A protocol for tracking outcomes post intensive care

Tracking Outcomes Post Intensive Care: Findings of a longitudinal observational study

BACKGROUND

Many intensive care unit (ICU) survivors experience new or worsening impairments, termed post-intensive care syndrome. Substantial investment has been made in identifying patients at risk and developing interventions, but evidence remains equivocal. A more nuanced understanding of risk and outcomes is therefore warranted.

OBJECTIVES

This study aimed to describe patients' health status 6 months after ICU discharge and characterise those with, and without, clinically significant physical, cognitive, or psychological impairments.

METHODS

In this prospective, multisite observational study, patients discharged from four ICUs were screened and invited to participate. Consenting participants completed a questionnaire-based survey by telephone that encompassed preadmission characteristics and validated self-report questionnaires of physical and cognitive function, anxiety, depression, and post-traumatic stress disorder. Routine ICU data were collected from hospital records. Participants reporting clinically significant impairments were compared with those not reporting impairments on demographics and hospital data.

RESULTS

A total of 132 participants completed 6-month follow-up: 30% reported impairments in any domain. Of these, 43% reported impairments in two or more domains. The rates of impairment varied between sites, ranging from 21% to 88%. Depression was most common, followed by physical impairment, anxiety, and cognitive impairment, with post-traumatic stress disorder being the least common.

PARTICIPANTS

Reporting impairments did not differ significantly from others on Acute Physiology and Chronic Health Evaluation II scores, delirium rates, mechanical ventilation rates, or duration and length of stay. Planned admissions were less common in the impairment group, as was inotrope use. Mental health diagnosis was not associated with post-ICU impairments.

CONCLUSIONS

This study demonstrates the heterogeneity of patients experiencing impairments after ICU discharge and highlights the importance of attending to patients' unique circumstances, encompassing characteristics and treatment factors, when assessing risk and planning support. Whilst generalisability is uncertain, these findings support a whole of health service approach towards post-ICU recovery.

Time in ICU and post-intensive care syndrome: how long is long enough?

BACKGROUND

Our understanding of post-ICU recovery is influenced by which patients are selected to study and treat. Many studies currently list an ICU length of stay of at least 24, 48, or 72 h as an inclusion criterion. This may be driven by established evidence that prolonged time in an ICU bed and prolonged ventilation can complicate post-ICU rehabilitation. However, recovery after short ICU stays still needs to be explored.

METHODS

This is a secondary analysis from the tracking outcomes post-intensive care (TOPIC) study. One hundred and thirty-two participants were assessed 6-months post-ICU discharge using standardised and validated self-report tools for physical function, cognitive function, anxiety, depression and post-traumatic stress disorder (with clinically significant impairment on any tool being considered a complicated recovery). Routinely collected data relating to the ICU stay were retrospectively accessed, including length of stay and duration of mechanical ventilation. Patients with short ICU stays were intentionally included, with 77 (58%) participants having an ICU length of stay < 72 h.

RESULTS

Of 132 participants, 40 (30%) had at least one identified post-ICU impairment 6 months after leaving ICU, 22 (17%) of whom had an ICU length of stay < 72 h.

CONCLUSION

Many patients with an ICU length of stay < 72 h are reporting post-ICU impairment 6 months after leaving ICU. This is a population often excluded from studies and interventions. Future research should further explore post-ICU impairment among shorter stays.