Life Of Intensive Care Unit Survivors Research Articles

Quality of life in ICU survivors and their relatives with post-intensive care syndrome: A systematic review.

Post-intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status. This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post-intensive care syndrome (PICS-F) and to report anxiety, depression and Post-Traumatic Stress Disorders (PTSD) in studies investigating PICS. A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123). We included 19 studies of PICS and PICS-F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post-traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain-related symptoms and sleep disorders were problems encountered by ICU relatives with PICS-F. PICS and PICS-F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS-F on QoL. PICS and PICS-F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission.

Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): feasibility of a pragmatic randomised controlled trial

BackgroundICU survivors often suffer from prolonged physical and mental impairments resulting in the so called “Post-Intensive Care Syndrome” (PICS). The aftercare of former ICU patients affected by PICS in particular has not been addressed sufficiently in Germany so far. The aim of this study was to evaluate the feasibility of a pragmatic randomised trial (RCT) comparing an intensive care unit (ICU) follow-up clinic intervention to usual care.MethodsThis pilot study in a German university hospital evaluated the feasibility of a pragmatic RCT. Patients were assigned in a 1:1 ratio to an ICU follow-up clinic intervention or to usual care. The concept of this follow-up clinic was previously developed in a participatory process with patients, next of kin, health care professionals and researchers. We performed a process evaluation and determined acceptability, fidelity, completeness of measurement instruments and practicality as feasibility outcomes. The RCT’s primary outcome (health-related quality of life) was assessed six months after ICU discharge by means of the physical component scale of the Short-Form-12 self-report questionnaire.ResultsThe pilot study was conducted from June 2020 to May 2021 with 21 and 20 participants in the intervention and control group. Principal findings related to feasibility were 85% consent rate (N = 48), 62% fidelity rate, 34% attrition rate (N = 41) and 77% completeness of outcome measurements. The primary effectiveness outcome (health-related quality of life) could be measured in 93% of participants who completed the study (N = 27). The majority of participants (85%) needed assistance with follow-up questionnaires (practicality). Median length of ICU stay was 13 days and 85% (N = 41) received mechanical ventilation, median Sequential Organ Failure Assessment Score was nine. Six-month follow-up assessment was planned for all study participants and performed for 66% (N = 41) of the participants after 197 days (median).ConclusionThe participatory developed intervention of an ICU follow-up clinic and the pragmatic pilot RCT both seem to be feasible. We recommend to start a pragmatic RCT on the effectiveness of the ICU follow-up clinic.Trial registrationClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468

QUALITY OF LIFE DURING ONE YEAR FOLLOW UPAFTER INTENSIVE CARE DISCHARGE

Patient treated in an Intensive care unit (ICU) are seriously ill. Have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of large numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. (1)Death and full recovery are two main and contrary outcomes of intensive care. As survivors often suffer from post intensive care unit (post‐ ICU) consequences, they cannot be regarded as fully recovered. Post‐ICU consequences are caused by an illness itself, organ dysfunction developed before ICU admission or acquired during the stay in the ICU, and/or prolonged intensive care support of failed organ(s). Organ failure in intensive care may have an impact on the life of ICU survivors long after their discharge from the ICU. To evaluate the quality of health and life in such patients as a whole, mere objective clinical or laboratory analyses are not enough. Subjective perception of the physical and mental quality of life by patients themselves becomes more and more important for the evaluation of post‐ICU outcomes.(2) As initial care advances and ICU mortality decreases number of survivors of critical illness is increasing. These survivors frequently experience longlasting complications of critical care. The purpose of this study is to understand these complications & implement evidence based practices to minimize them.

A feasibility study of a randomised controlled trial to examine the impact of the ABCDE bundle on quality of life in ICU survivors

BackgroundEarly rehabilitation has been found to prevent delirium and weakness that can hamper the recovery of intensive care unit (ICU) survivors. Integrated clinical practice guidelines for managing patient pain, agitation and delirium (PAD) have been developed. The Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle provides a strategy to implement PAD guidelines into everyday clinical practice. However, there is limited evidence on the effectiveness of the ABCDE bundle in the literature.The purpose of this study was to evaluate the feasibility of conducting a full-scale randomised controlled trial comparing the ABCDE bundle to standard care in an ICU. Trial feasibility was defined as the successful recruitment and retention of trial participants, adherence to the intervention, identification of barriers to the intervention, and the rigorous collection of outcome data.MethodsA prospective, single-centre, randomised controlled feasibility study was conducted. Thirty adult mechanically ventilated participants were recruited from an eight-bed ICU in south east Queensland, Australia, between April 2015 and December 2015. Participants were randomised to receive either the ABCDE bundle or standard routine management. The ABCDE bundle integrated prescribed awakening and breathing trials, delirium monitoring and management, and prescribed exercise and mobility regimes. Feasibility outcomes measured included recruitment and retention rates, intervention fidelity, and the feasibility of participant outcome data collection. Outcome measurement assessors were blinded to participant assignment. It was not possible to blind the research team or the participant to group assignment.ResultsIn total, 30 (81.1%) of 37 eligible participants consented and were randomised to the intervention group (n = 15) or the control group (n = 15). Of these, 23 (76.6%) participants successfully completed the 90-day post discharge assessment. A lengthy recruitment period of 8 months was related to overly stringent inclusion and exclusion criteria. Intervention adherence exceeded defined success rates with participation in awakening and breathing trials, delirium monitoring and exercise interventions performed on 80.2, 97.4 and 90.2% of ventilated days respectively. Outcome assessments were successfully and accurately performed at ICU and hospital discharge and 90-day post hospital discharge. Intervention participants were deemed to be delirious on 39.6% of mechanically ventilated days indicating a requirement for a scripted regime to prevent delirium.ConclusionsWith minor adjustment of inclusion and exclusion criteria, the inclusion of delirium management protocols, and encouragement of family engagement and involvement, a large-scale definitive randomised controlled trial to test the impact of the ABCDEF bundle will be feasible.Trial registrationAustralian New Zealand Clinical Trials Registry 12614000763640 Date registered 17/08/2014

The effect of early cognitive rehabilitation on cognitive, physical function and quality of life in ICU survivors

Objective To explore the clinical effect of early cognitive rehabilitation on cognitive, physical function and quality of life in the patients transferred from intensive care unit (ICU). Methods A total of 120 cases of patients who were transferred from ICU to general wards was randomly divided into the control group and the observation group with 60 cases in each group. The control group was given symptomatic treatment according to their original disease, without cognitive intervention. On the basis of the control group, the observation group was treated with cognitive rehabilitation training, 2 times / week, 2 h/ times, 12 weeks of treatment. The cognitive function, physical function and quality of life of two groups were compared with the memory and executive screening scale (MES), the daily activity scale (ADL), and the concise Health Survey (SF-36) before and after treatment. Results Compared to before treatment, after treatment, MES, SF-36 (in addition to bodily pain) and ADL scale project score in the observation group was significantly higher, SF-36 bodily pain scores decreased significantly, all the differences were statistically significant (P<0.05); Compared to the control group, after treatment, the MES, SF-36 (in addition to bodily pain) and ADL scale scores in the observation group of were significantly increased, the bodily pain score of SF-36 in the observation group compared with the control group decreased significantly, all the differences were statistically significant (P<0.05). Conclusions Early cognitive rehabilitation can significantly improve the cognitive, physical function and quality of life in the patients transferred from ICU, and it is worthy of clinical reference. Key words: Cognition; Rehabilitation; Quality of life; Intensive care units

Quality of life in ICU survivors with severe sepsis who received activated protein C

Appropriate treatment of severe sepsis with activated protein C (rhAPC) has been associated with an absolute reduction in mortality of 6.1% [1]. The aim of this study was to followup patients who received rhAPC and to evaluate their quality of life postdischarge from the intensive care unit (ICU).