Focus on long-term cognitive, psychological and physical impairments after critical illness

Bein, Thomas; Bienvenu, O. Joseph; Hopkins, Ramona O.

doi:10.1007/s00134-019-05718-7

Cited by 22 publications

(17 citation statements)

References 16 publications

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“…In recent decades, the key question in intensive care medicine has changed from “‘Will my patient survive or die” into “How will my patient survive” ( 45 ). However, the use of accurate ICU prognostic models, such as the APACHE-IV or Simplified Acute Physiology Scores, is not sufficient to answer this question: they predict short-term survival ( 46 ), but are unable to predict important outcomes for ICU survivors, namely physical, mental, and cognitive functioning; return to work; and quality of life in the months and years following ICU discharge ( 47 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study

Geense¹,

Boogaard²,

Peters

et al. 2020

Critical Care Medicine

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Section: Discussionmentioning

confidence: 99%

Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study

Geense¹,

Boogaard²,

Peters

et al. 2020

Critical Care Medicine

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“…The long-term outcomes of critically ill patients with and without cancer have been the focus of an increasing number of research efforts in recent years. 18 , 19 The long-term impacts of the management applied during ICU admission are increasingly being recognized as a crucial issue in critical care medicine due to the steady decrease in ICU mortality as well as high post-ICU mortality rates in the past 2 decades. 20 Shankar-Hari et al analyzed the additional mortality at 1-year after ICU discharge in 43 studies and determined that the 1-year postacute mortality was 16.1%.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Fluid Balance on 1-Year Mortality in Critically Ill Patients With Cancer: A Retrospective Study in Central Taiwan

et al. 2020

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A positive fluid balance has been found to be deleterious in critically ill patients; however, the impact of early fluid balance, particularly on long-term outcomes, in critically ill patients with cancer remains unclear. We performed this retrospective study at a tertiary-care referral hospital with 1500 beds and 6 intensive care units (ICUs) in central Taiwan, and 942 patients with cancer admitted to ICUs during 2013 to 2016 were enrolled. The primary outcome was 1-year mortality. Cancer-related data were obtained from the cancer registry, and data during ICU admissions were retrieved from the electronic medical records. The association between fluid balance, which was represented by median and interquartile range, and 1-year mortality was determined by calculating the hazard ratio (HR) with 95% confidence interval (CI) using a multivariable Cox proportional hazards regression model. The in-hospital mortality rate was 22.9% (216 of 942), and the mortality within 1 year after the index ICU admission was 38.7% (365 of 942). Compared to survivors, nonsurvivors tended to have a higher Acute Physiology and Chronic Health Evaluation II score (24.1 ± 6.9 vs 20.5 ± 6.2, P < .01), a higher age (65.0 ± 14.4 vs 61.3 ± 14.3, P < .01), a higher serum creatinine (1.5 ± 1.3 vs 1.0 ± 1.0, P < .01), and a higher cumulative day 1 to 4 fluid balance (2669, 955-5005 vs 4103, 1268-7215 mL, P < .01). Multivariable Cox proportional hazards regression analysis found that cumulative day-4 fluid balance was independently associated with 1-year mortality (adj HR 1.227, 95% CI: 1.132-1.329). A positive day 1 to 4 cumulative fluid balance was associated with shorter 1-year survival in critically ill patients with cancer. Further studies are needed to validate this association.

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“…In recent years, there has been an increased focus on post-ICU quality-of-life, morbidity, and survivorship (e.g., post-intensive care syndrome) [75,76]. Reductions in the number of days that patients require organ support, are in the ICU, or are in the hospital are attractive to most stakeholders and are associated with reduced long-term morbidity and mortality.…”

Section: Non-mortality Outcome Measuresmentioning

confidence: 99%

Contemporary strategies to improve clinical trial design for critical care research: insights from the First Critical Care Clinical Trialists Workshop

et al. 2020

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Background: Conducting research in critically-ill patient populations is challenging, and most randomized trials of critically-ill patients have not achieved pre-specified statistical thresholds to conclude that the intervention being investigated was beneficial. Methods: In 2019, a diverse group of patient representatives, regulators from the USA and European Union, federal grant managers, industry representatives, clinical trialists, epidemiologists, and clinicians convened the First Critical Care Clinical Trialists (3CT) Workshop to discuss challenges and opportunities in conducting and assessing critical care trials. Herein, we present the advantages and disadvantages of available methodologies for clinical trial design, conduct, and analysis, and a series of recommendations to potentially improve future trials in critical care. Conclusion: The 3CT Workshop participants identified opportunities to improve critical care trials using strategies to optimize sample size calculations, account for patient and disease heterogeneity, increase the efficiency of trial conduct, maximize the use of trial data, and to refine and standardize the collection of patient-centered and patientinformed outcome measures beyond mortality.

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Focus on long-term cognitive, psychological and physical impairments after critical illness

Cited by 22 publications

References 16 publications

Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study

Physical, Mental, and Cognitive Health Status of ICU Survivors Before ICU Admission: A Cohort Study

Impact of Early Fluid Balance on 1-Year Mortality in Critically Ill Patients With Cancer: A Retrospective Study in Central Taiwan

Contemporary strategies to improve clinical trial design for critical care research: insights from the First Critical Care Clinical Trialists Workshop

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