Long-term Quality of Life After Intensive Care Unit Admission (a Single-Center Observational Study)

Patients may experience long-term physical, psychological and cognitive impairment after intensive care unit (ICU) discharge, a condition commonly described as post-intensive care syndrome. The relative contribution of each of these components to long-term quality of life was never investigated.

The aim of this study is to identify the type and severity of disability and QoL at the discharge from ICU and up to following 6 months.

Material and Methods. All patients (n=218) discharged from a university hospital ICU between April 2016 and July 2017 were eligible. Exclusion criteria included: age <18 years, brain or spinal injury, life expectancy <90 days, and ICU stay <12 hours. The Short Form Health Survey (SF-36), and 5-level EuroQoL-5D (EQ-5D-5L) questionnaires were administered at ICU discharge, and at 30-, 90- and 180-days. We compared patients requiring short-term ICU monitoring (IM, Intensive Monitoring, n=109) or patients requiring ICU treatment (IT, Intensive Treatment, n=109).

Results. All dimensions of SF-36 and EQ-5D-5L parameters increased from ICU discharge to 180-days, except for the SF-36 Synthetic index linked to mental health (P=0.08). All EQ-5D-5L parameters improved significantly in the IT group, while only Visual Analog Scale Health Perception improved in the IM group.

Conclusion. ICU survivors suffer long-term physical and psychological sequelae. The perception of Quality of Life is reduced after ICU discharge. The psychological and cognitive dimensions were more compromised than physical ones. Patients discharged from the ICU may benefit from specific intensive care follow-up clinics addressing their needs in term of psychological and cognitive support.

1. Norman B.C., Jackson J.C., Graves J.A., Girard T.D., Pandharipande P.P., Brummel N.E., Wang L., Thompson J.L., Chandrasekhar R., Ely E.W. Employment Outcomes After Critical Illness: An Analysis of the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors Cohort. Crit Care Med. 2016; 44: 2003-2009. PMID: 27171492. DOI: 10.1097/CCM.0000000000001849

2. Azoulay E., Vincent J.L., Angus D.C., Arabi Y.M., Brochard L., Brett S.J., Citerio G., Cook D.J., Curtis J.R., Dos Santos C.C., Ely E.W., Hall J., Halpern S.D., Hart N., Hopkins R.O., Iwashyna T.J., Jaber S., Latronico N., Mehta S., Needham D.M., Nelson J., Puntillo K., Quintel M., Rowan K., Rubenfeld G., Van den Berghe G., Van der Hoeven J., Wunsch H., Herridge M. Recovery after critical illness: putting the puzzle together-a consensus of 29. Crit Care. 2017; 21: 296. PMID: 29208005. DOI: 10.1186/s13054-017-1887-7.

3. Jensen J.F., Overgaard D., Bestle M.H., Christensen D.F., Egerod I. Towards a new orientation: a qualitative longitudinal study of an intensive care recovery programme. J Clin Nurs. 2017; 26: 77-90. PMID: 27667681. DOI: 10.1111/jocn.13372

4. Rawal G., Yadav S., Kumar R. Post-intensive Care Syndrome: an Overview. J Transl Int Med. 2017; 5: 90-92. PMID: 28721340. DOI: 10.1515/jtim-2016-0016

5. Needham D.M., Davidson J., Cohen H., Hopkins R.O., Weinert C., Wunsch H., Zawistowski C., Bemis-Dougherty A., Berney S.C., Bienvenu O.J., Brady S.L., Brodsky M.B., Denehy L., Elliott D., Flatley C., Harabin A.L., Jones C., Louis D., Meltzer W., Muldoon S.R., Palmer J.B., Perme C., Robinson M., Schmidt D.M., Scruth E., Spill G.R., Storey C.P., Render M., Votto J., Harvey M.A. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012; 40: 502-509. PMID: 21946660. DOI: 10.1097/CCM.0b013e318232da75

6. Gajic O., Ahmad S.R., Wilson M.E., Kaufman D.A. Outcomes of critical illness: what is meaningful? Curr Opin Crit Care. 2018; 24: 394-400. PMID: 30045089. DOI: 10.1097/MCC.0000000000000530

7. McPeake J., Devine H., MacTavish P., Fleming L., Crawford R., Struthers R., Kinsella J., Daniel M., Shaw M., Quasim T. Caregiver strain following critical care discharge: An exploratory evaluation. J Crit Care. 2016; 35: 180-184. PMID: 27481756. DOI: 10.1016/j.jcrc.2016.05.023

8. Balas M.C., Vasilevskis E.E., Burke W.J., Boehm L., Pun B.T., Olsen K.M., Peitz G.J., Ely E.W. Critical care nurses' role in implementing the «ABCDE bundle» into practice. Crit Care Nurse. 2012; 32: 35-38, 40-47. PMID: 22467611. DOI: 10.4037/ccn2012229

9. Ranzani O.T., Zampieri F.G., Besen B.A., Azevedo L.C., Park M. One-year survival and resource use after critical illness: impact of organ failure and residual organ dysfunction in a cohort study in Brazil. Crit Care. 2015; 19: 269. PMID: 26108673. DOI: 10.1186/s13054-015-0986-6

10. Vincent J.L., Shehabi Y., Walsh T.S., Pandharipande P.P., Ball J.A., Spronk P., Longrois D., Str0m T., Conti G.,Funk G.C., Badenes R., Mantz J., Spies C., Takala J. Comfort and patient-centred care without excessive sedation: the eCASH concept. Intensive Care Med. 2016; 42: 962-971. PMID: 27075762. DOI: 10.1007/s00134-016-4297-4

11. Myers E.A., Smith D.A., Allen S.R., Kaplan L.J. Post-ICU syndrome: Rescuing the undiagnosed. JAAPA. 2016; 29: 34-37. PMID: 27023654. DOI: 10.1097/01.JAA.0000481401.21841.32

12. von Elm E., Altman D.G., Egger M., Pocock S.J., G0tzsche P.C., Vandenbroucke J.P.; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007; 147: 573-577. PMID: 17938396. DOI: 10.7326/0003-4819147-8-200710160-00010

13. Vandenbroucke J.P., von Elm E., Altman D.G., G0tzsche P.C., Mulrow C.D., Pocock S.J., Poole C., Schlesselman J.J., Egger M.; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297. PMID: 17941715. DOI: 10.1371/journal.pmed.0040297

14. Orsi L.; Societa Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva. [SIAARTI recommendations for the admission and discharge from Intensive Care and for the limitation of treatments in Intensive Care]. Minerva Anestesiol. 2003; 69: 179. PMID: 12766703

15. Ware J.E. Jr., Sherbourne C.D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. MedCare. 1992; 30: 473-483. PMID: 1593914

16. EuroQol G. EuroQol — a new facility for the measurement of health-related quality of life. Health Policy. 1990; 16: 199-208. PMID: 10109801. DOI: 10.1016/0168-8510 (90)90421-9

17. Aaronson N.K., Acquadro C., Alonso J., Apolone G., Bucquet D., Bullinger M., Bungay K., Fukuhara S., Gandek B., Keller S., Razavi D., Sanson-Fisher R., Sullivan M., Wood-Dauphinee S., Wagner A., Ware J.E. Jr. International Quality of Life Assessment (IQOLA) Project. Qual Life Res. 1992; 1: 349-351. PMID: 1299467. DOI: 10.1007/BF00434949

18. Apolone G., Mosconi P. The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol. 1998; 51: 1025-1036. PMID: 9817120. DOI: 10.1016/s0895-4356(98)00094-8

19. Apolone G., Cifani S., Mosconi P. Questionario sullo stato di salute SF-36. Traduzione e validazione della versione italiana: risultati del progetto IQOLA. Medic. 1997; 2: 86-94.

20. Jammer I., Wickboldt N., Sander M., Smith A., Schultz M.J., Pelosi P., Leva B., Rhodes A., Hoeft A., Walder B., Chew M.S., Pearse R.M. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol. 2015; 32: 88-105. PMID: 25058504. DOI: 10.1097/EJA.0000000000000118

21. Elliott D., McKinley S., Alison J., Aitken L.M., King M., Leslie G.D., Kenny P., Taylor P., Foley R.,.Burmeister E. Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program. Crit Care. 2011; 15: R142. PMID: 21658221. DOI: 10.1186/cc10265

22. Ferrao C., Quintaneiro C., Camila C., Aragao I., Cardoso T. Evaluation of long-term outcomes of very old patients admitted to intensive care: Survival, functional status, quality of life, and quality-adjusted life-years. J Crit Care. 2015; 30: 1150 e7-11. PMID: 26143283. DOI: 10.1016/j.jcrc.2015.05.005

23. Hodgson C.L., Udy A.A., Bailey M., Barrett J., Bellomo R., Bucknall T., Gabbe B.J., Higgins A.M., Iwashyna T.J., Hunt-Smith J., Murray L.J., Myles P.S., Ponsford J., Pilcher D., Walker C., Young M., Cooper D.J. The impact of disability in survivors of critical illness. Intensive Care Med. 2017; 43: 992-1001. PMID: 28534110. DOI: 10.1007/s00134-017-4830-0

24. Cuthbertson B.H., Roughton S., Jenkinson D., Maclennan G., Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care. 2010; 14: R6. PMID: 20089197. DOI: 10.1186/cc8848

25. Ridley S.A., Chrispin P.S., Scotton H., Rogers J., Lloyd D. Changes in quality of life after intensive care: comparison with normal data. Anaesthesia. 1997; 52: 195-202. PMID: 9124657. DOI: 10.1111/j.1365-2044.1997.073-az0068.x

26. Lee M., Kang J., Jeong Y.J. Risk factors for post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care. 2020; 33: 287-294. PMID: 31839375. DOI: 10.1016/j.aucc.2019.10.004

27. Jensen J.F., Thomsen T., Overgaard D., Bestle M.H., Christensen D., Egerod I. Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med. 2015; 41: 763-775. PMID: 25731633. DOI: 10.1007/s00134-015-3689-1

28. Elliott D., Davidson J.E., Harvey M.A., Bemis-Dougherty A., Hopkins R.O., Iwashyna T.J., Wagner J., Weinert C., Wunsch H., O Bienvenu J., Black G., Brady S., Brodsky M.B., Deutschman C., Doepp D., Flatley C., Fosnight S., Gittler M., Gomez B.T., Hyzy R., Louis D., Mandel R., Maxwell C., Muldoon S.R., Perme C.S., Reilly C., Robinson M.R., Rubin E., Schmidt D.M., Schuller J., Scruth E., Siegal E., Spill G.R., Sprenger S., Straumanis J.P., Sutton P., Swoboda S.M., Twaddle M.L., Needham D.M. Exploring the scope of post-intensive care syndrome therapy and care: engagement of non-critical care providers and survivors in a second stakeholders meeting. Crit Care Med. 2014; 42: 2518-2526. PMID: 25083984. DOI: 10.1097/CCM.0000000000000525

29. Harvey M.A., Davidson J.E. Postintensive Care Syndrome: Right Care, Right Now..and Later. Crit Care Med. 2016; 44: 381-385. PMID: 26771784. DOI: 10.1097/CCM.0000000000001531

30. Meyer J., Brett S.J., Waldmann C. Should ICU clinicians follow patients after ICU discharge? Yes. Intensive Care Med. 2018; 44: 1539-41. PMID: 30054690. DOI: 10.1007/s00134-018-5260-3

31. Cook K., Bartholdy R., Raven M., von Dohren G., Rai S., Haines K., Ramanan M. A national survey of intensive care follow-up clinics in Australia. Aust Crit Care. 2020; 33: 533-537. PMID: 32430169. DOI: 10.1016/j.aucc.2020.03.005

32. Heydon E., Wibrow B., Jacques A., Sonawane R., Anstey M. The needs of patients with post-intensive care syndrome: A prospective, observational study. Aust Crit Care. 2020; 33: 116-122. PMID: 31160217. DOI: 10.1016/j.aucc.2019.04.002