Prevalence and experience of fatigue in survivors of critical illness: A mixed-methods systematic review

Abstract

<jats:p>Objective To investigate the prevalence, experience and management of fatigue in adult survivors of critical illness. Data sources An electronic search was performed on seven databases: CINAHL, Medline, EMBASE, PsycINFO, Emcare, British Nursing Index, and Web of Science. Study selection and data extraction Seventy-six peer-reviewed, English language studies that investigated fatigue or vitality in adult patients admitted to an Intensive Care Unit (ICU) and followed up for any period were included. Extracted data were split into three datasets for analysis: data from vitality domain of SF-36 (dataset A), other quantitative data (dataset B), and qualitative data (dataset C). Methodological quality was assessed using the critical appraisal skills programme (CASP) tools. Data synthesis We adopted a segregated approach to mixed-methods synthesis. We merged all datasets, attributing all results to one of four qualitative themes. These were prevalence and severity, contributing factors, impacts on quality of life, assessment and management. Results The prevalence of fatigue ranged from 13.8 to 80.9 %. Fatigue severity reached its nadir at approximately one month post ICU discharge, improved over time but seldom reached reference population scores. Various biological, disease related and psychological factors associated with fatigue were identified including age, poor pre-morbid status and sleep disturbance. No critical illness specific tool to assess fatigue in ICU survivors was identified. A paucity of evidence based interventions for management of fatigue in ICU survivors were identified despite fatigue negatively impacting on survivors quality of life. Conclusions This mixed method review shows that fatigue is highly prevalent in ICU survivors, negatively impacting their recovery. To date, no ICU specific fatigue assessment tool or targeted intervention has been designed to manage this symptom. Our review has identified factors, which may increase or mitigate against fatigue, along with potential management strategies, which should be used to inform future research and practice.</jats:p>

Men and COVID-19: the aftermath

“…Although too soon to be formally diagnosed as chronic fatigue syndrome there are growing reports of symptoms similar to Myalgic encephalomyelitis (ME) as part of a post-viral response, with a similar picture to those seen in previous epidemics [94,95]. Debilitating levels of fatigue, which has a substantial impact on quality of life, is also found as part of the post-intensive care syndrome [96], and with the number of men who have had survived severe disease the numbers affected could be predicted to be substantial.…”

Fatigue in critical care survivors: multidisciplinary and self‐management strategies

“…Fast forward to today and in this issue of the journal, Bench et al. [8] report the results of a mixed‐methods review focused on one of medicine’s most ubiquitous and challenging symptoms: fatigue. The authors report that the prevalence of fatigue is high, but variable (range 14%–81%) in ICU survivors.…”

Recovery from Covid-19 critical illness: a secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

“…The prevalence of fatigue in ICU-survivors ranges from 13.8% to 80.9% 18 . This has a profound negative impact on survivors’ quality of life (QOL), and is one of the most prevalent and debilitating challenges of ICU-survivorship 18,19 .…”

“…The prevalence of fatigue in ICU-survivors ranges from 13.8% to 80.9% 18 . This has a profound negative impact on survivors’ quality of life (QOL), and is one of the most prevalent and debilitating challenges of ICU-survivorship 18,19 . Fatigue may lead to delayed return to employment and pre-critical illness physical fitness, difficulty in completing activities of daily living, social isolation, depression, and many other negative sequalae 18–20 .…”

“…This has a profound negative impact on survivors’ quality of life (QOL), and is one of the most prevalent and debilitating challenges of ICU-survivorship 18,19 . Fatigue may lead to delayed return to employment and pre-critical illness physical fitness, difficulty in completing activities of daily living, social isolation, depression, and many other negative sequalae 18–20 . It is unclear if recovery is different in survivors of Covid-19 critical illness compared to other critical illness, requiring distinct risk assessment tools or interventions to support their recovery.…”