Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital

Péricles A.D Duarte,Jaquilene Barreto Costa,Silvana Trilo Duarte,Sheila Taba,Claudia Regina Felicetti Lordani,Erica Fernanda Osaku,Claudia Rejane Lima Macedo Costa,Dalas Cristina Miglioranza,Daniela Prochnow Gund,Amaury Cesar Jorge

doi:10.6061/clinics/2017(12)08

Abstract

OBJECTIVES:To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country.METHODS:Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil.RESULTS:A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government.CONCLUSIONS:A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Highlights

As the survival rates of patients admitted to intensive care units (ICUs) improve, concerns have arisen regarding mid- to long-term morbidity in this population
The most common reasons given for not attending the scheduled consultation were a) transportation difficulties since a considerable number of patients lived in other municipalities; b) difficulty arranging for a family member to transport the patient to the consultation, especially in cases of elderly patients; and c) the patient’s clinical condition and limitations
Differences were detected between the patients admitted to the ICU and the survivors regarding the following: age, reason for hospitalization, admission Acute Physiology and Chronic Health Evaluation (APACHE) II score, comorbid conditions ( COPD), and the use of invasive mechanical ventilation (MV)

Summary

Introduction

As the survival rates of patients admitted to intensive care units (ICUs) improve, concerns have arisen regarding mid- to long-term morbidity in this population. Patients who survive a critical illness and hospitalization in an ICU (ICU survivors) may develop physical and/or psychological complications. The number of studies that have focused on the social and economic impacts of acute illness or on admission to an ICU is low [6]. These topics are important when considering the high intrinsic costs of an ICU admission and the wide variety of locations and countries that face the problem of post-ICU complications. Despite recent studies that have evaluated different characteristics of post-ICU patients [7,8,9], the economic and social impacts

Objectives

Methods

Results

Conclusion