Long-Term Outcomes After Severe Shock

Abstract

Background Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Methods Seventy-six patients who were alive 90 days after severe shock (received ≥1 mcg/kg/min of norepinephrine equivalent) were eligible for the study. We measured three-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. Results The mean long-term survival was 5.1 years: 82% (62/76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of five years after hospital admission. The patients’ Physical Functioning scores were below US population norms (p<0.001), whereas mental health scores were similar to population norms. Nineteen percent of the patients had symptoms of depression, 39% had symptoms of anxiety and 8% had symptoms of posttraumatic stress disorder. Thirty-six percent were disabled, and 17% were working full time. Conclusions Early survivors of severe shock had a high three-year survival rate. Patients’ long term physical and psychological outcomes were similar to those reported for cohorts of less severely ill ICU survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcome to general ICU survivor populations.

Return to work after critical illness: a systematic review and meta-analysis

“…Among these articles, 52 unique studies evaluated return to work in previously employed ICU survivors (figure 1, table 1, online supplementary eTable 2). 4 5 13–63 These studies included 13 retrospective16 18 23 30 33 39 42 43 47 48 52 56 62 and 39 prospective4 5 13–15 17 19–22 24–28 30–32 34–38 40 41 44–46 49–51 53–55 57–61 63 cohort studies, of which three were longitudinal follow-up within a randomised trial 4 37 59. Eleven (21%) studies included more than one follow-up time point after discharge 4 5 26 28 29 34 37 45 49 51 55 62.…”

“…Eleven studies conducted employment assessments during either the first (2000–2004) or second (2008–2010) global economic downturns occurring during the publication period 4 32 36 46–48 50–52 55 63 64. Twenty-eight (54%) studies were conducted in Europe,15 17 18 20 22 25–27 30–36 38–42 44 48–51 58 62 63 14 (27%) in North America,4 5 13 14 16 19 23 24 28 29 37 45 52 55 60 8 (15%) in Australia/New Zealand21 43 46 47 53 54 59 61 and 2 (4%) in Asia 56 57. Nine studies (17%) evaluated return to work in survivors of ARDS 4 5 19 24 39 45 47 57 63.…”

“…Nine studies (17%) evaluated return to work in survivors of ARDS 4 5 19 24 39 45 47 57 63. Employment evaluation occurred via in-person visit in 18 (35%) studies,18 19 21 26–29 31 36 39 43 45 50 55 57–60 63 telephone interview in 18 (35%) studies,4 5 13–15 23 30 32 34 42 46 47 49 52–54 56 61 mailed questionnaire in 15 (29%) studies16 17 20 22 24 25 33 35 37 38 40 41 44 48 51 and national database in 1 study 62. The majority of studies used ‘had returned to work’, ‘back to work’, ‘working’ or multiple phrases to describe survivors’ post-ICU employment status, and did not report the specific employment question(s) used, the timing of return to work or status of survivors who had not returned to work (ie, retirement, unemployment, disability).…”

Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center

“…ICU survivors have high rates of mortality and increased health care utilization following discharge [2–13]. The rise in survivorship has created a burgeoning population suffering from long-term consequences of critical care [13–18], including cognitive impairment [18–23], anxiety [16–18], depression [13, 15–18], post-traumatic stress disorder [13–18, 24], decreased quality of life [9, 12, 25–29], and physical disability [17, 20, 30, 31]. This constellation of problems is now known as PICS, a condition of new or worsening dysfunction in key domains such as cognition and physical function that persists beyond the inciting critical illness [32].…”

What’s New in Shock? February 2015

“…A clinical study on the long-term outcome of severe shock revealed that most patients who survived a 90-day period also survived 3 years or more (6). Thirty-nine percent had anxiety, and 19% had depression symptoms.…”