Gabriela Rech
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | - Lívia Biason
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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12
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Gluck S, Andrawos A, Summers MJ, Lange J, Chapman MJ, Finnis ME, Deane AM. The use of smartphone-derived location data to evaluate participation following critical illness: A pilot observational cohort study. Aust Crit Care 2021; 35:225-232. [PMID: 34373172 DOI: 10.1016/j.aucc.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Disability is common following critical illness, impacting the quality of life of survivors, and is difficult to measure. 'Participation' can be quantified as involvement in life outside of their home requiring movement from their home to other locations. Participation restriction is a key element of disability, and following critical illness, participation may be diminished. It may be possible to quantify this change using pre-existing smartphone data. OBJECTIVES The feasibility of extracting location data from smartphones of survivors of intensive care unit (ICU) admission and assessing participation, using location-based outcomes, during recovery from critical illness was evaluated. METHODS Fifty consecutively admitted, consenting adult survivors of non-elective admission to ICU of greater than 48-h duration were recruited to a prospective observational cohort study where they were followed up at 3 and 6 months following discharge. The feasibility of extracting location data from survivors' smartphones and creating location-derived outcomes assessing participation was investigated over three 28-d study periods: pre-ICU admission and at 3 and 6 months following discharge. The following were calculated: time spent at home; the number of destinations visited; linear distance travelled; and two 'activity spaces', a minimum convex polygon and standard deviation ellipse. RESULTS Results are median [interquartile range] or n (%). The number of successful extractions was 9/50 (18%), 12/39 (31%), and 13/33 (39%); the percentage of time spent at home was 61 [56-68]%, 77 [66-87]%, and 67 [58-77]% (P = 0.16); the number of destinations visited was 34 [18-64], 38 [22-63], and 65 [46-88] (P = 0.02); linear distance travelled was 367 [56-788], 251 [114-323], and 747 [326-933] km over 28 d (P = 0.02), pre-ICU admission and at 3 and 6 months following ICU discharge, respectively. Activity spaces were successfully created. CONCLUSION Limited smartphone ownership, missing data, and time-consuming data extraction limit current implementation of mass extraction of location data from patients' smartphones to aid prognostication or measure outcomes. The number of journeys taken and the linear distance travelled increased between 3 and 6 months, suggesting participation may improve over time.
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Affiliation(s)
- Samuel Gluck
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Alice Andrawos
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Matthew J Summers
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia.
| | - Jarrod Lange
- Hugo Centre for Population and Housing, University of Adelaide, Napier Building, North Terrace, Adelaide, SA 5000, Australia.
| | - Marianne J Chapman
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Mark E Finnis
- Discipline of Acute Care Medicine, The University of Adelaide, AHMS, North Terrace, Adelaide, SA 5000, Australia; 4G751 Intensive Care Unit Research Department, The Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000, Australia.
| | - Adam M Deane
- Intensive Care Unit, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Melbourne, VIC 3010, Australia; The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Parkville, Australia, VIC 3050.
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13
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Kean S, Donaghy E, Bancroft A, Clegg G, Rodgers S. Theorising survivorship after intensive care: A systematic review of patient and family experiences. J Clin Nurs 2021; 30:2584-2610. [PMID: 33829568 DOI: 10.1111/jocn.15766] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVE This systematic literature review explores and maps what we know about survivorship to understand how survivorship can be theoretically defined. BACKGROUND Survivorship of critical illness has been identified as a challenge for the 21st Century. Whilst the use of the term 'survivorship' is now common in critical care, it has been borrowed from the cancer literature where the discourse on what survivorship means in a cancer context is ongoing and remains largely descriptive. In the absence of a theoretical understanding, the term 'survivorship' is often used in critical illness in a generic way, limiting our understanding of what survivorship is. The current COVID-19 pandemic adds to an urgency of understanding what intensive care unit (ICU) survivorship might mean, given the emerging long-term consequences of this patient cohort. We set out to explore how survivorship after critical illness is being conceptualised and what the implications might be for clinical practice and research. DESIGN Integrated systematic literature review. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS The three main themes around which the reviewed studies were organised are: (a) healthcare system; (b) ICU survivors' families; and (c) ICU survivor's identity. These three themes feed into an overarching core theme of 'ICU Survivorship Experiences'. These themes map our current knowledge of what happens when a patient survives a critical illness and where we are in understanding ICU survivorship. CONCLUSION We mapped in this systematic review the different pieces of the jigsaw that emerge following critical illness to understand and see the bigger picture of what happens after patients survive critical illness. It is evident that existing research has mapped these connections, but what we have not managed to do yet is defining what survivorship is theoretically. We offer a preliminary definition of survivorship as a process but are aware that this definition needs to be developed further with patients and families.
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Affiliation(s)
- Susanne Kean
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- Usher Institute of Population Health Sciences and Informatics & Edinburgh Critical Care Research Group, The University of Edinburgh, Edinburgh, UK
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Gareth Clegg
- Deanery of Clinical Sciences, Centre for Inflammation Research, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK
| | - Sheila Rodgers
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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14
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Bench S, Stayt L, Shah A, Dhiman P, Czuber-Dochan W. Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review. Anaesthesia 2021; 76:1233-1244. [PMID: 33694157 DOI: 10.1111/anae.15441] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.
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Affiliation(s)
- S Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - L Stayt
- Oxford Brookes University, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Czuber-Dochan
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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15
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Flaws DF, Barnett A, Fraser J, Latu J, Ramanan M, Tabah A, Tippett V, Tronstad O, Patterson S. A protocol for tracking outcomes post intensive care. Nurs Crit Care 2021; 27:341-347. [PMID: 33609311 DOI: 10.1111/nicc.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Critically ill patients are more likely to survive intensive care than ever before due to advances in treatment. However, a proportion subsequently experiences post-intensive care syndrome (PICS) incurring substantial personal, social, and economic costs. PICS is a debilitating set of physical, psychological, and cognitive sequelae but the size and characteristics of the affected population have been difficult to describe, impeding progress in intensive care rehabilitation. AIMS AND OBJECTIVES The aim of this protocol is to describe recovery after admission to intensive care unit (ICU) and the predictors, correlates, and patient-reported outcomes for those experiencing PICS. The study will support the development of screening, diagnostic, and outcome measures to improve post-ICU recovery. DESIGN A prospective, multi-site observational study in three ICUs in Brisbane, Australia. Following consent, data will be collected from clinical records and using validated self-report instruments from 300 patients, followed up at 6 weeks and 6 months post ICU discharge. METHODS TOPIC is a prospective, multi-site observational study using self-report and clinical data on risk factors, including comorbidities, and outcomes. Data will be collected with consent from hospital records and participants 6 weeks and 6months post ICU discharge. RESULTS The main outcome measures will be self-reported physical, cognitive, and psychological function 6 weeks and 6 months post-ICU discharge. RELEVANCE TO CLINICAL PRACTICE This protocol provides a methodological framework to measure recovery and understand PICS. Data analysis will describe characteristics associated with recovery and PICS. The subsequent prediction and screening tools developed then aim to improve the effectiveness of post-ICU prevention and rehabilitation through more targeted screening and prediction and found a program of research developing a more tailored approach to PICS.
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Affiliation(s)
- Dylan F Flaws
- Department of Mental Health, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Adrian Barnett
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - John Fraser
- Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Jiville Latu
- Department of Intensive Care, Intensive Care Unit, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Mahesh Ramanan
- Department of Intensive Care, Intensive Care Unit, Caboolture Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care, Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Critical Care Division, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexis Tabah
- Department of Intensive Care, Intensive Care Unit, Redcliffe Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Vivienne Tippett
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Oystein Tronstad
- Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Sue Patterson
- Department of Mental Health, Metro North Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Intensive Care, Critical Care Research Group, Prince Charles Hospital, Brisbane, Queensland, Australia.,School of Dentistry, University of Queensland, Brisbane, Queensland, Australia
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16
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Friedman LA, Young DL, Nelliot A, Colantuoni E, Mendez-Tellez PA, Needham DM, Dinglas VD. Factors Associated With Home Visits in a 5-Year Study of Acute Respiratory Distress Syndrome Survivors. Am J Crit Care 2020; 29:429-438. [PMID: 33130864 DOI: 10.4037/ajcc2020966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Participant retention is vital for longitudinal studies. Home visits may increase retention, but little is known about the subset of patients they benefit. OBJECTIVE To evaluate patient-related variables associated with home visits. METHODS In a 5-year, longitudinal, multisite, prospective study of 195 survivors of acute respiratory distress syndrome, in-person assessments were conducted at a research clinic. Home visits were offered to participants who could not attend the clinic. Associations between having a home visit, prior follow-up visit status, and baseline and in-hospital patient variables were evaluated with multivariable, random-intercept logistic regression models. The association between home visits and patients' posthospital clinical status was evaluated with a subsequent regression model adjusted for these variables. RESULTS Participants had a median age of 49 years and were 56% male and 58% White. The following had independent associations with home visits (adjusted odds ratio [95% CI]): age (per year: 1.03 [1.00-1.05]) and immediately preceding visit incomplete (2.46 [1.44-4.19]) or at home (8.24 [4.57-14.86]). After adjustment for prior-visit status and baseline and hospitalization variables, these posthospital patient outcome variables were associated with a subsequent home visit: instrumental activities of daily living (≥ 2 vs < 2 dependencies: 2.32 [1.29-4.17]), EQ-5D utility score (per 0.1-point decrease: 1.15 [1.02-1.30]), and 6-minute walk test (per 10-percentage-point decrease in percent-predicted distance: 1.50 [1.26-1.79]). CONCLUSIONS Home visits were important for retaining older and more physically impaired study participants, helping reduce selection bias caused by excluding them.
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Affiliation(s)
- Lisa Aronson Friedman
- Lisa Aronson Friedman is a senior biostatistician in the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland
| | - Daniel L. Young
- Daniel L. Young is a visiting scientist and adjunct associate professor in the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, and an associate professor in the Department of Physical Therapy, School of Allied Health Sciences, University of Nevada, Las Vegas, Nevada
| | - Archana Nelliot
- Archana Nelliot is a resident in the Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Elizabeth Colantuoni
- Elizabeth Colantuoni is a senior scientist in the Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University
| | - Pedro A. Mendez-Tellez
- Pedro A. Mendez-Tellez is an assistant professor in the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Dale M. Needham
- Dale M. Needham is a professor in the Division of Pulmonary and Critical Care Medicine, and in the Department of Physical Medicine and Rehabilitation at Johns Hopkins University School of Medicine and at Johns Hopkins University School of Nursing, Baltimore, Maryland; and the director of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University
| | - Victor D. Dinglas
- Victor D. Dinglas is a research associate in the Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and a member of the Outcomes After Critical Illness and Surgery Group, Johns Hopkins University
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17
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Akhlaghi N, Needham DM, Bose S, Banner-Goodspeed VM, Beesley SJ, Dinglas VD, Groat D, Greene T, Hopkins RO, Jackson J, Mir-Kasimov M, Sevin CM, Wilson E, Brown SM. Evaluating the association between unmet healthcare needs and subsequent clinical outcomes: protocol for the Addressing Post-Intensive Care Syndrome-01 (APICS-01) multicentre cohort study. BMJ Open 2020; 10:e040830. [PMID: 33099499 PMCID: PMC7590359 DOI: 10.1136/bmjopen-2020-040830] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION As short-term mortality declines for critically ill patients, a growing number of survivors face long-term physical, cognitive and/or mental health impairments. After hospital discharge, many critical illness survivors require an in-depth plan to address their healthcare needs. Early after hospital discharge, numerous survivors experience inadequate care or a mismatch between their healthcare needs and what is provided. Many patients are readmitted to the hospital, have substantial healthcare resource use and experience long-lasting morbidity. The objective of this study is to investigate the gap in healthcare needs occurring immediately after hospital discharge and its association with hospital readmissions or death for survivors of acute respiratory failure (ARF). METHODS AND ANALYSIS In this multicentre prospective cohort study, we will enrol 200 survivors of ARF in the intensive care unit (ICU) who are discharged directly home from their acute care hospital stay. Unmet healthcare needs, the primary exposure of interest, will be evaluated as soon as possible within 1 to 4 weeks after hospital discharge, via a standardised telephone assessment. The primary outcome, death or hospital readmission, will be measured at 3 months after discharge. Secondary outcomes (eg, quality of life, cognitive impairment, depression, anxiety and post-traumatic stress disorder) will be measured as part of 3-month and 6-month telephone-based follow-up assessments. Descriptive statistics will be reported for the exposure and outcome variables along with a propensity score analysis, using inverse probability weighting for the primary exposure, to evaluate the relationship between the primary exposure and outcome. ETHICS AND DISSEMINATION The study received ethics approval from Vanderbilt University Medical Center Institutional Review Board (IRB) and the University of Utah IRB (for the Veterans Affairs site). These results will inform both clinical practice and future interventional trials in the field. We plan to disseminate the results in peer-reviewed journals, and via national and international conferences. TRIAL REGISTRATION DETAILS ClinicalTrials.gov (NCT03738774). Registered before enrollment of the first patient.
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Affiliation(s)
- Narjes Akhlaghi
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Somnath Bose
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Valerie M Banner-Goodspeed
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sarah J Beesley
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Danielle Groat
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Tom Greene
- Division of Epidemiology Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
- Psychology and Neuroscience, Brigham Young University, Provo, UT, USA
| | - James Jackson
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mustafa Mir-Kasimov
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Carla M Sevin
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Wilson
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care and Pulmonary/Critical Care Medicine, Intermountain Medical Center, Murray, UT, USA
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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18
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Flaws D, Patterson S, Fraser J, Tronstad O, Scott JG. Reconceptualizing post-intensive care syndrome: Do we need to unpick our PICS? Nurs Crit Care 2020; 26:67-69. [PMID: 32869887 DOI: 10.1111/nicc.12545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Dylan Flaws
- Metro North Mental Health Service, Brisbane, Australia.,Queensland University of Technology, Brisbane, Australia.,Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia
| | - Susan Patterson
- Metro North Mental Health Service, Brisbane, Australia.,Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia
| | - John Fraser
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Oystein Tronstad
- Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Physiotherapy Department, TPCH, Brisbane, Australia
| | - James G Scott
- Metro North Mental Health Service, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Australia
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19
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McClafferty B, Umer I, Fye G, Kepko D, Kalayanamitra R, Shahid Z, Ramgobin D, Cai A, Groff A, Bhandari A, Aggarwal CS, Patel R, Bhatt D, Polimera H, Sahu N, Vunnam R, Golamari R, Kumar A, Jain R. Approach to critical illness myopathy and polyneuropathy in the older SARS-CoV-2 patients. J Clin Neurosci 2020; 79:241-245. [PMID: 33070904 PMCID: PMC7380205 DOI: 10.1016/j.jocn.2020.07.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/08/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
One of the major concerns of the health care community and the public surrounding the SARS-CoV-2 pandemic is the availability and use of ventilators. Unprecedented surges of patients presented to intensive care units across the country, with older adults making up a large proportion of the patient population. This paper illustrates contemporary approaches to critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) in older patients, including incidence, risk factors, mechanisms for pathology, diagnosis, contemporary treatment approaches, and outcomes. We hope that the following analysis may help educate clinicians and ultimately decrease the duration of the mechanical ventilation required by these patients, resulting in improved clinical outcomes and an increase in ventilator availability for other patients in need.
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Affiliation(s)
| | - Ibrahim Umer
- Lake Erie College of Osteopathic Medicine, United States
| | - Gary Fye
- Lake Erie College of Osteopathic Medicine, United States
| | - Douglas Kepko
- Lake Erie College of Osteopathic Medicine, United States
| | | | - Zainab Shahid
- Lake Erie College of Osteopathic Medicine, United States
| | | | - Alice Cai
- Penn State College of Medicine, United States
| | | | - Abani Bhandari
- Department of Internal Medicine, KISTMC, Tribhuvan University, Nepal, India
| | | | - Ravi Patel
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Dhirisha Bhatt
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Hyma Polimera
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Nitasa Sahu
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Ramarao Vunnam
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Reshma Golamari
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
| | - Ashutosh Kumar
- Department of Pediatrics and Neurology, Penn State Milton S. Hershey Medical Center, United States
| | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, United States
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20
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Sareen J, Olafson K, Kredentser MS, Bienvenu OJ, Blouw M, Bolton JM, Logsetty S, Chateau D, Nie Y, Bernstein CN, Afifi TO, Stein MB, Leslie WD, Katz LY, Mota N, El-Gabalawy R, Sweatman S, Marrie RA. The 5-Year Incidence of Mental Disorders in a Population-Based ICU Survivor Cohort. Crit Care Med 2020; 48:e675-e683. [PMID: 32697508 DOI: 10.1097/ccm.0000000000004413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To estimate incidence of newly diagnosed mental disorders among ICU patients. DESIGN Retrospective-matched cohort study using a population-based administrative database. SETTING Manitoba, Canada. PARTICIPANTS A total of 49,439 ICU patients admitted between 2000 and 2012 were compared with two control groups (hospitalized: n = 146,968 and general population: n = 141,937), matched on age (± 2 yr), sex, region of residence, and hospitalization year. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Incident mental disorders (mood, anxiety, substance use, personality, posttraumatic stress disorder, schizophrenia, and psychotic disorders) not diagnosed during the 5-year period before the index ICU or hospital admission date (including matched general population group), but diagnosed during the subsequent 5-year period. Multivariable survival models adjusted for sociodemographic variables, Charlson comorbidity index, admission diagnostic category, and number of ICU and non-ICU exposures. ICU cohort had a 14.5% (95% CI, 14.0-15.0) and 42.7% (95% CI, 42.0-43.5) age- and sex-standardized incidence of any diagnosed mental disorder at 1 and 5 years post-ICU exposure, respectively. In multivariable analysis, ICU cohort had increased risk of any diagnosed mental disorder at all time points versus the hospitalized cohort (year 5: adjusted hazard ratio, 2.00; 95% CI, 1.80-2.23) and the general population cohort (year 5: adjusted hazard ratio, 3.52; 95% CI, 3.23-3.83). A newly diagnosed mental disorder was associated with younger age, female sex, more recent admitting years, presence of preexisting comorbidities, and repeat ICU admission. CONCLUSIONS ICU admission is associated with an increased incidence of mood, anxiety, substance use, and personality disorders over a 5-year period.
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Affiliation(s)
- Jitender Sareen
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kendiss Olafson
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maia S Kredentser
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marcus Blouw
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - James M Bolton
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Sarvesh Logsetty
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Yao Nie
- Manitoba Centre for Health Policy, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tracie O Afifi
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - William D Leslie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Laurence Y Katz
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sophia Sweatman
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ruth Ann Marrie
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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21
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Spies CD, Krampe H, Paul N, Denke C, Kiselev J, Piper SK, Kruppa J, Grunow JJ, Steinecke K, Gülmez T, Scholtz K, Rosseau S, Hartog C, Busse R, Caumanns J, Marschall U, Gersch M, Apfelbacher C, Weber-Carstens S, Weiss B. Instruments to measure outcomes of post-intensive care syndrome in outpatient care settings - Results of an expert consensus and feasibility field test. J Intensive Care Soc 2020; 22:159-174. [PMID: 34025756 DOI: 10.1177/1751143720923597] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care. Methods We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal. Results We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale - revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)). Conclusions We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT04175236; first posted 22 November 2019).
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Affiliation(s)
- Claudia D Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nicolas Paul
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Denke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jörn Kiselev
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sophie K Piper
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Jochen Kruppa
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karin Steinecke
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tuba Gülmez
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simone Rosseau
- Klinikum Ernst von Bergmann, Pneumologisches Beatmungszentrum, Bad Belzig, Germany
| | - Christiane Hartog
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Klinik Bavaria, Kreischa, Germany
| | - Reinhard Busse
- Department for Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Jörg Caumanns
- Innovation Center Telehealth Technologies, Fraunhofer Institute for Open Communication Systems (FOKUS), Berlin, Germany
| | | | - Martin Gersch
- Department of Information Systems, School of Business & Economics, Freie Universität Berlin, Berlin, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.,Institute of Social Medicine and Health Economics, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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22
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Kamdar BB, Suri R, Suchyta MR, Digrande KF, Sherwood KD, Colantuoni E, Dinglas VD, Needham DM, Hopkins RO. Return to work after critical illness: a systematic review and meta-analysis. Thorax 2020; 75:17-27. [PMID: 31704795 PMCID: PMC7418481 DOI: 10.1136/thoraxjnl-2019-213803] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/11/2019] [Accepted: 09/01/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Survivors of critical illness often experience poor outcomes after hospitalisation, including delayed return to work, which carries substantial economic consequences. OBJECTIVE To conduct a systematic review and meta-analysis of return to work after critical illness. METHODS We searched PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from 1970 to February 2018. Data were extracted, in duplicate, and random-effects meta-regression used to obtain pooled estimates. RESULTS Fifty-two studies evaluated return to work in 10 015 previously employed survivors of critical illness, over a median (IQR) follow-up of 12 (6.25-38.5) months. By 1-3, 12 and 42-60 months' follow-up, pooled return to work prevalence (95% CI) was 36% (23% to 49%), 60% (50% to 69%) and 68% (51% to 85%), respectively (τ2=0.55, I2=87%, p=0.03). No significant difference was observed based on diagnosis (acute respiratory distress syndrome (ARDS) vs non-ARDS) or region (Europe vs North America vs Australia/New Zealand), but was observed when comparing mode of employment evaluation (in-person vs telephone vs mail). Following return to work, 20%-36% of survivors experienced job loss, 17%-66% occupation change and 5%-84% worsening employment status (eg, fewer work hours). Potential risk factors for delayed return to work include pre-existing comorbidities and post-hospital impairments (eg, mental health). CONCLUSION Approximately two-thirds, two-fifths and one-third of previously employed intensive care unit survivors are jobless up to 3, 12 and 60 months following hospital discharge. Survivors returning to work often experience job loss, occupation change or worse employment status. Interventions should be designed and evaluated to reduce the burden of this common and important problem for survivors of critical illness. TRIAL REGISTRATION NUMBER PROSPERO CRD42018093135.
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Affiliation(s)
- Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Rajat Suri
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mary R Suchyta
- InstaCare, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Kyle F Digrande
- Department of Medicine, University of California Irvine, Irvine, California, USA
| | - Kyla D Sherwood
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
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23
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Parry SM, Nalamalapu SR, Nunna K, Rabiee A, Friedman LA, Colantuoni E, Needham DM, Dinglas VD. Six-Minute Walk Distance After Critical Illness: A Systematic Review and Meta-Analysis. J Intensive Care Med 2019; 36:343-351. [PMID: 31690160 DOI: 10.1177/0885066619885838] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Impaired physical functioning is common and long lasting after an intensive care unit (ICU) admission. The 6-minute walk test (6MWT) is a validated and widely used test of functional capacity. This systematic review synthesizes existing data in order to: (1) evaluate 6-minute walk distance (6MWD) in meters over longitudinal follow-up after critical illness, (2) compare 6MWD between acute respiratory distress syndrome (ARDS) versus non-ARDS survivors, and (3) evaluate patient- and ICU-related factors associated with 6MWD. DATA SOURCES Five databases (PubMed, EMBASE, Cumulative Index of Nursing and Allied Health Literature, PsychINFO, and Cochrane Controlled Trials Registry) were searched to identify studies reporting 6MWT after hospital discharge in survivors from general (ie, nonspeciality) ICUs. The last search was run on February 14, 2018. Databases were accessed via Johns Hopkins University Library. DATA EXTRACTION AND SYNTHESIS Pooled mean 6MWD were reported, with separate linear random effects models used to evaluate associations of 6MWD with ARDS status, and patient- and ICU-related variables. Twenty-six eligible articles on 16 unique participant groups were included. The pooled mean (95% confidence interval [CI]) 6MWD results at 3- and 12-months post discharge were 361 (321-401) and 436 (391-481) meters, respectively. There was a significant increase in 6MWD at 12 months compared to 3 months (P = .017). In ARDS versus non-ARDS survivors, the mean (95% CI) 6MWD difference over 3-, 6-, and 12-month follow-up was 73 [13-133] meters lower. Female sex and preexisting comorbidity also were significantly associated with lower 6MWD, with ICU-related variables having no consistent associations. CONCLUSIONS Compared to initial assessment at 3 months, significant improvement in 6MWD was reported at 12 months. Female sex, preexisting comorbidity, and ARDS (vs non-ARDS) were associated with lower 6MWT results. Such factors warrant consideration in the design of clinical research studies and in the interpretation of patient status using the 6MWT.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, 2281The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Anahita Rabiee
- Department of Medicine, 12228Yale School of Medicine, New Haven, CT, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Biostatistics, Bloomberg School of Public Health, 1466John Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery Group, 1466Johns Hopkins University, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, School of Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
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24
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Warrillow S, Raper R. The evolving role of intensive care in health care and society. Med J Aust 2019; 211:294-297.e1. [PMID: 31544249 DOI: 10.5694/mja2.50340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Warrillow
- Austin Heath, Melbourne, VIC.,Australian and New Zealand Intensive Care Society, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Raymond Raper
- College of Intensive Care Medicine of Australia and New Zealand, Melbourne, VIC.,Royal North Shore Hospital, Sydney, NSW
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25
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26
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Heydon E, Wibrow B, Jacques A, Sonawane R, Anstey M. The needs of patients with post-intensive care syndrome: A prospective, observational study. Aust Crit Care 2019; 33:116-122. [PMID: 31160217 DOI: 10.1016/j.aucc.2019.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/28/2019] [Accepted: 04/07/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The needs of critical illness survivors and how best to address these are unclear. OBJECTIVES The objective of this study was to identify critical illness survivors who had developed post-intensive care syndrome and to explore their use of community healthcare resources, the socioeconomic impact of their illness, and their self-reported unmet healthcare needs. METHODS Patients from two intensive care units (ICUs) in Western Australia who were mechanically ventilated for 5 days or more and/or had a prolonged ICU admission were included in this prospective, observational study. Questionnaires were used to assess participants' baseline health and function before admission, which were then repeated at 1 and 3 months after ICU discharge. RESULTS Fifty participants were enrolled. Mean Functional Activities Questionnaire scores increased from 1.8 out of 30 at baseline (95% confidence interval [CI]: 0-3.5) to 8.9 at 1 month after ICU discharge (95% CI: 6.5-11.4; P = <0.001) and 7.0 at 3 months after ICU discharge (95% CI: 4.9-9.1; P = < 0.001). Scores indicating functional dependence increased from 8% at baseline to 54% and 33% at 1 and 3 months after ICU discharge, respectively. Statistically significant declines in health-related quality of life were identified in the domains of Mobility, Personal Care, Usual Activities, and Pain/Discomfort at 1 month after ICU discharge and in Mobility, Personal Care, Usual Activities, and Anxiety/Depression at 3 months after ICU discharge. An increase in healthcare service use was identified after ICU discharge. Participants primarily identified mental health services as the service that they felt they would benefit from but were not accessing. Very low rates of return to work were observed, with 35% of respondents at 3 months, indicating they were experiencing financial difficulty as a result of their critical illness. CONCLUSIONS Study participants developed impairments consistent with post-intensive care syndrome, with associated negative socioeconomic ramifications, and identified mental health as an area they need more support in.
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Affiliation(s)
- Edward Heydon
- Department of Intensive Care, 4th Floor G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia.
| | - Bradley Wibrow
- Department of Intensive Care, 4th Floor G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Faculty of Health and Medical Sciences, UWA Medical School, Nedlands, Western Australia, 6009, Australia.
| | - Angela Jacques
- Institute for Health Research, The University of Notre Dame Australia, ND46 33 Phillimore St, Fremantle, Western Australia, 6959, Australia.
| | - Ravikiran Sonawane
- Intensive Care Unit, Rockingham General Hospital, Elanora Drive, Cooloongup, Western Australia, 6168, Australia.
| | - Matthew Anstey
- Department of Intensive Care, 4th Floor G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Western Australia, 6009, Australia; Faculty of Health and Medical Sciences, UWA Medical School, Nedlands, Western Australia, 6009, Australia.
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