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Intensive Care Medicine

Published in:

01-08-2003 | Original

Long-term outcome in ICU patients:

What about quality of life?

Authors: Francisca García Lizana, Daliana Peres Bota, Michael De Cubber, Jean-Louis Vincent

Published in: Intensive Care Medicine | Issue 8/2003

Abstract

Objective

Analysis of mortality and quality of life (QOL) after intensive care unit (ICU) discharge.

Design

Prospective, observational study.

Setting

Mixed, 31-bed, medico-surgical ICU.

Patients

Consecutive adult ICU admissions between June 25 and September 10, 2000, except admissions for uncomplicated elective postoperative surveillance.

Interventions

None.

Measurements and results

Age, past history, admission APACHE II, SOFA score (admission, maximum, discharge), ICU and hospital mortality were recorded. A telephone interview employing the EuroQol 5D system was conducted 18 months after discharge. Of 202 patients, 34 (16.8%) died in the ICU and 23 (11.4%) died in the hospital after ICU discharge. Of the 145 patients discharged alive from hospital, 22 could not be contacted and 27 (13.4%) had died after hospital discharge. Of the 96 patients (47.5%) who completed the questionnaire, 38% had a worse QOL than prior to ICU admission, but only 8.3% were severely incapacitated. Twenty-three patients (24%) had reduced mobility, 15 (15.6%) had limited autonomy, 24 (25%) had alteration in usual daily activities, 29 (30.2%) expressed more anxiety/depression, and 42 (44%) had more discomfort or pain. Twenty-eight (62.2% of those who worked previously) patients had returned to work 18 months after ICU discharge.

Conclusions

Comparing QOL after discharge with that before admission, patients more frequently report worse QOL for the domains of pain/discomfort and anxiety/depression than for physical domains. Factors commonly associated with a change in QOL were previous problems in the affected domains, prolonged hospital length of stay (LOS), greater disease severity at admission and degree of organ dysfunction during ICU stay.

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Heyland DK, Guyatt G, Cook DJ, Meade M, Juniper E, Cronin L, Gafni A (1998) Frequency and methodologic rigor of quality-of-life assessments in the critical care literature. Crit Care Med 26:591–598PubMed

Sanders C, Egger M, Donovan J, Tallon D, Frankel S (1998) Reporting on quality of life in randomised controlled trials: bibliographic study. BMJ 317:1191–1194PubMed

Oye RK, Bellamy PE (1991) Patterns of resource consumption in medical intensive care. Chest 99:685–689PubMed

Detsky AS, Stricker SC, Mulley AG, Thibault GE (1981) Prognosis, survival and the expenditure of hospital resources for patients in an intensive-care unit. N Engl J Med 305:667–672PubMed

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed

Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter P, Sprung C, Colardyn FC, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 26:1793–1800PubMed

Lopes Ferreira F, Peres Bota D, Bross A, Melot C, Vincent JL (2001) Serial evaluation of the SOFA score to predict outcome. JAMA 286:1754–1758PubMed

The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208PubMed

Badia X, Diaz-Prieto A, Gorriz MT, Herdman M, Torrado H, Farrero E, Cavanilles JM (2001) Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 27:1901–1907CrossRefPubMed

10.

Garcia LF, Manzano Alonso JL, Gonzalez SB, Fuentes EJ, Saavedra SP (2000) [Survival and quality of life of patients with multiple organ failure one year after leaving an intensive care unit]. Med Clin (Barc) 114 Suppl 3:99–103

11.

Reynolds HN, Haupt MT, Thill-Baharozian MC, Carlson RW (1988) Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 260:3446–3450PubMed

12.

Pollack MM, Katz RW, Ruttiman UE, Getson PR (1988) Improving the outcome and efficiency of intensive care: the impact of an intensivist. Crit Care Med 16:11–17PubMed

13.

Brown JJ, Sullivan G (1989) Effect on ICU mortality of a full-time critical care specialist. Chest 96:127–129PubMed

14.

Carson SS, Stocking C, Podsadecki T, Christenson J, Pohlman A, MacRae S, Jordan J, Humphrey H, Siegler M, Hall J (1996) Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of "open" and "closed" formats. JAMA 276:322–328PubMed

15.

Metcalfe MA, Sloggett A, McPherson K (1997) Mortality among appropriately referred patients refused admission to intensive care units. Lancet 350:7-11PubMed

16.

Ghorra S, Reinert SE, Cioffi W, Buczko G, Simms HH (1999) Analysis of the effect of conversion from open to closed surgical intensive care unit. Ann Surg 229:163–171CrossRefPubMed

17.

Konopad E, Noseworthy TW, Johnston R, Shustack A, Grace M (1995) Quality of life measures before and one year after admission to an intensive care unit. Crit Care Med 23:1653–1659

18.

Garcia Lizana F, Manzano Alonso JL (2001) Predicting factors of mortality after ICU discharge. Med Intensiva 25:179–186

19.

Flaatten H, Kvale R (2001) Survival and quality of life 12 years after ICU. A comparison with the general Norwegian population. Intensive Care Med 27:1005–1011PubMed

20.

Dragsted L, Qvist L (1989) Outcome from intensive care. I. A 5-year study of 1308 patients: Short-term outcome. Eur J Anaesthesiol 6:131–144PubMed

21.

Dragsted L, Qvist J (1989) Outcome from intensive care. III. A 5-year study of 1308 patients: activity levels. Eur J Anaesthesiol 6:385–396PubMed

22.

Rosenberg AL, Watts C (2000) Patients readmitted to ICUs: a systematic review of risk factors and outcomes. Chest 118:492–502PubMed

23.

Udekwu P, Gurkin B, Oller D, Lapio L, Bourbina J (2001) Quality of life and functional level in elderly patients surviving surgical intensive care. J Am Coll Surg 193:245–249CrossRefPubMed

24.

Chelluri L, Grenvik A, Silverman M (1995) Intensive care for critically ill elderly: mortality, costs and quality of life. Review of the literature. Arch Intern Med 155:1013–1022PubMed

25.

Ip SP, Leung YF, Ip CY, Mak WP (1999) Outcomes of critically ill elderly patients: is high-dependency care for geriatric patients worthwhile? Crit Care Med 27:2351–2357

26.

Rowan KM, Jenkinson C, Black N (2003) Health-related quality of life. In: Angus DC, Carlet J (eds) Surviving intensive care. Springer, Heidelberg pp 35–50

27.

Bergner M, Bobbitt RA, Carter WB, Gilson BS (1981) The Sickness Impact Profile: development and final revision of a health status measure. Med Care 19:787–805PubMed

28.

Hunt SM, McKenna SP, McEwen J, Williams J, Papp E (1981) The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med [A] 15:221–229

29.

Fernandez RR, Cruz JJ, Mata GV (1996) Validation of a quality of life questionnaire for critically ill patients. Intensive Care Med 22:1034–1042PubMed

30.

Ware JJ, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMed

31.

Richmond TS, Kauder D, Schwab CW (1998) A prospective study of predictors of disability at 3 months after non- central nervous system trauma. J Trauma 44:635–642PubMed

32.

Jones C, Griffiths RD, Macmillan RR, Palmer TEA (1994) Psychological problems occurring after intensive care. Br J Intensive Care 4:46–53

33.

Tian ZM, Miranda DR (1995) Quality of life after intensive care with the sickness impact profile. Intensive Care Med 21:422–428PubMed

34.

Hurel D, Loirat P, Saulnier F, Nicolas F, Brivet F (1997) Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med 23:331–337CrossRef

35.

Ridley SA, Chrispin PS, Scotton H, Rogers J, Lloyd D (1997) Changes in quality of life after intensive care: comparison with normal data. Anaesthesia 52:195–202PubMed

36.

Capuzzo M, Grasselli C, Carrer S, Gritti G, Alvisi R (2000) Validation of two quality of life questionnaires suitable for intensive care patients. Intensive Care Med 26:1296–1303CrossRefPubMed

37.

Vazquez MG, Rivera FR, Gonzalez CA, Delgado-Rodriguez M, Torres Ruiz JM, Raya PA, Aguayo DH (1992) Factors related to quality of life 12 months after discharge from an intensive care unit. Crit Care Med 20:1257–1262

38.

Chrispin PS, Scotton H, Rogers J, Lloyd D, Ridley SA (1997) Short Form 36 in the intensive care unit: assessment of acceptability, reliability and validity of the questionnaire. Anaesthesia 52:15–23PubMed

39.

Heyland DK, Hopman W, Coo H, Tranmer J, McColl MA (2000) Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life. Crit Care Med 28:3599–3605PubMed

40.

Badia X, Diaz-Prieto A, Rue M, Patrick DL (1996) Measuring health and health state preferences among critically ill patients. Intensive Care Med 22:1379–1384CrossRef

41.

Granja C, Teixeira-Pinto A, Costa-Pereira A (2002) Quality of life after intensive care—evaluation with EQ-5D questionnaire. Intensive Care Med 28:898–907CrossRef

42.

Sage WM, Rosenthal MH, Silverman JF (1986) Is intensive care worth it? An assessment of input and outcome for the critically ill. Crit Care Med 14:777–782PubMed

43.

Brooks R, Kerridge R, Hillman K, Bauman A, Daffurn K (1997) Quality of life outcomes after intensive care. Comparison with a community group. Intensive Care Med 23:581–586CrossRefPubMed

44.

Badia X, Schiaffino A, Alonso J, Herdman M (1998) Using the EuroQoI 5-D in the Catalan general population: feasibility and construct validity. Qual Life Res 7:311–322PubMed

45.

Rivera-Fernandez R, Vazquez-Mata G, Bravo M, Aguayo-Hoyos E, Zimmerman J, Wagner D, Knaus W (1998) The Apache III prognostic system: customized mortality predictions for Spanish ICU patients. Intensive Care Med 24:574–581

46.

Pettila V, Kaarlola A, Makelainen A (2000) Health-related quality of life of multiple organ dysfunction patients one year after intensive care. Intensive Care Med 26:1473–1479PubMed

47.

Jacobs CJ, Van der Vliet JA, Roozendaal MT, Van der Linden CJ (1988) Mortality and quality of life after intensive care for critical illness. Intensive Care Med 14:217–220PubMed

48.

Barie PS, Hydo LJ, Fischer E (1996) Utility of illness severity scoring for prediction of prolonged surgical critical care. J Trauma 40:513–518PubMed

49.

Zaren B, Hedstrand U (1987) Quality of life among long-term survivors of intensive care. Crit Care Med 15:743–747PubMed

Title: Long-term outcome in ICU patients:
What about quality of life?
Authors: Francisca García Lizana
Daliana Peres Bota
Michael De Cubber
Jean-Louis Vincent
Publication date: 01-08-2003
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2003
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-1875-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Long-term outcome in ICU patients:

What about quality of life?

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and results

Conclusions

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