Recovery following discharge from intensive care: What do patients think is helpful and what services are missing?

Prevalence of Post-intensive care syndrome among intensive care unit-survivors and its association with intensive care unit length of stay: Systematic review and meta-analysis

BACKGROUND

Post-intensive Care Syndrome (PICS) is defined as various physical, psychological, and cognitive, impairments that can arise during an ICU stay, continue after leaving the ICU, or even persist following hospital discharge. It impacts both patients and their family's quality of life. Various primary studies worldwide have reported prevalence of PICS among ICU survivors. However, these studies exhibit inconsistency and wide variations. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of post intensive care syndrome among intensive care unit survivors along with its association with ICU length of stay.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist for this review. We searched PubMed/Medline, CINHAL, Embase, and Google scholar to retrieve articles. The Newcastle Ottawa Scale (NOS) was used for quality assessment of articles. The random effects model with I-squared test was used to estimate the prevalence of PICS and its association with ICU length of stay. To identify the source of heterogeneity within the included studies, meta-regression and subgroup analysis were used. We employed Egger's regression test and funnel plots for assessing publication bias. STATA version 17.0 software was used for all statistical analyses. A p-value of < 0.05 with 95% confidence interval was used declare statistically significant.

RESULTS

A total of 19 articles with a population of 10179 ICU-survivors were included in this review. The pooled prevalence of PICS was found to be 54.35% (95% CI = 45.54, 63.15). In sub-group analysis by region, the highest prevalence was observed in studies done in south and north America with overall prevalence of 61.95% (95% CI = 28.33, 95.62). Among the three domains of PICS (physical, cognitive and mental domains), the highest prevalence score was observed in the physical domain with overall prevalence of 45.99% (95% CI = 34.66, 57.31). In this meta-analysis, those patients who stayed more than four days in the ICU were 1.207 [95% CI = 1.119, 1.295] times more likely to develop at least one among the three domains of PICS in the post-intensive care period than their counterparts.

CONCLUSION

This systematic review and meta-analysis demonstrate a high prevalence of PICS among ICU survivors, and highlight the significant association between ICU length of stay and the development of PICS. These findings underscore the need for targeted interventions to mitigate the long-term effects of critical illness, particularly for patients with prolonged ICU stays.

Remote multicomponent rehabilitation compared to standard care for survivors of critical illness after hospital discharge (iRehab): a protocol for a randomised controlled assessor-blind clinical and cost-effectiveness trial

Background

The consequences of critical illness can be substantial and multifactorial, encompassing physical deconditioning, mental health impairments, fatigue, and declines in health-related quality of life. We hypothesise that for people discharged after intensive care unit (ICU) for a critical illness, a six-week remote multicomponent rehabilitation intervention improves health-related quality of life, physical function, fatigue, mood, and other health-related outcomes after eight weeks, compared to standard care.

Methods

This is a pragmatic, randomised controlled, open-label, assessor blind, multicentre, clinical and cost effectiveness trial with internal pilot and embedded process evaluation. Recruitment will take place in NHS hospitals across the UK. Adults (n=428: control n= 197; intervention: n=231) within 12 weeks of discharge from hospital following an ICU admission for critical illness, requiring mechanical ventilation ≥48hours will be recruited.The intervention is a six week multicomponent, structured, rehabilitation programme, delivered remotely by a trained intervention team. The intervention includes four components: weekly symptom management; targeted exercise; psychological support, and peer support and information. The control group will receive standard NHS care.The primary outcome is Health-related quality of life (HRQoL) at eight weeks post-randomisation measured using the EQ-5D-5L. Secondary outcomes are: HRQoL (six months), physical function, fatigue, anxiety and depression, healthcare resource use at eight weeks and six months and intervention acceptability.

Conclusions

This trial will test a centrally delivered mulitcomponent rehabilitation intervention for survivors of critical illness, irrespective of geographic location or critical illness diagnosis.

Trial registration

The trial is registered (04.07.2022) with the International Standard Randomised Controlled Trial Number (ISRCTN) Register ISRCTN11266403 https://doi.org/10.1186/ISRCTN11266403.

Missing data and long-term outcomes from nutrition research in the critically ill

PURPOSE OF REVIEW

The use of functional outcomes in critical care nutrition research is increasingly advocated; however, this inevitably gives rise to missing data. Consequently there is a need to adopt modern approaches to the foreseeable problem of missing functional and survival outcomes in research trials.

RECENT FINDINGS

Analyses that ignore unobserved or missing data will often return biased effect estimates. An improved approach is to routinely anticipate the types and extent of missing data, and consider the likely mechanisms of that missingness. The researcher and their statistical advisor may then choose from a number of modern strategies to assess the sensitivity of the research conclusions to the patterns of missingness contained in these research data. Methods widely employed include multiple imputation of missing observations, mixed regression models, use of composite outcome variables with patients who die being attributed a value reflecting the lack of ability to function, and selected Bayesian methodology.

SUMMARY

Conclusions from clinical research in critical care nutrition will become more clinically interpretable and generalizable with the adoption of modern methods for the statistical handling of missing data.