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Lotfalla A, Halm J, Schepers T, Giannakópoulos G. Health-related quality of life after severe trauma and available PROMS: an updated review (part I). Eur J Trauma Emerg Surg 2022; 49:747-761. [PMID: 36445397 PMCID: PMC10175342 DOI: 10.1007/s00068-022-02178-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022]
Abstract
Abstract
Introduction
Throughout the years, a decreasing trend in mortality rate has been demonstrated in patients suffering severe trauma. This increases the relevance of documentation of other outcomes for this population, including patient-reported outcome measures (PROMs), such as health-related quality of life (HRQoL). The aim of this review was to summarize the results of the studies that have been conducted regarding HRQoL in severely injured patients (as defined by the articles’ authors). Also, we present the instruments that are used most frequently to assess HRQoL in patients suffering severe trauma.
Methods
A literature search was conducted in the Cochrane Library, EMBASE, PubMed, and Web of Science for articles published from inception until the 1st of January 2022. Reference lists of included articles were reviewed as well. Studies were considered eligible when a population of patients with major, multiple or severe injury and/or polytrauma was included, well-defined by means of an ISS-threshold, and the outcome of interest was described in terms of (HR)QoL. A narrative design was chosen for this review.
Results
The search strategy identified 1583 articles, which were reduced to 113 after application of the eligibility criteria. In total, nineteen instruments were used to assess HRQoL. The SF-36 was used most frequently, followed by the EQ-5D and SF-12. HRQoL in patients with severe trauma was often compared to normative population norms or pre-injury status, and was found to be reduced in both cases, regardless of the tool used to assess this outcome. Some studies demonstrated higher scoring of the patients over time, suggesting improved HRQoL after considerable time after severe trauma.
Conclusion
HRQoL in severely injured patients is overall reduced, regardless of the instrument used to assess it. The instruments that were used most frequently to assess HRQoL were the SF-36 and EQ-5D. Future research is needed to shed light on the consequences of the reduced HRQoL in this population. We recommend routine assessment and documentation of HRQoL in severely injured patients.
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Tugnoli S, Spadaro S, Corte FD, Valpiani G, Volta CA, Caracciolo S. Health Related Quality of Life and Mental Health in ICU Survivors: Post-Intensive Care Syndrome Follow-Up and Correlations between the 36-Item Short Form Health Survey (SF-36) and the General Health Questionnaire (GHQ-28). Health (London) 2022. [DOI: 10.4236/health.2022.145037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Many Intensive Care (ICU) survivors experience long lasting impairments in physical and psychological health as well as social functioning. The objective of our study was to evaluate these effects up to 10 years after ICU discharge. We performed a long-term prospective cohort study in patients admitted for longer than 48 h in a medical-surgical ICU. We evaluated health-related quality of life (HRQOL) before ICU admission using the Short-form-36 (SF-36), at ICU discharge, at hospital discharge and at 1, 2, 5 and 10 years follow up (all by patients). Changes in HRQOL were assessed based on linear mixed modeling. We included a total of 749 patients (from 2000 to 2008). During 10 years 475 (63.4%) patients had died, 125 (16.7%) patients were lost to follow up and 149 (19.9%) patients could be evaluated. The mean scores of four HRQOL dimensions (i.e., physical functioning (p < 0.001; mean 54, SD 32, effect size 0.77, 95% CI [0.54-1.0]), role-physical (p < 0.001; mean 44, SD 47, effect size 0.65, 95% CI [0.41-0.68] general health (p < 0.001; mean 52, SD 27, effect size 0.48; 95% CI 0.25-0.71) and social functioning (p < 0.001; mean 72, SD 32, effect size 0.41, 95% CI [0.19-0.64]) were still lower 10 years after ICU discharge compared with pre-admission levels (n = 149) and with an age reference population. Almost all SF-36 dimensions changed significantly over time from ICU discharge up to 10 years after ICU discharge. Over the 10 year follow up physical functioning of medical-surgical ICU survivors remains impaired compared with their pre-admission values and an age reference population. However, effect sizes showed no significant differences suggesting that surviving patients largely regained their age-specific HRQOL at 10 years.
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Kalbfell EL, Buffington A, Kata A, Brasel KJ, Mosenthal AC, Cooper Z, Finlayson E, Schwarze ML. Expressions of conflict following postoperative complications in older adults having major surgery. Am J Surg 2021; 222:670-676. [PMID: 34218931 DOI: 10.1016/j.amjsurg.2021.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 06/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND After serious postoperative complications, patients and families may experience conflict about goals of care. METHODS We performed a multisite randomized clinical trial to test the effect of a question prompt list on postoperative conflict. We interviewed family members and patients age ≥60 who experienced serious complications. We used qualitative content analysis to analyze conflict and characterize patient experiences with complications. RESULTS Fifty-six of 446 patients suffered a serious complication. Participants generally did not report conflict relating to postoperative treatments and expressed support for the care they received. We did not appreciate a difference in conflict between intervention and usual care. Respondents reported feeling unprepared for complications, witnessing heated interactions among team members, and a failure to develop trust for their surgeon preoperatively. CONCLUSION Postoperative conflict following serious complications is well described but its incidence may be low. Nonetheless, patient and family observations reveal opportunities for improvement.
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Affiliation(s)
- Elle L Kalbfell
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Anne Buffington
- Department of Surgery, University of Wisconsin, Madison, WI, USA
| | - Anna Kata
- Department of Surgery, Georgetown University Hospital, Washington D.C, USA
| | - Karen J Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Anne C Mosenthal
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
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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 2019; 75:17-27. [PMID: 31704795 DOI: 10.1136/thoraxjnl-2019-213803] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [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 (τ 2=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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Return to Employment after Critical Illness and Its Association with Psychosocial Outcomes. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 16:1304-1311. [DOI: 10.1513/annalsats.201903-248oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Alexopoulou C, Bolaki M, Akoumianaki E, Erimaki S, Kondili E, Mitsias P, Georgopoulos D. Sleep quality in survivors of critical illness. Sleep Breath 2018; 23:463-471. [PMID: 30030695 DOI: 10.1007/s11325-018-1701-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 06/24/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE There is limited data regarding the sleep quality in survivors of critical illness, while the time course of the sleep abnormalities observed after ICU discharge is not known. The aim of this study was to assess sleep quality and the time course of sleep abnormalities in survivors of critical illness. METHODS Eligible survivors of critical illness without hypercapnia and hypoxemia were evaluated within 10 days (1st evaluation, n = 36) and at 6 months after hospital discharge (2nd evaluation, n = 29). At each visit, all patients underwent an overnight full polysomnography and completed health-related quality of life questionnaires (HRQL). Lung function and electro-diagnostic tests (ED) were performed in 24 and 11 patients, respectively. RESULTS At 1st evaluation, sleep quality and HRQL were poor. Sleep was characterised by high percentages of N1, low of N3 and REM stages, and high apnea-hypopnea index (AHI, events/h). Twenty-two out of 36 patients (61%) exhibited AHI ≥ 15 (21 obstructive, 1 central). None of the patients' characteristics, including HRQL and lung function, predicted the occurrence of AHI ≥ 15. At 6 months, although sleep quality remained poor (high percentages of N1 and low of REM), sleep architecture had improved as indicated by the significant increase in N3 [4.2% (0-12.5) vs. 9.8% (3.0-20.4)] and decrease in AHI [21.5 (6.5-29.4) vs. 12.8 (4.7-20.4)]. HRQL improved slightly but significantly at 6 months. Neither the changes in HRQL nor in lung function tests were related to these of sleep architecture. Six out of eight patients with abnormal ED at 1st evaluation continued to exhibit abnormal results at 6 months. CONCLUSIONS Survivors of critical illness exhibited a high prevalence of obstructive sleep-disordered breathing and poor sleep architecture at hospital discharge, which slightly improved 6 months later, indicating that reversible factors are partly responsible for these abnormalities.
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Affiliation(s)
- Ch Alexopoulou
- Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece.,Sleep Laboratory, Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - M Bolaki
- Department of Pulmonary Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - E Akoumianaki
- Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - S Erimaki
- Neurology Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - E Kondili
- Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece.,Sleep Laboratory, Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - P Mitsias
- Neurology Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - D Georgopoulos
- Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece. .,Sleep Laboratory, Intensive Care Medicine Department, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece.
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Cubro H, Somun-Kapetanovic R, Thiery G, Talmor D, Gajic O. Cost effectiveness of intensive care in a low resource setting: A prospective cohort of medical critically ill patients. World J Crit Care Med 2016; 5:150-164. [PMID: 27152258 PMCID: PMC4848158 DOI: 10.5492/wjccm.v5.i2.150] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/29/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To calculate cost effectiveness of the treatment of critically ill patients in a medical intensive care unit (ICU) of a middle income country with limited access to ICU resources.
METHODS: A prospective cohort study and economic evaluation of consecutive patients treated in a recently established medical ICU in Sarajevo, Bosnia and Herzegovina. A cost utility analysis of the intensive care of critically ill patients compared to the hospital ward treatment from the perspective of the health care system was subsequently performed. Incremental cost effectiveness was calculated using estimates of ICU vs non-ICU treatment effectiveness based on a formal systematic review of published studies. Decision analytic modeling was used to compare treatment alternatives. Sensitivity analyses of the key model parameters were performed.
RESULTS: Out of 148 patients, seventy patients (47.2%) survived to one year after critical illness with a median quality of life index 0.64 [interquartile range(IQR) 0.49-0.76]. Median number of life years gained per patient was 30 (IQR 16-40) or 18 quality adjusted life years (QALYs) (IQR 7-28). The cost of treatment of critically ill patients varied between 1820 dollar and 20109 dollar per hospital survivor and between 100 dollar and 2514 dollar per QALY saved. Mean factors that influenced costs were: Age, diagnostic category, ICU and hospital length of stay and number and type of diagnostic and therapeutic interventions. The incremental cost effectiveness ratio for ICU treatment was estimated at 3254 dollar per QALY corresponding to 35% of per capita GDP or a Very Cost Effective category according to World Health Organization criteria.
CONCLUSION: The ICU treatment of critically ill medical patients in a resource poor country is cost effective and compares favorably with other medical interventions. Public health authorities in low and middle income countries should encourage development of critical care services.
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9
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Health care utilization before and after intensive care unit admission in multiple sclerosis. Mult Scler Relat Disord 2015. [DOI: 10.1016/j.msard.2015.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Curzel J, Forgiarini Junior LA, Rieder MDM. Evaluation of functional independence after discharge from the intensive care unit. Rev Bras Ter Intensiva 2015; 25:93-8. [PMID: 23917973 PMCID: PMC4031825 DOI: 10.5935/0103-507x.20130019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/04/2013] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE 1) To evaluate the functional independence measures immediately after discharge from an intensive care unit and to compare these values with the FIMs 30 days after that period. 2) To evaluate the possible associated risk factors. METHODS The present investigation was a prospective cohort study that included individuals who were discharged from the intensive care unit and underwent physiotherapy in the unit. Functional independence was evaluated using the functional independence measure immediately upon discharge from the intensive care unit and 30 days thereafter via a phone call. The patients were admitted to the Hospital Santa Clara intensive care unit during the period from May 2011 to August 2011. RESULTS During the predetermined period of data collection, 44 patients met the criteria for inclusion in the study. The mean age of the patients was 55.4±10.5 years. Twenty-seven of the subjects were female, and 15 patients were admitted due to pulmonary disease. The patients exhibited an functional independence measure of 84.1±24.2. When this measure was compared to the measure at 30 days after discharge, there was improvement across the functional independence variables except for that concerned with sphincter control. There were no significant differences when comparing the gender, age, clinical diagnosis, length of stay in the intensive care unit, duration of mechanical ventilation, and the presence of sepsis during this period. CONCLUSION Functional independence, as evaluated by the functional independence measure scale, was improved at 30 days after discharge from the intensive care unit, but it was not possible to define the potentially related factors.
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Affiliation(s)
- Juliane Curzel
- Centro Universitário Metodista - IPA - Porto Alegre RS, Brazil
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11
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Connolly BA, Jones GD, Curtis AA, Murphy PB, Douiri A, Hopkinson NS, Polkey MI, Moxham J, Hart N. Clinical predictive value of manual muscle strength testing during critical illness: an observational cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R229. [PMID: 24112540 PMCID: PMC4057053 DOI: 10.1186/cc13052] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 08/13/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Impaired skeletal muscle function has important clinical outcome implications for survivors of critical illness. Previous studies employing volitional manual muscle testing for diagnosing intensive care unit-acquired weakness (ICU-AW) during the early stages of critical illness have only provided limited data on outcome. This study aimed to determine inter-observer agreement and clinical predictive value of the Medical Research Council sum score (MRC-SS) test in critically ill patients. METHODS Study 1: Inter-observer agreement for ICU-AW between two clinicians in critically ill patients within ICU (n = 20) was compared with simulated presentations (n = 20). Study 2: MRC-SS at awakening in an unselected sequential ICU cohort was used to determine the clinical predictive value (n = 94) for outcomes of ICU and hospital mortality and length of stay. RESULTS Although the intra-class correlation coefficient (ICC) for MRC-SS in the ICU was 0.94 (95% CI 0.85-0.98), κ statistic for diagnosis of ICU-AW (MRC-SS <48/60) was only 0.60 (95% CI 0.25-0.95). Agreement for simulated weakness presentations was almost complete (ICC 1.0 (95% CI 0.99-1.0), with a κ statistic of 1.0 (95% CI 1.0-1.0)). There was no association observed between ability to perform the MRC-SS and clinical outcome and no association between ICU-AW and mortality. Although ICU-AW demonstrated limited positive predictive value for ICU (54.2%; 95% CI 39.2-68.6) and hospital (66.7%; 95% CI 51.6-79.6) length of stay, the negative predictive value for ICU length of stay was clinically acceptable (88.2%; 95% CI 63.6-98.5). CONCLUSIONS These data highlight the limited clinical applicability of volitional muscle strength testing in critically ill patients. Alternative non-volitional strategies are required for assessment and monitoring of muscle function in the early stages of critical illness.
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Cuthbertson BH, Elders A, Hall S, Taylor J, MacLennan G, Mackirdy F, Mackenzie SJ. Mortality and quality of life in the five years after severe sepsis. Crit Care 2013; 17:R70. [PMID: 23587132 PMCID: PMC4057306 DOI: 10.1186/cc12616] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 04/16/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Severe sepsis is associated with high levels of morbidity and mortality, placing a high burden on healthcare resources. We aimed to study outcomes in the five years after severe sepsis. Methods This was a cohort study using data from a prospective audit in 26 adult ICUs in Scotland. Mortality was measured using clinical databases and quality of life using Short Form 36 (SF-36) at 3.5 and 5 years after severe sepsis. Results A total of 439 patients were recruited with a 58% mortality at 3.5 years and 61% mortality at 5 years. A total of 85 and 67 patients responded at 3.5 and 5 years follow-up, respectively. SF-36 physical component score (PCS) was low compared to population controls at 3.5 years (mean 41.8 (SD 11.8)) and at 5 years (mean 44.8 (SD 12.7)). SF-36 mental component score (MCS) was slightly lower than population controls at 3.5 years (mean 47.7 (SD 14.6)) and at 5 years after severe sepsis (mean 48.8 (SD 12.6)). The majority of patients were satisfied with their current quality of life (QOL) (80%) and all patients would be willing to be treated in an ICU again if they become critically ill despite many having unpleasant memories (19%) and recall (29%) of ICU events. Conclusions Patients with severe sepsis have a high ongoing mortality after severe sepsis. They also have a significantly lower physical QOL compared to population norms but mental QOL scores were only slightly below population norms up to five years after severe sepsis. All survivors would be willing to be treated in an ICU again if critically ill. Mortality and QOL outcomes were broadly similar to other critically ill cohorts throughout the five years of follow-up.
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Schenk P, Warszawska J, Fuhrmann V, König F, Madl C, Ratheiser K. Health-related quality of life of long-term survivors of intensive care: changes after intensive care treatment. Experience of an Austrian intensive care unit. Wien Klin Wochenschr 2012; 124:624-32. [PMID: 22875391 DOI: 10.1007/s00508-012-0224-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/09/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to determine if health-related quality of life of long-term survivors changes 24 months after intensive care treatment compared to the quality of life before admission. METHODS From 281 patients treated at the ICU in 2001, 132 survivors were contacted by phone on average 24 months after discharge. Fernandez questionnaire was used to assess preadmission quality of life prospectively and postdischarge quality of life, retrospectively. In addition, age, sex, admission diagnosis, ICU length of stay, presence of organ failure, and necessity of mechanical ventilation were determined. RESULTS In the 101 ICU survivors who responded to the questionnaire, the total score of quality of life did not change significantly over time (5.48 ± 5.3 before admission vs. 5.6 ± 5.8 at follow-up; p = 0.9). Similarly, the performance of normal daily activities did not alter (3.0 ± 3.5 vs. 3.39 ± 3.6; p = 0,3). In contrast, the ability to perform basic physiological activities worsened significantly (0.39 ± 0.76 vs. 0.76 ± 1.52; p = 0.037), whereas the emotional state improved significantly after intensive care treatment (2.08 ± 1.78 vs. 1.46 ± 1.56, p = 0.003). In a stepwise multiple regression analysis the total score of quality of life before admission was the only variable which influenced the quality of life 2 years after ICU-stay. CONCLUSIONS In the interviewed population the total score of health-related quality of life did not change after intensive care treatment. Surprisingly, emotional state improved significantly although physical performance decreased. Quality of life after ICU discharge was predominantly influenced by preadmission quality of life. However, these results are not reflective of all ICU survivors.
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Affiliation(s)
- Peter Schenk
- Department of Pulmonology, Landesklinikum Thermenregion Hochegg, Hocheggerstrasse 88, 2840, Grimmenstein, Austria.
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14
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Physical effects of trauma and the psychological consequences of preexisting diseases account for a significant portion of the health-related quality of life patterns of former trauma patients. J Trauma Acute Care Surg 2012; 72:504-12. [PMID: 22439224 DOI: 10.1097/ta.0b013e31821a416a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is known to be significantly affected in former trauma patients. However, the underlying factors that lead to this outcome are largely unknown. In former intensive care unit (ICU) patients, it has been recognized that preexisting disease is the most important factor for the long-term HRQoL. The aim of this study was to investigate HRQoL up to2 years after trauma and to examine the contribution of the trauma-specific, ICU-related, sociodemographic factors together with the effects of preexisting disease, and further to make a comparison with a large general population. METHODS A prospective 2-year multicenter study in Sweden of 108 injured patients. By mailed questionnaires, HRQoL was assessed at 6 months,12 months, and 24 months after the stay in ICU by Short Form (SF)-36, and information of preexisting disease was collected from the national hospital database. ICU-related factors were obtained from the local ICU database. Comorbidity and HRQoL (SF-36) was also examined in the reference group, a random sample of 10,000 inhabitants in the uptake area of the hospitals. RESULTS For the trauma patients, there was a marked and early decrease in the physical dimensions of the SF-36 (role limitations due to physical problems and bodily pain). This decrease improved rapidly and was almost normalized after 24 months. In parallel, there were extensive decreases in the psychologic dimensions (vitality, social functioning, role limitations due to emotional problems,and mental health) of the SF-36 when comparisons were made with the general reference population. CONCLUSIONS The new and important finding in this study is that the trauma population seems to have a trauma-specific HRQoL outcome pattern.First, there is a large and significant decrease in the physical dimensions of the SF-36, which is due to musculoskeletal effects and pain secondary to the trauma. This normalizes within 2 years, whereas the overall decrease in HRQoL remains and most importantly it is seen mainly in the psychologic dimensions and it is due to preexisting diseases.
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Kayambu G, Boots RJ, Paratz JD. Early rehabilitation in sepsis: a prospective randomised controlled trial investigating functional and physiological outcomes The i-PERFORM Trial (Protocol Article). BMC Anesthesiol 2011; 11:21. [PMID: 22035174 PMCID: PMC3306201 DOI: 10.1186/1471-2253-11-21] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 10/31/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patients with sepsis syndromes in comparison to general intensive care patients can have worse outcomes for physical function, quality of life and survival. Early intensive care rehabilitation can improve the outcome in general Intensive Care Unit (ICU) patients, however no investigations have specifically looked at patients with sepsis syndromes. The 'i-PERFORM Trial' will investigate if early targeted rehabilitation is both safe and effective in patients with sepsis syndromes admitted to ICU. METHODS/DESIGN A single-centred blinded randomized controlled trial will be conducted in Brisbane, Australia. Participants (n = 252) will include those ≥ 18 years, mechanically ventilated for ≥ 48 hours and diagnosed with a sepsis syndrome. Participants will be randomised to an intervention arm which will undergo an early targeted rehabilitation program according to the level of arousal, strength and cardiovascular stability and a control group which will receive normal care.The primary outcome measures will be physical function tests on discharge from ICU (The Acute Care Index of Function and The Physical Function ICU Test). Health-related quality of life will be measured using the Short Form-36 and the psychological component will be tested using The Hospital Anxiety and Depression Scale. Secondary measures will include inflammatory biomarkers; Interleukin-6, Interleukin-10 and Tumour Necrosis Factor-α, peripheral blood mitochondrial DNA content and lactate, fat free muscle mass, tissue oxygenation and microcirculatory flow. DISCUSSION The 'i-PERFORM Trial' will determine whether early rehabilitation for patients with sepsis is effective at improving patient outcomes with functional and physiological parameters reflecting long and short-term effects of early exercise and the safety in its application in critical illness. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000808044.
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Affiliation(s)
- Geetha Kayambu
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
| | - Robert J Boots
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
- Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane QLD 4029, Australia
| | - Jennifer D Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane QLD 4029, Australia
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Daubin C, Chevalier S, Séguin A, Gaillard C, Valette X, Prévost F, Terzi N, Ramakers M, Parienti JJ, du Cheyron D, Charbonneau P. Predictors of mortality and short-term physical and cognitive dependence in critically ill persons 75 years and older: a prospective cohort study. Health Qual Life Outcomes 2011; 9:35. [PMID: 21575208 PMCID: PMC3112374 DOI: 10.1186/1477-7525-9-35] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/16/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors. METHODS We conducted a prospective observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period, except those admitted after cardiac arrest, All patients were followed for 3 months or until death. Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the Katz index of Activity of Daily Living (ADL). Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham Health Profile (NHP) score. RESULTS One hundred patients were included in the analysis. The mean age was 79.3 ± 3.4 years. The median Charlson index was 6 [IQR, 4 to 7] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4, respectively, corresponding to a population with a high level of comorbidities but low physical and cognitive dependence. Mortality was 61/100 (61%) at 3 months. In multivariate analysis only comorbidities assessed by the Charlson index [Adjusted Odds Ratio, 1.6; 95% CI, 1.2-2.2; p < 0.003] and the number of organ failures assessed by the SOFA score [Adjusted Odds Ratio, 2.5; 95% CI, 1.1-5.2; p < 0.02] were independently associated with 3-month mortality. All 22 patients needing renal support after Day 3 died. Compared with pre-admission, physical (p = 0.04), and cognitive (p = 0.62) dependence in survivors had changed very little at 3 months. In addition, the mean NHP score was 213.1 ± 132.8 at 3 months, suggesting an acceptable perception of their quality of life. CONCLUSIONS In a selected population of non surgical patients 75 years and older, admission into the ICU is associated with a 3-month survival rate of 38% with little impact on physical and cognitive dependence and subjective health status. Nevertheless, a high comorbidity level (ie, Charlson index), multi-organ failure, and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death.
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Affiliation(s)
- Cédric Daubin
- Department of Medical Intensive Care, Avenue Côte de Nacre, Caen University Hospital, 14033 Caen Cedex, France.
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Williams TA, Leslie GD, Brearley L, Dobb GJ. Healthcare Utilisation among Patients Discharged from Hospital after Intensive Care. Anaesth Intensive Care 2010; 38:732-9. [DOI: 10.1177/0310057x1003800417] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surviving critical illness can be life-changing and presents new healthcare challenges for patients after hospital discharge. This feasibility study aimed to examine healthcare service utilisation for patients discharged from hospital after intensive care unit stay. Following Ethics Committee approval, patients aged 18 years and older were recruited over three months. Those admitted after cardiac surgery, discharged to another facility or against medical advice were excluded. Patients were informed of the study by post and followed-up by telephone at two and six months after discharge. General practitioners were also contacted (44% responded). Among 187 patients discharged from hospital, 11 died, 25 declined to participate and 39 could not be contacted. For 112 patients (60%) who completed a survey, the majority (82%) went home from hospital and were cared for by their partner (53%). More than half of the patients (58%) reported taking the same number of medications after intensive care unit stay but 30% took more (P=0.023). While there was no change in the number of visits to the general practitioner for 64% of patients, 29% reported an increase after intensive care unit stay. At six months, 40% of responders who were not retired were unemployed. Discharge summary surveys revealed 39 general practitioners (71%) were satisfied with details of ongoing healthcare needs. Twenty-one general practitioners wrote comments: 10 reported insufficient information about ongoing needs/rehabilitation and two reported no mention of intensive care unit stay. Survivors of critical illness had increased healthcare needs and despite most returning home, had a low workforce participation rate. This requires further investigation to maximise the benefits of survival from critical illness.
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Affiliation(s)
- T. A. Williams
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Adjunct Research Fellow, Curtin Health Innovation Research Institute, Curtin University and Nurse Researcher Critical Care Division, Royal Perth Hospital
| | - G. D. Leslie
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Professor, Critical Care Nursing, Curtin Health Innovation Research Institute, Curtin University and Royal Perth Hospital
| | - L. Brearley
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Nursing Director, Critical Care Division
| | - G. J. Dobb
- Intensive Care Unit, Royal Perth Hospital, Perth, Western Australia, Australia
- Head of Department and Senior Intensivist, Critical Care Division, Royal Perth Hospital and School of Medicine and Pharmacology, The University of Western Australia
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Health-related quality of life and return to work after critical illness in general intensive care unit patients: A 1-year follow-up study. Crit Care Med 2010; 38:1554-61. [DOI: 10.1097/ccm.0b013e3181e2c8b1] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Health-related quality of life after fast-track treatment results from a randomized controlled clinical equivalence trial. Qual Life Res 2010; 19:631-42. [PMID: 20340049 PMCID: PMC2874031 DOI: 10.1007/s11136-010-9625-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2010] [Indexed: 11/03/2022]
Abstract
PURPOSE This randomized clinical equivalence trial was designed to evaluate health-related quality of life (HRQoL) after fast-track treatment for low-risk coronary artery bypass (CABG) patients. METHODS Four hundred and ten CABG patients were randomly assigned to undergo either short-stay intensive care treatment (SSIC, 8 h of intensive care stay) or control treatment (care as usual, overnight intensive care stay). HRQoL was measured at baseline and 1 month, and one year after surgery using the multidimensional index of life quality (MILQ), the EQ-5D, the Beck Depression Inventory and the State-Trait Anxiety Inventory. RESULTS At one month after surgery, no statistically significant difference in overall HRQoL was found (MILQ-score P-value=.508, overall MILQ-index P-value=.543, EQ-5D VAS P-value=.593). The scores on the MILQ-domains, physical, and social functioning were significantly higher at one month postoperatively in the SSIC group compared to the control group (P-value=.049; 95%CI: 0.01-2.50 and P-value=.014, 95% CI: 0.24-2.06, respectively). However, these differences were no longer observed at long-term follow-up. CONCLUSIONS According to our definition of clinical equivalence, the HRQoL of SSIC patients is similar to patients receiving care as usual. Since safety and the financial benefits of this intervention were demonstrated in a previously reported analysis, SSIC can be considered as an adequate fast-track intensive care treatment option for low-risk CABG patients.
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Health-related quality of life in critically ill patients: how to score and what is the clinical impact? Curr Opin Crit Care 2009; 15:425-30. [DOI: 10.1097/mcc.0b013e32833079e4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Iribarren-Diarasarri S, Aizpuru-Barandiaran F, Muñoz-Martínez T, Dudagoitia-Otaolea JL, Castañeda-Sáez A, Hernández-López M, Martínez-Alutiz S, Vinuesa-Lozano C, Aretxabala-Kortajarena N. [Variations in health-related quality of life in critical patients]. Med Intensiva 2009; 33:115-22. [PMID: 19406084 DOI: 10.1016/s0210-5691(09)70944-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the changes in the health-related quality of life (hRQOL) six months after discharge from the ICU and the conditions associated to them. DESIGN A prospective cohort study. SETTING 14 beds medical-surgical intensive care unit (ICU). PATIENTS A total of 247 patients admitted to our ICU for more than 24 hours with a follow-up of 6 months were study. Those admitted with acute coronary syndrome or for monitoring purposes were excluded. INTERVENTION A quality of life survey was conducted using the score developed by the PAEEC group (project of the epidemiological analysis of critical illness) to assess hRQOL before ICU admission and 6 months after discharge. RESULTS The hRQOL deteriorated, going from a median value of 3 to 6 (p < 0.001). The multivariate analysis showed less deterioration of hRQOL in patients with chronic health conditions registered on the APAChE-II score (regression coefficient [RC] = -1.4; 95% CI, -2.5 to -0.2; p < 0.02) and in those with a hRQOL > or = 10 points (RC = -4,4; 95% CI, -5.9 to -2.8; p < 0.001). There was more deterioration in polytraumatized patients (RC = 1.9; 95% CI, 0.6-3.3; p = 0.01) or with renal failure (RC = 3.9; 95% CI, 1.9-5.9; p < 0.001) or in those with a stay duration longer than 10 days (RC = 1.9; 95% CI, 0.6-3.2; p < 0.001). CONCLUSIONS Most patients experience deterioration of hRQOL. Patients with chronic diseases or with worst previous hRQOL who survive 6 months experience less deterioration of hRQOL than those who are polytraumatized or have renal failure or a longer ICU stay.
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van der Schaaf M, Beelen A, de Vos R. Functional outcome in patients with critical illness polyneuropathy. Disabil Rehabil 2009; 26:1189-97. [PMID: 15371019 DOI: 10.1080/09638280410001724861] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the functional outcome of intensive care patients with critical illness polyneuropathy (CIP), 6 and 12 months after the onset. METHODS DESIGN A prospective observational cohort study and a cross-sectional study. SETTING University hospital in the Netherlands. PATIENTS Eight consecutive intensive care patients with CIP for the prospective study and eight patients diagnosed with CIP in the past 6 months for the cross-sectional study. MAIN OUTCOME MEASURES Functional outcome regarding body functions and structure, activities, participation and perceived quality of life. RESULTS Nine patients (56%) died within one year. Functional outcome, participation and subjective health status in survivors varied widely at 6 and 12 months. After 12 months, physical functioning was improved in all patients. However activities related to mobility outdoors, autonomy, participation and quality of life were restricted in most patients. CONCLUSIONS The majority of survivors have persistent functional disabilities in activities, reduced quality of life and restrictions in autonomy and participation one year after the onset of CIP. Prolonged rehabilitation treatment is necessary for an increasing number of intensive care patients who develop CIP, in order to reduce handicaps and achieve optimal autonomy and social participation.
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Affiliation(s)
- Marike van der Schaaf
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands
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Abstract
People over age 65 are the fastest growing segment of the population and account for 42% to 52% of the intensive care unit admissions in the United States. There are many physiologic changes that occur with aging which can impact on both the presentation and management of older patients with critical illness. Older patients have an increased risk for the development of sepsis, and age itself impacts on outcomes related to sepsis. Delirium is also very prevalent among older intensive care unit patients and is associated with adverse outcomes. While outcome studies suggest that chronologic age itself is not a risk factor for poor outcomes after adjusting for severity of illness, older patients clearly have physiologic changes which need to be considered when providing critical care. This article will review important physiologic changes of aging, as well as sepsis and delirium and outcomes of older ICU patients.
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Affiliation(s)
- Margaret A Pisani
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
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Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers AJP, Rommes JH, Bakker J. The Impact of Severe Sepsis on Health-Related Quality of Life: A Long-Term Follow-Up Study. Anesth Analg 2008; 107:1957-64. [DOI: 10.1213/ane.0b013e318187bbd8] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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de Beer T. What is the Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease after Invasive Ventilation? J Intensive Care Soc 2008. [DOI: 10.1177/175114370800900308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) make up a large proportion of hospital in-patients; they account for 12% of general medical admissions. Decisions to ventilate a patient with an exacerbation of COPD are partly based on the physician's prediction of future quality of life. In this systematic review, Pubmed, Medline, Embase, Biomed Central and the Cochrane library were electronically searched for observational and interventional studies of health-related quality of life (HRQoL) in patients with COPD, who were invasively ventilated, survived to hospital discharge and were followed up for HROoL measurements to be made. The results of the nine studies included showed that HROoL does deteriorate after invasive ventilation in intensive care, but is similar to that of patients who are on long-term oxygen therapy (LTOT) or in pulmonary rehabilitation programmes. Despite the high long-term mortality of patients with COPD, the HROoL in patients who do survive is reasonable. Identifying these patients remains a significant challenge.
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Dhainaut JF, Payet S, Vallet B, França LR, Annane D, Bollaert PE, Tulzo YL, Runge I, Malledant Y, Guidet B, Le Lay K, Launois R. Cost-effectiveness of activated protein C in real-life clinical practice. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 11:R99. [PMID: 17822547 PMCID: PMC2556742 DOI: 10.1186/cc6116] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 06/27/2007] [Accepted: 09/06/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recombinant human activated protein C (rhAPC) has been reported to be cost-effective in severely ill septic patients in studies using data from a pivotal randomized trial. We evaluated the cost-effectiveness of rhAPC in patients with severe sepsis and multiple organ failure in real-life intensive care practice. METHODS We conducted a prospective observational study involving adult patients recruited before and after licensure of rhAPC in France. Inclusion criteria were applied according to the label approved in Europe. The expected recruitment bias was controlled by building a sample of patients matched for propensity score. Complete hospitalization costs were quantified using a regression equation involving intensive care units variables. rhAPC acquisition costs were added, assuming that all costs associated with rhAPC were already included in the equation. Cost comparisons were conducted using the nonparametric bootstrap method. Cost-effectiveness quadrants and acceptability curves were used to assess uncertainty of the cost-effectiveness ratio. RESULTS In the initial cohort (n = 1096), post-license patients were younger, had less co-morbid conditions and had failure of more organs than did pre-license patients (for all: P < 0.0001). In the matched sample (n = 840) the mean age was 62.4 +/- 14.9 years, Simplified Acute Physiology Score II was 56.7 +/- 18.5, and the number of organ failures was 3.20 +/- 0.83. When rhAPC was used, 28-day mortality tended to be reduced (34.1% post-license versus 37.4% pre-license, P = 0.34), bleeding events were more frequent (21.7% versus 13.6%, P = 0.002) and hospital costs were higher (47,870 euros versus 36,717 euros, P < 0.05). The incremental cost-effectiveness ratios gained were as follows: 20,278 euros per life-year gained and 33,797 euros per quality-adjusted life-year gained. There was a 74.5% probability that rhAPC would be cost-effective if there were willingness to pay 50,000 euros per life-year gained. The probability was 64.3% if there were willingness to pay 50,000 euros per quality-adjusted life-year gained. CONCLUSION This study, conducted in matched patient populations, demonstrated that in real-life clinical practice the probability that rhAPC will be cost-effective if one is willing to pay 50,000 euros per life-year gained is 74.5%.
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Affiliation(s)
- Jean-François Dhainaut
- Department of Intensive Care, Cochin Port-Royal University Hospital, AP-HP, René Descartes University, Paris 5, Paris, France
| | - Stéphanie Payet
- REES France, Réseau d'Evaluation en Economie de la Santé, Paris, France
| | - Benoit Vallet
- Department of Anesthesiology and Intensive Care, University Hospital of Lille, University of Lille 2, Lille, France
| | | | - Djillali Annane
- Department of Intensive Care, Raymond Poincaré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Garches, France
| | | | - Yves Le Tulzo
- Department of Infectious Diseases and Medical Intensive Care, University Hospital of Rennes, Rennes, France
| | - Isabelle Runge
- Department of Intensive Care, La Source Hospital, Orléans, France
| | - Yannick Malledant
- Department of Anesthesiology and Intensive Care, University Hospital of Rennes, Rennes, France
| | - Bertrand Guidet
- Department of Intensive Care, Saint Antoine Hospital, AP-HP, Pierre et Marie Curie University, Paris 6, Paris, France
| | - Katell Le Lay
- REES France, Réseau d'Evaluation en Economie de la Santé, Paris, France
| | - Robert Launois
- REES France, Réseau d'Evaluation en Economie de la Santé, Paris, France
| | - the PREMISS Study Group
- Members of the Protocole en Réanimation d'Evaluation Médico-économique d'une Innovation dans le Sepsis Sévère (PREMISS) study are listed in Appendix 1
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Borel M, Veber B, Robillard F, Rigaud JP, Dureuil B, Hervé C. [Admission of elderly in intensive care: does age affect access to care?]. ACTA ACUST UNITED AC 2008; 27:472-80. [PMID: 18468838 DOI: 10.1016/j.annfar.2008.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 03/26/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The life expectancy of the population increasing, contrary to the resources of beds in reanimation, the question of the admission of the old subject in reanimation is increasingly frequent. We will be interested in the role of the age in the medical decision-making. PATIENTS AND METHODS A questionnaire was sent to the intensivists of the same department, then the troop of the subjects refused within an intensive care of the University Hospital of this same department was studied. RESULTS The age arrives in third place among the factors of refusal of admission quoted. It does not seem to be an appalling criterion for access to intensive care, but rather to lead to a thorough evaluation of the patient. This idea is translated in the open questions as in the clinical settings in situation. The age modulates the recourse to the entry in intensive care. It tends to be integrated in a total process of evaluation of a patient, even if the consensus is not total... The analysis of the troop of the refused subjects showed a first reason for refusal which is the lack of place. The age is not quoted. CONCLUSION The age does not seem a determining element. It cannot solve the question which is to know if the admission in reanimation is relevant or not for the patient proposed. More than the admission or not of a possibly old subject in reanimation, the problem lies in the resolution with accuracy of the acute dilemma which is the decision-making to admit or refuse a patient whatever it is for the benefit of the person.
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Affiliation(s)
- M Borel
- Département d'anesthésie-réanimation-Samu, hôpital universitaire de Rouen, 1, rue Germont, 76000 Rouen, France.
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Goodridge D, Duggleby W, Gjevre J, Rennie D. Caring for critically ill patients with advanced COPD at the end of life: a qualitative study. Intensive Crit Care Nurs 2008; 24:162-70. [PMID: 18313923 DOI: 10.1016/j.iccn.2008.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 01/10/2008] [Accepted: 01/12/2008] [Indexed: 11/19/2022]
Abstract
Providing expert critical care for the high acuity patient with a diagnosis of COPD at the end of life is both complex and challenging. The purpose of this descriptive study was to examine intensive care unit (ICU) clinicians' perspectives on the obstacles to providing quality care for individuals with COPD who die within the critical care environment. Transcripts of three focus groups of ICU clinicians were analyzed using thematic analysis. The three themes of "managing difficult symptoms", "questioning the appropriateness of life-sustaining care" and "conflicting care priorities" were noted to be significant challenges in providing high quality end of life care to this population. Difficulties in palliating dyspnea and anxiety were associated with caregiver feelings of helplessness, empathy and fears about "killing the patient". A sense of futility, concerns about "torturing the patient" and questions about the patient/family's understanding of treatment pervaded much of the discourse about caring for people with advanced COPD in the ICU. The need to prioritize care to the most unstable ICU patients meant that patients with COPD did not always receive the attention clinicians felt they should ideally have. Organizational support must be made available for critical care clinicians to effectively deal with these issues.
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Affiliation(s)
- Donna Goodridge
- College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan S7T5E5, Canada.
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Fildissis G, Zidianakis V, Tsigou E, Koulenti D, Katostaras T, Economou A, Baltopoulos G. Quality of life outcome of critical care survivors eighteen months after discharge from intensive care. Croat Med J 2008; 48:814-21. [PMID: 18074416 DOI: 10.3325/cmj.2007.6.814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To assess the changes in health-related quality of life in patients discharged from the intensive care unit (ICU). METHODS At the General University ICU, Trauma Hospital in Athens, 242 patients were enrolled prospectively over a study period of 18 months. Out of these, 116 participants (47.9%) completed all survey components at 6, 12, and 18 months. We used Quality of Life-Spanish (QOL-SP) to assess the health-related quality of life. Patients or their relatives were interviewed on ICU admission and at 6, 12, and 18 months after discharge from the ICU. RESULTS Mean quality of life score of the patients increased from 2.9+/-4.8 (out of maximum 25 points) on ICU admission to 7.0+/-7.2 points at 6 months after discharge, and then decreased to 5.6+/-6.9 points at 18 months (P<0.001; Friedman Test). Multilinear regression analysis showed that the variables which had the strongest association with the quality of life on admission were age (P=0.002) and male sex (P=0.001), whereas age (P<0.001), length of ICU stay (P<0.001), and male sex (P=0.002) had the strongest association 18 months after discharge from the ICU. Survival rate was 66.9% at discharge from ICU and 61.6% at hospital discharge. There were 33% deaths in the ICU, 5.3% in the hospital, and 6.2% after ICU discharge. There were 7.4% patients lost to follow-up. CONCLUSIONS After discharge from the ICU, patients' quality of life was poor and showed an improvement at 18 months after discharge, but was still worse than on admission. Age, ICU length of stay, and male sex were the factors that had the strongest impact on the quality of life on admission and at 18 months after discharge from the ICU.
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Affiliation(s)
- George Fildissis
- Athens University, Faculty of Nursing, ICU at KAT General Hospital, Nikis 2, 14561, Kifissia, Athens, Greece.
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Abstract
Sleep is an essential part of life with many important roles which include immunologic, cognitive and muscular functions. Of the working population 20% report sleep disturbances and in critically ill patients an incidence of more than 50% has been shown. However, sleep disturbances in the intensive care unit (ICU) population have not been investigated in detail. Sleep disturbances in ICU patients have a variety of reasons: e.g. patient-related pathologies like sepsis, acute or chronic pulmonary diseases, cardiac insufficiency, stroke or epilepsy, surgery, therapeutical interventions like mechanical ventilation, noise of monitors, pain or medication. Numerous scales and questionnaires are used to quantify sleep and the polysomnogramm is used to objectify sleep architecture. To improve sleep in ICU patients concepts are needed which include in addition to pharmacological treatment (pain reduction and sedation) synchronization of ICU activities with daylight, noise reduction and music for relaxation. In order to establish evidence-based guidelines, research activities about sleep and critical illness should be intensified. Questions to be answered are: 1) Which part of sleep disturbances in critically ill patients is directly related to the illness or trauma? 2) Is the grade of sleep disturbance correlated with the severity of the illness or trauma? 3) Which part is related to the medical treatment and can be modified or controlled? In order to define non-pharmacological and pharmacological concepts to improve sleep quality, studies need to be randomized and to include different ICU populations. The rate of nosocomial infections, cognitive function and respiratory muscle function should be considered in these studies as well. This will help to answer the question, whether it is useful to monitor sleep in ICU patients as a parameter to indicate therapeutical success and short-term quality of life. Follow-up needs to be long enough to detect adverse effects of withdrawal symptoms after termination of analgesia and sedation or delirium.
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Affiliation(s)
- B Walder
- Service d'Anesthésiologie, Hôpitaux Universitaires, Rue Micheli-du-Crest 24, 1211 Genève 14.
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Abstract
Bacteremia and sepsis are common complications of infection in older patients. Comorbidities, institutionalization, instrumentation, and immunosenescence place older persons at high risk for bacteremia and sepsis, and clinicians must have a heightened suspicion for these infectious disorders in older patients because nonspecific clinical manifestations of infection are common in this vulnerable population. Although increasing age is associated with a high risk of death due to bacteremia and sepsis, recent evidence suggests that many older patients respond well to treatments of proven efficacy. This article discusses the epidemiology, pathophysiology, diagnosis, and prognosis of bacteremia and sepsis in older patients and provides evidence-based recommendations regarding the treatment of these infectious disorders in older persons.
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Affiliation(s)
- Timothy D Girard
- Division of Allergy, Pulmonary, and Critical Care Medicine, Center for Health Services Research, Vanderbilt University School of Medicine, 6th Floor Medical Center East, Suite 6100, Nashville, TN 37232-8300, USA.
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Hofhuis JGM, Spronk PE, van Stel HF, Schrijvers GJP, Rommes JH, Bakker J. The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study. Chest 2007; 133:377-85. [PMID: 17925419 DOI: 10.1378/chest.07-1217] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The time course of changes in health-related quality of life (HRQOL) following discharge from the ICU and during a general ward stay has not been studied. We therefore studied the immediate impact of critical illness on HRQOL and its recovery over time. METHODS In a prospective study, all patients admitted to the ICU for > 48 h who ultimately survived to follow-up at 6 months were included. The Medical Outcomes Study 36-item short form was used to measure HRQOL before ICU admission, at discharge from the ICU and hospital, and at 3 and 6 months following discharge from the ICU and hospital. An age-matched healthy Dutch population was used as a reference. RESULTS Of the 451 included patients, 252 could be evaluated at 6 months (40 were lost to follow-up, and 159 died). Pre-ICU admission HRQOL in survivors was significantly worse compared to the healthy population. Patients who died between ICU admission and long-term follow-up had significantly worse HRQOL in all dimensions already at ICU admission when compared to the long-term survivors. HRQOL decreased in all dimensions (p < 0.001) during ICU stay followed by a rapid improvement during hospital stay, gradually improving to near pre-ICU admission HRQOL at 6 months following ICU discharge. Physical functioning (PF), general health (GH), and social functioning (SF) remained significantly lower than pre-ICU admission values. Compared to the healthy Dutch population, ICU survivors had significantly lower HRQOL 6 months following ICU discharge (except for the bodily pain score). CONCLUSIONS A sharp multidimensional decline in HRQOL occurs during ICU admission where recovery already starts following ICU discharge to the general ward. Recovery is incomplete for PF, GH, and SF when compared to baseline values and the healthy population.
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Affiliation(s)
- Jose G M Hofhuis
- Erasmus MC University Medical Center Rotterdam, Department of ICU, PO Box 2040, Room HS320, 3000 CA Rotterdam, the Netherlands
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Broessner G, Helbok R, Lackner P, Mitterberger M, Beer R, Engelhardt K, Brenneis C, Pfausler B, Schmutzhard E. Survival and long-term functional outcome in 1,155 consecutive neurocritical care patients*. Crit Care Med 2007; 35:2025-30. [PMID: 17855816 DOI: 10.1097/01.ccm.0000281449.07719.2b] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To analyze survival, mortality, and long-term functional disability outcome and to determine predictors of unfavorable outcome in critically ill patients admitted to a neurologic intensive care unit (neuro-ICU). DESIGN Retrospective cohort study with post-neuro-ICU health-related evaluation of functional long-term outcome. SETTING Ten-bed neuro-ICU in a tertiary care university hospital. PATIENTS A consecutive cohort of 1,155 patients admitted to a neuro-ICU during a 36-month period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 1,155 consecutive patients, of whom 41% were women, were enrolled in the study. The predominant reasons for neuro-ICU care were cerebrovascular diseases, such as intracerebral hemorrhage (20%), subarachnoid hemorrhage (16%), and complicated, malignant ischemic stroke (15%). A total of 213 patients (18%) died in the neuro-ICU. The Glasgow Outcome Scale and modified Rankin scale were dichotomized into two groups determining unfavorable vs. favorable outcome (Glasgow Outcome Scale scores 1-3 vs. 4-5 and modified Rankin scale scores 2-6 vs. 0-1). Factors associated with unfavorable outcome in the unselected cohort according to logistic regression analysis were admission diagnosis, age (p < .01), and a higher score in the simplified Therapeutic Intervention Scoring System (TISS-28) at time of admission (p < .01). Functional long-term outcome was evaluated by telephone interview for 662 patients after a median follow-up of approximately 2.5 yrs by evaluating modified Rankin scale and Glasgow Outcome Scale scores. Factors associated with unfavorable functional long-term outcome were admission diagnosis, sex, age of >70 yrs (odds ratio, 8.45; 95% confidence interval, 4.52-15.83; p < .01), TISS-28 of >40 points at admission (odds ratio, 4.05; 95% confidence interval, 2.54-6.44; p < .01), TISS-28 of >40 points at discharge from the neuro-ICU (odds ratio, 3.50; 95% confidence interval, 1.51-8.09; p < .01), and length of stay (odds ratio, 1.01; 95% confidence interval, 1.00-1.03; p = .02). CONCLUSION We found admission diagnosis, age, length of stay, and TISS-28 scores at admission and discharge to be independent predictors of unfavorable long-term outcome in an unselected neurocritical care population.
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Affiliation(s)
- Gregor Broessner
- Neurologic Intensive Care Unit, Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria.
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Abelha FJ, Santos CC, Maia PC, Castro MA, Barros H. Quality of life after stay in surgical intensive care unit. BMC Anesthesiol 2007; 7:8. [PMID: 17650325 PMCID: PMC1949812 DOI: 10.1186/1471-2253-7-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 07/24/2007] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In addition to mortality, Health Related Quality of Life (HRQOL) has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL) six months after discharge from an Intensive Care Unit (ICU), and to study its determinants. METHODS All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS), type and magnitude of surgical procedure, ICU and hospital length of stay (LOS), mortality and Simplified Acute Physiology Score II (SAPS II). Six months after discharge, a Short Form-36 questionnaire (SF-36) and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. RESULTS Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV), had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01-1.11, p = 0,016). Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI) and personal ADL (ADLP). ASA-PS (OR 3.00, 95%CI 1.31-6.87, p = 0.009) and age (OR 2.36, 95%CI, 1.04-5.34, p = 0.04) were associated with dependency in ADLI. For ADLP, only ASA-PS (OR 4.58, 95%CI, 1.68-12.46, p = 0.003) was associated with higher dependency. CONCLUSION ASA-PS, age, type of surgery, ICU LOS and SAPS II could be seen as determinants of HRQOL.
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Affiliation(s)
- Fernando J Abelha
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Cristina C Santos
- Biostatistics and Medical Informatics Department, University of Porto Medical School, Porto, Portugal
| | - Paula C Maia
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Maria A Castro
- Department of Anesthesia and Intensive Care, Hospital de São João, Porto, Portugal
| | - Henrique Barros
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal
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Boer KR, van Ruler O, Reitsma JB, Mahler CW, Opmeer BC, Reuland EA, Gooszen HG, de Graaf PW, Hesselink EJ, Gerhards MF, Steller EP, Sprangers MA, Boermeester MA, De Borgie CA. Health related quality of life six months following surgical treatment for secondary peritonitis--using the EQ-5D questionnaire. Health Qual Life Outcomes 2007; 5:35. [PMID: 17601343 PMCID: PMC1950493 DOI: 10.1186/1477-7525-5-35] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Accepted: 07/02/2007] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To compare health related quality of life (HR-QoL) in patients surgically treated for secondary peritonitis to that of a healthy population. And to prospectively identify factors associated with poorer (lower) HR-QoL. DESIGN A prospective cohort of secondary peritonitis patients was mailed the EQ-5D and EQ-VAS 6-months following initial laparotomy. SETTING Multicenter study in two academic and seven regional teaching hospitals. PATIENTS 130 of the 155 eligible patients (84%) responded to the HR-QoL questionnaires. RESULTS HR-QoL was significantly worse on all dimensions in peritonitis patients than in a healthy reference population. Peritonitis characteristics at initial presentation were not associated with HR-QoL at six months. A more complicated course of the disease leading to longer hospitalization times and patients with an enterostomy had a negative impact on the mobility (p = 0.02), self-care (p < 0.001) and daily activities: (p = 0.01). In a multivariate analysis for the EQ-VAS every doubling of hospital stay decreases the EQ-VAS by 3.8 points (p = 0.015). Morbidity during the six-month follow-up was not found to be predictive for the EQ-5D or EQ-VAS. CONCLUSION Six months following initial surgery, patients with secondary peritonitis report more problems in HR-QoL than a healthy reference population. Unfavorable disease characteristics at initial presentation were not predictive for poorer HR-QoL, but a more complicated course of the disease was most predictive of HR-QoL at 6 months.
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Affiliation(s)
- Kimberly R Boer
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Oddeke van Ruler
- Department of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - Johannes B Reitsma
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Cecilia W Mahler
- Department of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - Brent C Opmeer
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - E Ascelijn Reuland
- Department of Surgery, Academic Medical Center Amsterdam, The Netherlands
| | - Hein G Gooszen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter W de Graaf
- Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Eric J Hesselink
- Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - E Philip Steller
- Department of Surgery, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Mirjam A Sprangers
- Department of Medical Psychology, Academic Medical Center Amsterdam, The Netherlands
| | | | - Corianne A De Borgie
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
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Chon GR, Choi IS, Lim CM, Koh Y, Oh YM, Shim TS, Lee SD, Kim WS, Kim DS, Kim WD, Hong SB. The 3 years Prognosis of Patients with Long Term Mechanical Ventilation in Medical Intensive Care Unit at a University Hospital. Tuberc Respir Dis (Seoul) 2007. [DOI: 10.4046/trd.2007.62.5.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gyu Rak Chon
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Ik Su Choi
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon-Mok Oh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Soon Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Dong Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Bum Hong
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Riou França L, Launois R, Le Lay K, Aegerter P, Bouhassira M, Meshaka P, Guidet B. Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis with multiple organ failure. Int J Technol Assess Health Care 2006; 22:101-8. [PMID: 16673686 DOI: 10.1017/s0266462306050896] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim of this study was to estimate the expected cost and clinical benefits associated with the use of drotrecogin alfa (activated) (Xigris; Eli Lilly and Company; Indianapolis, IN) in the French hospital setting. METHODS The recombinant human activated PROtein C Worldwide Evaluation in Severe Sepsis (PROWESS) study results (1271 patients with multiple organ failure) were adjusted to 9,948 hospital stays from a database of Parisian area intensive-care units (ICUs)-the CubRea (Intensive Care Database User Group) database. The analysis features a decision tree with a probabilistic sensitivity analysis. RESULTS The cost per life year gained (LYG) of drotrecogin treatment for severe sepsis with multiple organ failure (European indication) was estimated to be dollars 11,812. At the hospital level, the drug is expected to induce an additional cost of dollars 7545 per treated patient. The incremental cost-effectiveness ratio ranges from dollars 7873 per LYG for patients receiving three organ supports during ICU stay to dollars 17,704 per LYG for patients receiving less than two organ supports. CONCLUSIONS Drotrecogin alfa (activated) is cost-effective in the treatment of severe sepsis with multiple organ failure when added to best standard care. The cost-effectiveness of the drug increases with baseline disease severity, but it remains cost-effective for all patients when used in compliance with the European approved indication.
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Williams TA, Dobb GJ, Finn JC, Webb SAR. Long-term survival from intensive care: a review. Intensive Care Med 2005; 31:1306-15. [PMID: 16132895 DOI: 10.1007/s00134-005-2744-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Accepted: 07/01/2005] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether the long-term benefit of an ICU requires prolonged patient follow-up we reviewed long-term survival of patients from general ICUs. METHOD We carried out a computerised search of online databases Medline (1966-2004), Embase (1966-2004) and Cochrane Library (1966-2004) for studies reporting patients' long-term survival for greater than 12 months from general ICUs. SELECTED STUDIES: We identified 19 studies that met the selection criteria. The casemix and severity of illness varied. Differences included the services provided, investigator inclusion/exclusion criteria and proportion of medical patients (range 13-79%). RESULTS Mean reported ICU length of stay was 5.3 days. The study initiation time for follow-up varied (mostly from time of ICU admission), as did the duration of follow-up (16 months-13 years). ICU and hospital mortality rates ranged from 8% to 33% and 11% to 64%, respectively. The reported 5-year mortality ranged from 40% to 58%. CONCLUSIONS Well designed studies on long-term outcomes are needed to demonstrate the value of intensive care. Deficiencies in design, methodology, and reporting make interpretation and comparison difficult. Recommendations are made for the reporting of outcome from the ICU. Optimum duration of follow-up has not been determined.
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Orwelius L, Nordlund A, Edéll-Gustafsson U, Simonsson E, Nordlund P, Kristenson M, Bendtsen P, Sjöberg F. Role of preexisting disease in patients' perceptions of health-related quality of life after intensive care. Crit Care Med 2005; 33:1557-64. [PMID: 16003062 DOI: 10.1097/01.ccm.0000168208.32006.1c] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To find out how patients perceive their health-related quality of life after they have been treated in an intensive care unit and whether preexisting disease influenced their perception. DESIGN : Follow-up, quantitative, dual-site study. SETTING Combined medical and surgical intensive care units of one university and one general hospital in Sweden. PATIENTS Among the 1,938 patients admitted, 562 were considered eligible (>24 hrs in the intensive care unit, and age >18 yrs). The effect of preexisting disease was assessed by use of a large reference group, a random sample (n = 10,000) of the main intake area of the hospitals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During 2000-2002, data were collected from the intensive care unit register and from a questionnaire mailed to the patients 6 months after their discharge from hospital. Subjects in the reference group were sent postal questionnaires during 1999. Of the patients in the intensive care unit group, 74% had preexisting diseases compared with 51% in the reference group. Six months after discharge, health-related quality of life was significantly lower among patients than in the reference group. When comparisons were restricted to the previously healthy people in both groups, the observed differences were about halved, and when we compared the patients in the intensive care unit who had preexisting diseases with subjects in the reference group who had similar diseases, we found little difference in perceived health-related quality of life. In some dimensions of health-related quality of life, we found no differences between patients in the intensive care unit and the subjects in the reference population. CONCLUSIONS Preexisting diseases significantly affect the extent of the decline of health-related quality of life after critical care, and this effect may have been underestimated in the past. As most patients who are admitted to an intensive care unit have at least one preexisting disease, it is important to account for these effects when examining outcome.
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Affiliation(s)
- Lotti Orwelius
- Department of Intensive Care, National Centre for Work and Rehabilitation, University/University Hospital of Linköping, Sweden
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Ahlström A, Tallgren M, Peltonen S, Räsänen P, Pettilä V. Survival and quality of life of patients requiring acute renal replacement therapy. Intensive Care Med 2005; 31:1222-8. [PMID: 16049711 DOI: 10.1007/s00134-005-2681-6] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2004] [Accepted: 05/26/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess long-term survival and health-related quality of life in patients with acute renal failure. DESIGN AND SETTING Cross-sectional cohort study in the ten-bed medical-surgical intensive care unit and the three-bed acute dialysis unit in a tertiary care hospital. PATIENTS 703 patients receiving renal replacement therapy for acute renal failure during 1998-2002. MEASUREMENTS AND RESULTS The mortality rate was 41% at 28 days, 57% at 1 year, and 70% at 5 years. SOFA score, age, and continuous renal replacement therapy were independent predictors of 1-year mortality. The median follow-up time was 3.9 years for mortality and 2.4 years for health-related quality of life. Of the 229 survivors in 2003, 153 (67%) responded to the health-related quality of life questionnaire. Health-related quality of life was evaluated with the EuroQol (EQ-5D) instrument including a visual analogue scale (VAS) score to evaluate the patient's perceived health. The EQ-5D score was significantly lower in the study population than in the age- and gender-matched Finnish population (0.68 vs. 0.86). Median VAS scores were 69.5 and 70.0, respectively. Patients' age and duration of follow-up had no significant effect on EQ-5D or VAS scores. Mortality and EQ-5D data were used to calculate quality-adjusted life years. Quality-adjusted survival was poor (15 quality-adjusted life years per 100 patients in the first year of follow-up). CONCLUSIONS The long-term survival of patients with acute renal failure is poor. Although survivors have a low health-related quality of life, they are as satisfied with their health as the general population.
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Affiliation(s)
- Annika Ahlström
- Intensive Care Unit, Division of Anesthesiology and Intensive Care Medicine, Department of Surgery, Helsinki University Central Hospital, Finland.
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Euteneuer S, Windisch W, Suchi S, Köhler D, Jones PW, Schönhofer B. Health-related quality of life in patients with chronic respiratory failure after long-term mechanical ventilation. Respir Med 2005; 100:477-86. [PMID: 16039838 DOI: 10.1016/j.rmed.2005.06.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Accepted: 06/09/2005] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVES This study was aimed at assessing health-related quality of life (HRQL) in patients with chronic respiratory failure (CRF) and long-term survival following prolonged intensive care mechanical ventilation. DESIGN Observational cohort study. SETTING Patients with CRF who had been transferred to our specialized weaning centre due to prolonged mechanical ventilation (>14 days) and weaning failure. PATIENTS AND PARTICIPANTS Out of 87 long-term survivors (>6 months), 73 patients (mean age: 60.3+/-13.6 years, chronic obstructive pulmonary disease (COPD, 43%), thoraco-restrictive (21%) or neuromuscular disorders (15%), various chronic diseases (22%)) returned the MOS 36-Item Short-Form Health Status Survey (SF-36) and the St. George's respiratory questionnaire (SGRQ). MEASUREMENTS AND RESULTS The total ventilation time was 38.7+/-45.9 days. The time between discharge from ICU and HRQL assessment was 31.0+/-22.2 months. Physical health was markedly reduced compared to general population norm, but mental health was mildly impaired. HRQL was comparable to patients with stable CRF receiving non-invasive ventilation who did not need prolonged invasive MV. In addition, general HRQL was better in patients with restrictive respiratory disease compared to patients with neuromuscular diseases (P<0.05). Physiological parameters such as blood gases or lung function parameters were not correlated to any HRQL measurements. CONCLUSIONS In patients with CRF surviving prolonged ventilation on ICU, the presence of CRF itself is the major determinant of HRQL. Here, the underlying cause of CRF is the major factor which determines the degree of HRQL impairment with patients suffering from restrictive ventilatory disorders reporting the best HRQL when compared to patients with COPD or neuromuscular diseases. Despite severe physical handicaps due to CRF mental health is only mildly compromised.
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Marino BS. Health-related quality-of-life assessment after intensive care therapy: Preexisting disease matters*. Crit Care Med 2005; 33:1658-9. [PMID: 16003086 DOI: 10.1097/01.ccm.0000171804.47527.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Factores pronósticos de mortalidad en pacientes con enfermedad pulmonar obstructiva crónica tras su ingreso en una Unidad de Medicina Intensiva. El papel de la calidad de vida. Med Intensiva 2005. [DOI: 10.1016/s0210-5691(05)74229-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Quality of life is often thought to be poor before and after intensive care unit admission. The aim of this study was to investigate changes in quality of life before and after intensive care. A prospective cohort study of 300 consecutive patients admitted to intensive care was performed in a Scottish Teaching Hospital. Quality of life was assessed premorbidly and 3, 6 and 12 months after intensive care admission for surviving patients using SF-36 as well as EQ-5D scores at 12 months. The median value for age was 60.5 years and for APACHE II score, 18. The mean length of stay was 6.7 days. SF-36 physical component scores decreased from premorbid values at 3 months (p = 0.05) and then returned to premorbid values at 12 months (p < 0.001). The mean physical scores were below the population norm at all time points but the mean mental scores were similar or higher than these population norms. Patients who died after intensive care discharge had lower quality of life scores than did survivors (all p < 0.01). Poor premorbid quality of life was demonstrated and appears to reduce after ICU discharge. For survivors there was a slow increase in physical quality of life to premorbid levels by the end of the first year but these remained lower than in the general population. ICU patients experience a considerable longer-term burden of ill health.
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Affiliation(s)
- B H Cuthbertson
- Health Services Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK.
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Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, Needham DM. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 2005; 31:611-20. [PMID: 15803303 DOI: 10.1007/s00134-005-2592-6] [Citation(s) in RCA: 355] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Accepted: 02/17/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine how the quality of life (QOL) of intensive care unit (ICU) survivors compares with the general population, changes over time, and is predicted by baseline characteristics. DESIGN Systematic literature review including MEDLINE, EMBASE, CINAHL and Cochrane Library. Eligible studies measured QOL > or = 30 days after ICU discharge using the Medical Outcomes Study 36-item Short Form (SF-36), EuroQol-5D, Sickness Impact Profile, or Nottingham Health Profile in representative populations of adult ICU survivors. Disease-specific studies were excluded. MEASUREMENTS AND RESULTS Of 8,894 citations identified, 21 independent studies with 7,320 patients were reviewed. Three of three studies found that ICU survivors had significantly lower QOL prior to admission than did a matched general population. During post-discharge follow-up, ICU survivors had significantly lower QOL scores than the general population in each SF-36 domain (except bodily pain) in at least four of seven studies. Over 1-12 months of follow-up, at least two of four studies found clinically meaningful improvement in each SF-36 domain except mental health and general health perceptions. A majority of studies found that age and severity of illness predicted physical functioning. CONCLUSIONS Compared with the general population, ICU survivors report lower QOL prior to ICU admission. After hospital discharge, QOL in ICU survivors improves but remains lower than general population levels. Age and severity of illness are predictors of physical functioning. This systematic review provides a general understanding of QOL following critical illness and can serve as a standard of comparison for QOL studies in specific ICU subpopulations.
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Affiliation(s)
- David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Elliott D, Mudaliar Y, Kim C. Examining discharge outcomes and health status of critically ill patients: some practical considerations. Intensive Crit Care Nurs 2004; 20:366-77. [PMID: 15567678 DOI: 10.1016/j.iccn.2004.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This prospective observational study examined the outcomes of 200 consecutive admissions to an adult tertiary level Intensive Care Unit (ICU). Eligible and consenting participants were also involved in a sub-study that examined health status at four measurement points from pre-illness to 6 months post-discharge. Of the 189 individual patients admitted, 23% died in ICU and 57% were discharged home. The health status sub-study enrolled 34 participants (39% of eligible patients) who were representative of the ICU population for demographic and clinical variables. Surviving participants returned to a similar, though not identical state of health at 6 months post-discharge, when compared to their pre-ICU health-state using the 15D and SF-36 instruments. Health status at ICU discharge was significantly impaired when compared to other measurement points, particularly for mobility, breathing, eating, usual activities and vitality. A number of methodological challenges were evident, particularly for the health status sub-study, including prospective subject recruitment and retention, losses to follow-up and instrument responsiveness. Despite the limitations noted, the study provided useful findings and recommendations for the continued development of methods to examine the health status of critically ill patients.
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Affiliation(s)
- Doug Elliott
- Prince of Wales Hospital, Randwick and Department of Clinical Nursing, The University of Sydney, Sydney, NSW 2006, Australia.
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Boyle M, Murgo M, Adamson H, Gill J, Elliott D, Crawford M. The effect of chronic pain on health related quality of life amongst intensive care survivors. Aust Crit Care 2004; 17:104-6, 108-13. [PMID: 15493858 DOI: 10.1016/s1036-7314(04)80012-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Intensive care unit (ICU) survivors report reductions in health-related quality of life (HR-QOL), whilst chronic pain is common in the general population. However, it is unknown whether there are associations between the experience of ICU and the incidence of chronic pain. A questionnaire--Pain Scale, Pain Self-Efficacy Questionnaire (PSEQ), Centre of Epidemiology Study Depression Scale (CES-D Scale) and the Short Form Health Survey (SF-36)--was sent to 99 consenting patients who had been in the ICU for >48 hours. Sixty-six and 52 questionnaires were returned at 1 and 6 months respectively. There was a general limitation in activities of daily living; younger ages (36-65 years) experienced a decease in work performance and other physical activities. Bodily pain increased, general health diminished, and engagements in social activities were severely affected. There was a decline in mental health for those 36-65 years of age. HR-QOL improved over time; 28% experienced chronic pain and had longer hospital length of stay (LOS), tended to have longer ICU LOS and were ventilated for longer. Those with chronic pain had significant reductions in physical function, bodily pain, general health and vitality. Ventilator hours and hospital LOS were associated with risk of chronic pain (OR 1.09, p=0.033 and OR 1.27, p=0.046). HR-QOL in ICU survivors declined, although there was a general improvement from 1-6 months. This decline in HR-QOL affected younger people (less than 65 years) more than older people. Chronic pain is a significant issue post ICU and is associated with poorer HR-QOL.
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Affiliation(s)
- Martin Boyle
- Intensive Care Unit, Prince of Wales Hospital, NSW
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Lamer C, Harboun M, Knani L, Moreau D, Tric L, LeGuillou JL, Gasquet I, Moreau T. Quality of life after complicated elective surgery requiring intensive care. Intensive Care Med 2004; 30:1594-601. [PMID: 15085322 DOI: 10.1007/s00134-004-2260-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2003] [Accepted: 02/25/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate outcomes of patients admitted to the ICU for complications after elective surgery and to assess perceived quality of life (pQOL) in survivors. DESIGN Two-year prospective case-control study. SETTING Twelve-bed ICU in a university-affiliated hospital. PATIENTS Patients admitted to the ICU for a complication following elective surgery were included. Six months after discharge, pQOL was assessed using the Nottingham Health Profile (NHP). Results were compared to those of matched controls without complications. INTERVENTIONS None. MEASUREMENTS AND RESULTS Of the 182 patients, 124 were alive after 6 months, among whom 116 had 6-month data and 104 of these had matched controls. Overall pQOL as assessed by the global NHP score was similar in both groups (median, 0.82 and 0.87 in cases and controls; P=0.24). NHP subscores showed significantly worse pain ( P=0.03) and physical impairment ( P=0.02) in the ICU patients. In the multivariate analysis, pQOL was better in patients with cancer as the reason for surgery ( P=0.05). Severity of illness at inclusion had no influence on subsequent pQOL, but cardiovascular dysfunction was associated with decreased energy ( P=0.04). CONCLUSIONS Although overall pQOL was satisfactory after 6 months, patients admitted to the ICU for postoperative complications had worse pain and physical impairment than controls. Whether these outcomes could be improved by early physiotherapy and aggressive pain management deserves investigation.
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Affiliation(s)
- Christian Lamer
- Département de Réanimation Polyvalente, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75674 Paris, France.
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Dimopoulou I, Anthi A, Mastora Z, Theodorakopoulou M, Konstandinidis A, Evangelou E, Mandragos K, Roussos C. Health-Related Quality of Life and Disability in Survivors of Multiple Trauma One Year After Intensive Care Unit Discharge. Am J Phys Med Rehabil 2004; 83:171-6. [PMID: 15043350 DOI: 10.1097/01.phm.0000107497.77487.c1] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate health-related quality of life and disability in multiple-trauma patients requiring intensive care unit management. DESIGN A total of 87 survivors of multiple trauma, with a median age of 31 yrs and a median Injury Severity Score of 22, were enrolled in the present study. The Nottingham Health Profile, Glasgow Outcome Scale, and Rosser Disability Scale were used to assess the functional consequences of trauma 1 yr after intensive care unit discharge. RESULTS A total of 64 of 87 patients had a problem in at least one of the six domains related to subjective health status. The most prevalent complaint was related to somatic subdimensions, but emotional functioning was also affected. Nottingham Health Profile part 2 showed that 63 of the survivors experienced problems in at least one of the daily activities. Of particular importance, inability to work was reported by 47% of the patients. Fifty-nine percent experienced moderate-to-severe disability as evaluated by Glasgow Outcome Scale and Rosser Disability Scale. High aggregate injury severity score along with severe head trauma were independent predictors of poor health-related quality of life and disability. CONCLUSIONS The majority of survivors of major trauma exhibit considerable levels of disability and impairment in health-related quality of life. Global injury severity score and degree of brain trauma determine functional limitations. This information may help in organizing long-term rehabilitation of multiple-trauma patients.
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Affiliation(s)
- Ioanna Dimopoulou
- Department of Critical Care Medicine, Evangelismos Hospital, Athens, Greece
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Parthasarathy S, Tobin MJ. Sleep in the intensive care unit. Intensive Care Med 2004; 30:197-206. [PMID: 14564378 DOI: 10.1007/s00134-003-2030-6] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2003] [Accepted: 09/08/2003] [Indexed: 12/22/2022]
Abstract
Abnormalities of sleep are extremely common in critically ill patients, but the mechanisms are poorly understood. About half of total sleep time occurs during the daytime, and circadian rhythm is markedly diminished or lost. Judgments based on inspection consistently overestimate sleep time and do not detect sleep disruption. Accordingly, reliable polygraphic recordings are needed to measure sleep quantity and quality in critically ill patients. Critically ill patients exhibit more frequent arousals and awakenings than is normal, and decreases in rapid eye movement and slow wave sleep. The degree of sleep fragmentation is at least equivalent to that seen in patients with obstructive sleep apnea. About 20% of arousals and awakenings are related to noise, 10% are related to patient care activities, and the cause for the remainder is not known; severity of underlying disease is likely an important factor. Mechanical ventilation can cause sleep disruption, but the precise mechanism has not been defined. Sleep disruption can induce sympathetic activation and elevation of blood pressure, which may contribute to patient morbidity. In healthy subjects, sleep deprivation can decrease immune function and promote negative nitrogen balance. Measures to improve the quantity and quality of sleep in critically ill patients include careful attention to mode of mechanical ventilation, decreasing noise, and sedative agents (although the latter are double-edged swords).
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Affiliation(s)
- Sairam Parthasarathy
- Division of Pulmonary and Critical Care Medicine Edward Hines Jr., Veterans Administrative Hospital, Loyola University of Chicago Stritch School of Medicine, Route 111 N, Hines, IL 60141, USA.
| | - Martin J Tobin
- Division of Pulmonary and Critical Care Medicine Edward Hines Jr., Veterans Administrative Hospital, Loyola University of Chicago Stritch School of Medicine, Route 111 N, Hines, IL 60141, USA
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