Adult Survivors Of Critical Illness Research Articles

Iron and erythropoietin to heal and recover after intensive care (ITHRIVE): A pilot randomised clinical trial

ObjectiveTo determine the feasibility of a pivotal randomised clinical trial of intravenous (IV) iron and erythropoietin in adult survivors of critical illness with anaemia requiring treatment in the intensive care unit. DesignAn investigator-initiated, parallel group, placebo-controlled, randomised feasibility trial. SettingA tertiary intensive care unit (ICU) in Perth, Western Australia. ParticipantsAdults with anaemia (haemoglobin <100 g/L), requiring ICU-level care for more than 48 h, and likely to be ready for ICU discharge within 24 h. InterventionsA single dose of IV ferric carboxymaltose and Epoetin alfa (active group) or an equal volume of 0.9% saline (placebo group). Main outcome measuresStudy feasibility was considered met if the pilot achieved a recruitment rate of ≥2 participants per site per month, ≥90% of participants received their allocated study treatment, and≥ 90% of participants were followed up for the proposed pivotal trial primary outcome - days alive and at home to day 90 (DAH90). ResultsThe 40-participant planned sample size included twenty in each group and was enrolled between 1/9/2021 and 2/3/2022. Participants spent a median of 3.4 days (interquartile range 2.8–5.1) in the ICU prior to enrolment and had a mean baseline haemoglobin of 83.7 g/L (standard deviation 6.7). The recruitment rate was 6.7 participants per month [95% confidence interval (CI) 4.8–9.0], DAH90 follow-up was 100% (95% CI 91.2%–100%), and 39 (97.5%, 95% CI 86.8%–99.9%) participants received the allocated study intervention. No serious adverse events were reported. ConclusionThe iron and erythropoietin to heal and recover after intensive care (ITHRIVE) pilot demonstrated feasibility based on predefined participant recruitment, study drug administration, and follow-up thresholds.

Study on critical illness and bone turnover

Purpose: Critical illness has been recognized to acutely influence bone metabolism and, consequently, bone mineral density. The main purpose of this study was to describe bone metabolism changes in adult survivors of critical illness in an attempt to correlate them with severity scores. Methods: An open, prospective, observational, monocentric study in patients admitted to the intensive care unit (ICU) was conducted, evaluating bone metabolism at baseline (within 72 hours of ICU admission), 6 months, and 12 months. Results: Fifty-nine patients admitted to the ICU (63% males), mean age 58 ± 16 years, were enrolled. Of these, 20 patients (34%) completed the one-year follow up. At baseline, bone resorption showed an increase, which was maintained at 6 months, and followed by normalization at 12 months. Patients showed, in the majority of cases, hypovitaminosis D with hyperparathyroidism at baseline with subsequent normalization. A trend towards a correlation was described between severity scores and serum 25(OH) vitamin D and bone turnover marker levels. Conclusions: These results help to confirm a positive association between critical illness requiring ICU admission and bone metabolism changes. This study lays the foundations for further studies evaluating bone health in ICU patients. KEY WORDS: Critical illness, osteoporosis, bone turnover, bone metabolism, treatment.

Examining the needs of survivors of critical illness through the lens of palliative care: A qualitative study of survivor experiences

ObjectiveTo examine the needs of adult survivors of critical illness through a lens of palliative care. Research methodologyA qualitative study of adult survivors of critical illness using semi-structured interviews and framework analysis. SettingParticipants were recruited from the post-intensive care unit clinic of a mid-Atlantic academic medical center in the United States. FindingsSeventeen survivors of critical illness aged 34–80 (median, 66) participated in the study. The majority of patients were female (64.7 %, n = 11) with a median length of index ICU stay of 12 days (interquartile range [IQR] 8–19). Interviews were conducted February to March 2021 and occurred a median of 20 months following the index intensive care stay (range, 13–33 months). We identified six key themes which align with palliative care principles: 1) persistent symptom burden; 2) critical illness as a life-altering experience; 3) spiritual changes and significance; 4) interpreting/managing the survivor experience; 5) feelings of loss and burden; and 6) social support needs. ConclusionOur findings suggest that palliative care components such as symptom management, goals of care discussions, care coordination, and spiritual and social support may assist in the assessment and treatment of survivors of critical illness.

Association of Extracorporeal Membrane Oxygenation With New Mental Health Diagnoses in Adult Survivors of Critical Illness

Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients, but little is known regarding long-term psychiatric sequelae among survivors after ECMO. To investigate the association between ECMO survivorship and postdischarge mental health diagnoses among adult survivors of critical illness. Population-based retrospective cohort study in Ontario, Canada, from April 1, 2010, through March 31, 2020. Adult patients (N=4462; age ≥18 years) admitted to the intensive care unit (ICU), and surviving to hospital discharge were included. Receipt of ECMO. The primary outcome was a new mental health diagnosis (a composite of mood disorders, anxiety disorders, posttraumatic stress disorder; schizophrenia, other psychotic disorders; other mental health disorders; and social problems) following discharge. There were 8 secondary outcomes including incidence of substance misuse, deliberate self-harm, death by suicide, and individual components of the composite primary outcome. Patients were compared with ICU survivors not receiving ECMO using overlap propensity score-weighted cause-specific proportional hazard models. Among 642 survivors who received ECMO (mean age, 50.7 years; 40.7% female), median length of follow-up was 730 days; among 3820 matched ICU survivors who did not receive ECMO (mean age, 51.0 years; 40.0% female), median length of follow-up was 1390 days. Incidence of new mental health conditions among survivors who received ECMO was 22.1 per 100-person years (95% confidence interval [CI] 19.5-25.1), and 14.5 per 100-person years (95% CI, 13.8-15.2) among non-ECMO ICU survivors (absolute rate difference of 7.6 per 100-person years [95% CI, 4.7-10.5]). Following propensity weighting, ECMO survivorship was significantly associated with an increased risk of new mental health diagnosis (hazard ratio [HR] 1.24 [95% CI, 1.01-1.52]). There were no significant differences between survivors who received ECMO vs ICU survivors who did not receive ECMO in substance misuse (1.6 [95% CI, 1.1 to 2.4] per 100 person-years vs 1.4 [95% CI, 1.2 to 1.6] per 100 person-years; absolute rate difference, 0.2 per 100 person-years [95% CI, -0.4 to 0.8]; HR, 0.86 [95% CI, 0.48 to 1.53]) or deliberate self-harm (0.4 [95% CI, 0.2 to 0.9] per 100 person-years vs 0.3 [95% CI, 0.2 to 0.3] per 100 person-years; absolute rate difference, 0.1 per 100 person-years [95% CI, -0.2 to 0.4]; HR, 0.68 [95% CI, 0.21 to 2.23]). There were fewer than 5 total cases of death by suicide in the entire cohort. Among adult survivors of critical illness, receipt of ECMO, compared with ICU hospitalization without ECMO, was significantly associated with a modestly increased risk of new mental health diagnosis or social problem diagnosis after discharge. Further research is necessary to elucidate the potential mechanisms underlying this relationship.

Utility of Screening for Cognitive Impairment at Hospital Discharge in Adult Survivors of Critical Illness.

Few studies have explored the utility of screening for cognitive impairment near hospital discharge in intensive care unit survivors. To explore baseline and hospitalization characteristics associated with cognitive impairment at hospital discharge and the relationship between cognitive impairment and 6-month disability and mortality outcomes. Hospital disability status and treatment variables were collected from 2 observational cohort studies. Patients were screened for cognitive impairment at hospital discharge using the Montreal Cognitive Assessment (MoCA)-Blind, and telephone follow-up was conducted 6 months after discharge to assess vital and physical disability status. Of 423 patients enrolled, 320 were alive at hospital discharge. A total of 213 patients (66.6%) were able to complete the MoCA near discharge; 47 patients (14.7%) could not complete it owing to cognitive impairment. In MoCA completers, the median (IQR) score was 17 (14-19). Older age (β per year increase, -0.09 [95% CI, -0.13 to -0.05]) and blood transfusions during hospitalization (β, -1.20 [95% CI, -2.26 to -0.14]) were associated with lower MoCA scores. At 6-month follow-up, 176 of 213 patients (82.6%) were alive, of whom 41 (23.3%) had new severe physical disabilities. Discharge MoCA score was not significantly associated with 6-month mortality (adjusted odds ratio, 1.03 [95% CI, 0.93-1.14]) but was significantly associated with risk of new severe disability at 6 months (adjusted odds ratio, 0.85 [95% CI, 0.76-0.94]). Assessing for cognitive impairment at hospital discharge may help identify intensive care unit survivors at higher risk of severe physical disabilities after critical illness.

Educational Outcomes of Childhood Survivors of Critical Illness-A Population-Based Linkage Study.

OBJECTIVES:Major postintensive care sequelae affect up to one in three adult survivors of critical illness. Large cohorts on educational outcomes after pediatric intensive care are lacking. We assessed primary school educational outcomes in a statewide cohort of children who survived PICU during childhood.DESIGN:Multicenter population-based study on children less than 5 years admitted to PICU. Using the National Assessment Program—Literacy and Numeracy database, the primary outcome was educational achievement below the National Minimum Standard (NMS) in year 3 of primary school. Cases were compared with controls matched for calendar year, grade, birth cohort, sex, socioeconomic status, Aboriginal and Torres Strait Islander status, and school. Multivariable logistic regression models to predict educational outcomes were derived.SETTING:Tertiary PICUs and mixed ICUs in Queensland, Australia.PATIENTS:Children less than 5 years admitted to PICU between 1998 and 2016.INTERVENTIONS:Not applicable.MEASUREMENTS AND MAIN RESULTS:Year 3 primary school data were available for 5,017 PICU survivors (median age, 8.0 mo at first PICU admission; interquartile range, 1.9–25.2). PICU survivors scored significantly lower than controls across each domain (p < 0.001); 14.03% of PICU survivors did not meet the NMS compared with 8.96% of matched controls (p < 0.001). In multivariate analyses, socioeconomic status (odds ratio, 2.14; 95% CI, 1.67–2.74), weight (0.94; 0.90–0.97), logit of Pediatric Index of Mortality-2 score (1.11; 1.03–1.19), presence of a syndrome (11.58; 8.87–15.11), prematurity (1.54; 1.09–2.19), chronic neurologic conditions (4.38; 3.27–5.87), chronic respiratory conditions (1.65; 1.24–2.19), and continuous renal replacement therapy (4.20; 1.40–12.55) were independently associated with a higher risk of not meeting the NMS.CONCLUSIONS:In this population-based study of childhood PICU survivors, 14.03% did not meet NMSs in the standardized primary school assessment. Socioeconomic status, underlying diseases, and severity on presentation allow risk-stratification to identify children most likely to benefit from individual follow-up and support.

Exploring adult critical illness survivors' experiences of fatigue: A qualitative study.

To explore adult experiences of fatigue after discharge from an intensive care unit and identify potential management strategies. An exploratory qualitative study. One to one audio-recorded semi-structured interviews with 17 adult survivors of critical illness in the United Kingdom, lasting up to 1h, between September 2019 and January 2020. Anonymised and verbatim-transcribed interview data underwent a standard process of inductive thematic analysis as described by Braun and Clarke. Three themes were identified: fatigue is different for everyone; complex interrelating interactions; and personalised fatigue strategies. Fatigue was described as a distressing symptom, unique to the individual that causes an array of complex, often long-term interrelating impacts on the survivor and their wider family, made worse by a lack of understanding, empathy and support resources. Support from others, alongside interventions such as exercise, good nutrition, information and alternative therapies are used by survivors with variable degrees of success. This qualitative study reports peoples' experiences of fatigue after critical illness. Findings highlight the significant impact it has on people's lives and those of their family and friends.

Suicide and self-harm in adult survivors of critical illness: population based cohort study

ObjectiveTo analyse the association between survival from critical illness and suicide or self-harm after hospital discharge.DesignPopulation based cohort study using linked and validated provincial databases.SettingOntario, Canada between January 2009 and...

Long-Term Cognitive Outcomes and Sleep in Adults After Extracorporeal Life Support

Objectives:To assess differences in cognitive outcomes and sleep in adult survivors of critical illness, managed with venovenous extracorporeal membrane oxygenation as compared to conventional mechanical ventilation only.Design:Retrospective cohort study linked with data from the COGnitive outcomes and WELLness study.Setting:A multisite study from five adult medical/surgical ICUs in Toronto.Patients:Thirty-three ICU survivors including adult patients who received venovenous extracorporeal membrane oxygenation (n = 11) matched with patients who received mechanical ventilation only (n = 22) using specified covariates (e.g., age).Interventions:None.Measurements and Main Results:Baseline demographics and admission diagnoses were collected at enrollment. Cognitive outcome was evaluated using the Repeatable Battery for the Assessment of Neuropsychologic Status (global cognitive function) and Trail Making Test B (executive function), and sleep variables were estimated using actigraphy. Assessments occurred at 7 days post ICU discharge and again at 6- and 12-month follow-up. No statistically significant difference was seen between patients treated with or without venovenous extracorporeal membrane oxygenation in the mean daily Riker Sedation Agitation Score; however, patients in the venovenous extracorporeal membrane oxygenation group received greater amounts of fentanyl over their ICU stay as compared to patients receiving conventional mechanical ventilation only (p < 0.001). No significant differences were found in performance on either of the cognitive assessment tools, between survivors treated or not with venovenous extracorporeal membrane oxygenation at any of the time points assessed. Total sleep time estimated by actigraphy increased from approximately 6.5 hours in hospital to 7.5 hours at 6-month follow-up in all patients, regardless of treatment type. Total sleep time remained consistent in both groups from 6 to 12 months post ICU discharge.Conclusions:In this small retrospective case series, no significant differences were found in sleep or cognitive outcomes between extracorporeal life support and non–extracorporeal life support survivors. Further, in this hypothesis-generating study, differences in administered sedative doses during the ICU stay seen between the two groups did not impact 6- or 12-month cognitive performance or actigraphy-estimated sleep time.

After Five Years: Adverse Childhood Experiences and Response to Surviving Illness Contribute to Shorter Life Expectancy

ABSTRACT Initial research in 2012 described the psychological responses of 32 older adult survivors of critical illness. At the five year follow up in 2017, 15 participants were deceased. Only 2 of these 15 participants achieved their expected life span. Quantitative and qualitative analysis comparing deceased vs. surviving participants yielded significant results. The deceased participants who died 10 to 14 years before their life expectancy were more likely to have experienced severe trauma in childhood, followed by reoccurring illnesses as adults. Deceased participants’ survival was also impacted by their approach to coping with their recovery after illness. Significant correlations were found between Adverse Childhood Experiences (ACE), illness approach, reoccurring illness and death before life expectancy. A key conclusion is that the impact of childhood trauma should be studied across the entire life course. Social workers for older adults must consider the personal complexity of each client’s experience, by exploring unique personal and historical traumas that are not listed on the ACE Scale. Psycho-education can be utilized to teach older adults coping strategies and increase psychological agency.

Motoric Subtypes of Delirium and Long-Term Functional and Mental Health Outcomes in Adults After Critical Illness.

Adult ICU survivors that experience delirium are at high risk for developing new functional disabilities and mental health disorders. We sought to determine if individual motoric subtypes of delirium are associated with worse disability, depression, and/or post-traumatic stress disorder in ICU survivors. Secondary analysis of a prospective multicenter cohort study. Academic, community, and Veteran Affairs hospitals. Adult ICU survivors of respiratory failure and/or shock. We assessed delirium and level of consciousness using the Confusion Assessment Method-ICU and Richmond Agitation and Sedation Scale daily during hospitalization. We classified delirium as hypoactive (Richmond Agitation and Sedation Scale ≤ 0) or hyperactive (Richmond Agitation and Sedation Scale > 0). At 3- and 12-month postdischarge, we assessed for dependence in activities of daily living and instrumental activities of daily living, symptoms of depression, and symptoms of post-traumatic stress disorder. Adjusting for baseline and inhospital covariates, multivariable regression examined the association of exposure to delirium motoric subtype and long-term outcomes. In our cohort of 556 adults with a median age of 62 years, hypoactive delirium was more common than hyperactive (68.9% vs 16.8%). Dependence on the activities of daily living was present in 37% at 3 months and 31% at 12 months, whereas dependence on instrumental activities of daily living was present in 63% at 3 months and 56% at 12 months. At both time points, depression and post-traumatic stress disorder rates were constant at 36% and 5%, respectively. Each additional day of hypoactive delirium was associated with higher instrumental activities of daily living dependence at 3 months only (0.24 points [95% CI, 0.07-0.41; p = 0.006]). There were no associations between the motoric delirium subtype and activities of daily living dependence, depression, or post-traumatic stress disorder. Longer duration of hypoactive delirium, but not hyperactive, was associated with a minimal increase in early instrumental activities of daily living dependence scores in adult survivors of critical illness. Motoric delirium subtype was neither associated with early or late activities of daily living functional dependence or mental health outcomes, nor late instrumental activities of daily living functional dependence.

Prediction Models for Physical, Cognitive, and Mental Health Impairments After Critical Illness: A Systematic Review and Critical Appraisal.

Improved ability to predict impairments after critical illness could guide clinical decision-making, inform trial enrollment, and facilitate comprehensive patient recovery. A systematic review of the literature was conducted to investigate whether physical, cognitive, and mental health impairments could be predicted in adult survivors of critical illness. A systematic search of PubMed and the Cochrane Library (Prospective Register of Systematic Reviews ID: CRD42018117255) was undertaken on December 8, 2018, and the final searches updated on January 20, 2019. Four independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were eligible if a prediction model was developed, validated, or updated for impairments after critical illness in adult patients. Discrepancies were resolved by consensus or an independent adjudicator. Data on study characteristics, timing of outcome measurement, candidate predictors, and analytic strategies used were extracted. Risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool. Of 8,549 screened studies, three studies met inclusion. All three studies focused on the development of a prediction model to predict (1) a mental health composite outcome at 3 months post discharge, (2) return-to-pre-ICU functioning and residence at 6 months post discharge, and (3) physical function 2 months post discharge. Only one model had been externally validated. All studies had a high risk of bias, primarily due to the sample size, and statistical methods used to develop and select the predictors for the prediction published model. We only found three studies that developed a prediction model of any post-ICU impairment. There are several opportunities for improvement for future prediction model development, including the use of standardized outcomes and time horizons, and improved study design and statistical methodology.

Nighttime Sleep Duration Is Associated With Length of Stay Outcomes Among Older Adult Survivors of Critical Illness.

Older adults who required mechanical ventilation while in an intensive care unit (ICU) require adequate sleep throughout recovery from critical illness. Poor post-ICU sleep quality may contribute to worsening impairments in physical, cognitive, or psychological status after critical illness, known as post-ICU syndrome. Previous research has evaluated post-ICU sleep with qualitative or mixed methods (eg, interviews, questionnaires). We proposed measurement of sleep with actigraphy. We hypothesized that nighttime sleep is associated with length of stay (LOS). The aims of this study were to describe sleep quality of previously mechanically ventilated older adults recently transferred out of ICU and explore relationships between sleep duration and LOS outcomes. We enrolled 30 older adults, 65 years and older, within 24 to 48 hours after ICU discharge. We collected actigraphy data on post-ICU sleep duration (total sleep time [TST]) and sleep fragmentation (wake time after sleep onset) over 2 consecutive nights. We explored associations between TST and LOS (in days) outcomes using multivariate regression. Subjects' mean TST was 7.55 ± 2.52 hours, and mean wake time after sleep onset was 2.26 ± 0.17 hours. In exploratory regression analyses, longer ICU LOS (β = 0.543, P < .001) and longer length of mechanical ventilation (β = 0.420, P = .028) were associated with greater post-ICU TST, after adjusting for potential confounding factors. Total sleep time was prospectively associated with total hospital LOS (β = 0.535, P < .001). Older ICU survivors demonstrate greater sleep duration and worse sleep fragmentation. Poor sleep may contribute to longer LOS, secondary to post-ICU syndrome and sequelae. We recommend nursing interventions to promote sleep consolidation throughout transitions of care in the acute post-ICU recovery period.

Sleep Quality Associated With Motor Function Among Older Adult Survivors of Critical Illness.

Poor sleep is associated with worse motor function in older adults. Sleep may affect motor function specifically among older adults recovering from critical illness after transfer out of an intensive care unit (ICU). Describe motor function (grip strength) of older ICU survivors and explore relationships between sleep and ICU-acquired weakness in the early post-ICU transition period. We enrolled 30 older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24-48 hours post-ICU discharge. Handgrip dynamometry assessed post-ICU motor function (fully corrected T score on the National Institutes of Health Motor Battery Grip Strength Test). Actigraphy estimated post-ICU sleep duration (total sleep time [TST]) and fragmentation (wake after sleep onset) over two consecutive nights from 22:00 p.m. to 06:00 a.m.. We identified differences in grip strength by history of obstructive sleep apnea (OSA) using independent-samples t tests. We examined associations between sleep duration and grip strength using exploratory multivariate regression analyses, after adjustment for clinically relevant covariates. Grip strength among this cohort of older ICU survivors was almost 2 SDs below the norm for healthy older adults, indicating considerable ICU-acquired weakness. Grip strength was lower among subjects with history of OSA than those without OSA. Greater TST was associated with worse grip strength, after adjusting for history of OSA and Pittsburgh Sleep Quality Index global score. Moreover, among the subset of male subjects (n = 19), greater TST was significantly and negatively associated with grip strength, after adjusting for Acute Physiology, Age, and Chronic Health Evaluation III score, and Pittsburgh Sleep Quality Index global score. Sleep promotion may be a potentially modifiable risk factor to mitigate ICU-acquired weakness in older ICU survivors. We propose that improving sleep throughout recovery from critical illness may indirectly promote better outcomes, as poor grip strength is linked to longer length of hospital stay, higher acuity of discharge disposition, and worsened functional decline in older adults.

Nutrition-related symptoms in adult survivors of critical illness who are eating orally: a scoping review protocol.

This review will explore and map the current literature on the nutritional impact of symptoms reported by adult survivors of critical illness who are eating orally after discharge from the intensive care unit (ICU). Survivors of critical care often experience ICU-acquired weakness and poor functional recovery. It is plausible that nutrition interventions throughout their recovery could improve outcomes for these patients. Although a growing number of studies aim to explore the effect of nutrition delivered in the early phases of critical illness, this is also important post-ICU discharge, particularly in already nutritionally compromised patients presenting with muscle loss and fatigue. Therefore, the development of targeted nutrition interventions will be informed by a comprehensive insight into the physiological, physical, or psychological difficulties that critically ill patients experience after ICU discharge, which may impede oral intake. This review will consider primary research studies with adult patients 18 years and older, who are in the recovery phase after being critically ill, and eating orally. Studies must report on any symptoms related to the ability to eat, or represent nutrition inadequacy or utilization. A scoping review will be conducted in accordance with JBI methodology using a three-step search strategy of MEDLINE, Embase, CINAHL, AMED, Web of Science, Cochrane Database of Systematic Reviews, and JBI Evidence-based Practice Database to obtain primary research studies that meet the inclusion criteria. Duplicates will be removed, and study selection and data extraction will be conducted and cross-checked by two independent reviewers. Data synthesis will involve presenting the results in tabular form.

0702 Prolonged Sleep Duration Predicts Poorer Cognitive Function in Hospitalized Older Adult Survivors of Critical Illness

0702 Prolonged Sleep Duration Predicts Poorer Cognitive Function in Hospitalized Older Adult Survivors of Critical Illness

Incidence and risk factors for alopecia in survivors of critical illness: A multi-centre observational study

PurposeTo investigate the incidence, nature and risk factors for patient-reported alopecia in survivors of critical illness. Materials and methodsA multi-centre, mixed methods observational study in the intensive care units (ICU) of ten hospitals in Wales. All patients with an ICU stay of 5 days or more, able to give consent were included. Demographic variables and risk factors were collected. A pre-designed survey was completed at three months post-ICU discharge. Statistical analysis included numbers and percentages (categorical variables) and medians and interquartile ranges (continuous variables). Comparisons between patients with and without alopecia were made using Fisher's Exact test (categorical variables) and Mann Whitney U test (continuous variables). Multivariate logistic regression analysis was used to determine the risk factors for alopecia. ResultsThe survey was completed by 123 patients with alopecia reported in 44 (36%) patients. The only risk factor for alopecia on analysis was sepsis / septic shock (p < .001; OR: 5.1, 95%CI: 2.1–12.4). ConclusionsLimited research exists examining the incidence, nature and risk factors for patient-reported alopecia in adult survivors of critical illness. The results of this study highlight the need to discuss the potential for alopecia with survivors of critical illness, who had sepsis / septic shock.

Supervised exercise rehabilitation in survivors of critical illness: A randomised controlled trial.

To investigate the impact of a six-week supervised exercise programme on cardiopulmonary fitness, balance, muscle strength and anxiety and depression in patients who have been discharged home from hospital following an intensive care unit length of stay of greater than 48 h. To investigate patients' perceptions of a six-week supervised exercise programme delivered at three months post hospital discharge. A single centre parallel, randomised controlled trial. Outpatient department of a university teaching hospital in the UK. Sixty adult survivors of critical illness, at three months post-hospital discharge. A six-week individually prescribed and supervised exercise program, with associated advice to home exercise modification. Twice weekly exercise sessions were individualised to participant's functional status and included cardiopulmonary, balance and strengthening exercises. Follow up at seven weeks, six months and 12 months. Six-Minute Walk Test, BERG balance test, grip strength and Hospital Anxiety and Depression Scale. A pre-designed survey was used to explore patient perceptions of the programme. Sixty participants (n = 30 received allocated programme in both control and treatment groups) were randomised. Loss to follow up resulted in n = 34 participants for intention to treat analysis at 12 months follow up (leaving n = 19 in control group, n = 15 in treatment group). Median participant age at enrolment was 62 years (interquartile range: 49-72), with a median intensive care unit length of stay of nine days (interquartile range: 4-17). No significant differences were found for the Six-Minute Walk Test at any time point (p > 0.05). Anxiety levels and balance were significantly improved in the treatment group at 12 months (p = 0.006 and p = 0.040, respectively). Further research is needed into appropriate interventions and outcome measures, target patient populations and timing of such intervention post-hospital discharge.

Exercise rehabilitation following intensive care unit discharge for recovery from critical illness: executive summary of a Cochrane Collaboration systematic review.

Skeletal muscle wasting and weakness are major complications of critical illness and underlie the profound physical and functional impairments experienced by survivors after discharge from the intensive care unit (ICU). Exercise‐based rehabilitation has been shown to be beneficial when delivered during ICU admission. This review aimed to determine the effectiveness of exercise rehabilitation initiated after ICU discharge on primary outcomes of functional exercise capacity and health‐related quality of life. We sought randomized controlled trials, quasi‐randomized controlled trials, and controlled clinical trials comparing an exercise intervention commenced after ICU discharge vs. any other intervention or a control or ‘usual care’ programme in adult survivors of critical illness. Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature databases were searched up to February 2015. Dual, independent screening of results, data extraction, and quality appraisal were performed. We included six trials involving 483 patients. Overall quality of evidence for both outcomes was very low. All studies evaluated functional exercise capacity, with three reporting positive effects in favour of the intervention. Only two studies evaluated health‐related quality of life and neither reported differences between intervention and control groups. Meta‐analyses of data were precluded due to variation in study design, types of interventions, and selection and reporting of outcome measurements. We were unable to determine an overall effect on functional exercise capacity or health‐related quality of life of interventions initiated after ICU discharge for survivors of critical illness. Findings from ongoing studies are awaited. Future studies need to address methodological aspects of study design and conduct to enhance rigour, quality, and synthesis.

Incidence and Risk Factors for Intensive Care Unit-related Post-traumatic Stress Disorder in Veterans and Civilians.

The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort. To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians. This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization. Of 255 survivors, 181 and 160 subjects were assessed for ICU-related PTSD at 3- and 12-month follow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score ≥ 50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). In the multivariable regression, preexisting PTSD was independently associated with ICU-related PTSD at both 3 and 12 months (P < 0.001), as was preexisting depression (P < 0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-month P = 0.01, 12-month P = 0.48). This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.