Abstract
Chronic critical illness (CCI) is a relevant clinical, social and financial health issue. The aim of this study was to compare the mental outcomes (symptoms of anxiety and depression) and quality of life outcomes of the family members of patients with CCI from different socioeconomic backgrounds who were admitted to one of the intensive care units (ICUs) in two Brazilian hospitals, one private and one public. It is a prospective study involving a public hospital that serves a low-income population and a tertiary private hospital that serves a high-income population. Family members of patients with CCI answered the Hospital Anxiety and Depression Scale (HADS) and The World Health Organization Quality of Life–WHOQOL-bref questionnaires. They responded to the European Quality of life Five Dimension three Level (EuroQol-5D-3L) and the Activities of Daily Living (ADL) questionnaires on behalf of the patients at three time points: during the ICU stay, 30 and 90 days after the patient was discharged. We used logistic regression models to evaluate the main predictors of a binary outcome regarding symptoms of anxiety and depression. We enrolled 186 patients with CCI. Many patients from public hospitals who were independent became dependent for their ADLs at 90 days (41.7% versus 14.3%, p = 0.03). At 30 days, family members from public hospital had worse impact on all domains of WHOQOL-bref compared with families from private hospital. At 90-days, the difference persists in the physical domain, worse for families from public hospital (p = 0.006). The symptoms of depression at 30-days (p = 0.008) and at 90-days (p = 0.013) were worse in the public hospital. CCIs affected quality of life and the emotional condition of family members, especially in families with fewer resources when the patients became more dependent. Family members with higher education were more likely to experience depression, while depression was associated with cohabiting with the patient in low-income families.
Highlights
Chronic critical illness (CCI) impacts a growing population of patients who have survived acute critical illnesses. [1,2,3,4]
The demographic characteristics of the patients from the public hospital are characterized by a median age of 59 years, 50% of men, while the private hospital serves older patients, with a median age of 69 years and 68% of males. This prospective study was conducted in two hospitals attending patients of different socioeconomic levels: a public hospital, “Hospital Geral do Grajau”, with a 25-bed intensive care unit (ICU) located in a southern suburb and serving a population with low socioeconomic status, and a tertiary private hospital, “Hospital Sırio-Libanês”, with a 30-bed ICU located in Bela Vista, the central region, and attending a population with high socioeconomic status
No difference was found in EQ-5D-3L at baseline, ICU mortality was higher in the public hospital (32.6% versus 17.2%, p = 0.026), whereas there was no difference in the overall hospital mortality rates (38.1% versus 35.1%, p = 0.837) (Table 1)
Summary
Chronic critical illness (CCI) impacts a growing population of patients who have survived acute critical illnesses. [1,2,3,4]. In 2015, the ProVent study introduced a new definition of CCIs, that was patients who have spent at least 8 days in an ICU and who have presented with one of the six eligible clinical conditions: mechanical ventilation for at least 96 hours in a single episode; tracheotomy; sepsis or other severe infections; extensive wounds; stroke; and traumatic brain injury. This definition contrasts with the formerly used definition of CCI, which required a longer period of mechanical ventilation of up to 21 days [2]. Symptoms of psychological distress affect more than half of family members impacted by the patient’s CCI
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