Outcome of ICU survivors: a comprehensive review. The role of patient‐reported outcome studies

Abstract

Problems survivors face after intensive care unit (ICU) discharge begin while they are still in the ward, where many of their specific problems may run unrecognized, but they assume a heavy weight when they arrive at their homes and face several kind of limitations, from being unable to climb stairs because of weight loss, asthenia, dyspnea or joint stiffness to anxiety, depression or post-traumatic stress disorder. Follow-up consultations have given us a better understanding of these specific problems, and the information gained has been used to improve intensive care itself and promote a quality service for patients and relatives. The aim of this article is to provide an overview on adult ICU outcome studies and discuss how they have influenced and improved the delivery of intensive care. We will explain how we went from real patients to outcome studies and what we have learned concerning the consequences of critical illness and critical care. Development of outcome studies, what we have learned through them and our own experience will be outlined focusing mainly in four topics: mortality, physical disability, neuropsychological disability and health-related quality of life. Interventions to improve outcome on these main topics will be presented, and we will explain how we went from outcome studies to clinical interventions, focusing on the most recent proposals of intervention to improve outcome.

Health-Related Quality of Life and Associated Factors in Intensive Care Unit Survivors 6 Months After Discharge

“…[8][9][10] A study 8 of patients with multiple organ failure in 22 ICUs in the United Kingdom indicated that diminished HRQOL had an adverse effect on family employment and income; one-third of the families required support from government sources. In addition, one-quarter of the patients had decreased independence in activities of daily living and an increase in the use of health services.…”

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

“…These problems occur in up to 15% and 20% of the patients, respectively (Griffiths et al, 2007;Tully, 2012), and may hamper full recovery (Granja et al, 2012;McKhann et al, 1997;Pirraglia et al, 1999).…”

Depressive, Angst- und posttraumatische Belastungsstörungen als Konsequenzen intensivmedizinischer Behandlung

“…In order to reduce principally modifiable risk factors several strategies are illustrated, including well-reflected intensive care sedation and analgesia, special prophylactic medication regarding the major risk of traumatic memories and posttraumatic stress disorder (PTSD), psychological and psychotherapeutic interventions in states of increased acute stress symptoms and aids for personal memories and reorientation. [30]. Persistierende Neuropathien ("critical illness neuropathy", CIP) und Myopathien ("critical illness myopathy", CIM) nach intensivmedizinischer Behandlung werden als eigenständige neurologische Spätfolgen beschrieben [32].…”