Surviving Intensive Care: a report from the 2002 Brussels Roundtable

Abstract

The traditional goal of intensive care has been to decrease short-term mortality. While worthy, this goal fails to address the issue of what it means to survive intensive care. Key questions include whether intensive care survivors have optimal long-term outcomes and whether ICU care decisions would change if we knew more about these outcomes. The 2002 Brussels Roundtable, "Surviving Intensive care", highlighted these issues, summarizing the available evidence on natural history and risk factors for critical illness and outlining future directions for care and research. Critical illness is associated with a wide array of serious and concerning long-term sequelae that interfere with optimal patient-centered outcomes. Although traditional short-term outcomes, such as hospital mortality, remain extremely important, they are not likely to be adequate surrogates for subsequent patient-centered outcomes. As such, it is important to focus specifically on how critical illness and intensive care affects a patient's and relatives' long-term health and well-being. There are a large number of potential pre-, intra-, and post-ICU factors that may improve or worsen these outcomes, and these factors are subjects for future research. In addition, future clinical trials of ICU therapies should include long-term follow-up of survival, quality of life, morbidity, functional status, and costs of care. Follow-up ought to be for at least six months. The SF-36 and EuroQOL EQ-5D are the best-suited instruments for measuring quality of life in multicenter critical care trials though further methodologic research and instrument design is encouraged. There are also opportunities today to improve care. Key to taking advantage of such opportunities is the need for a global awareness of critical illness as an entity that begins and ends outside the ICU 'box'. Specific interventions that show promise for improving care include ICU discharge screening tools and ICU follow-up clinics.

Expectations and outcomes of prolonged mechanical ventilation

“…(18) To assess patient quality of life, surrogates completed the EuroQOL-5D (EQ-5D), a five-domain, preference-based measure used validated among critical illness survivors and their surrogates. (19,20) An EQ-5D index score calculated from domain scores can range from 0 (death) to 1 (excellent quality of life). We report surrogate EQ-5D reports because only 49 (39%) patients were able to complete 12-month interviews.…”

Prevalence and Significance of Coagulation Abnormalities in Community-Acquired Pneumonia

“…We performed telephone follow-up and National Death Index searches to monitor patient survival after discharge from the hospital. We used 90-d mortality as our primary measure of survival, based on recently formulated endpoint recommendations for sepsis trials from two recent international expert panels (22,23). We tracked clinical data and blood samples by using unique anonymized identification numbers, merging data only after assays had been completed.…”

Delirium in the Intensive Care Unit: A Narrative Review of Published Assessment Tools and the Relationship between ICU Delirium and Clinical Outcomes

“…13 Also, in a report from the international 'Surviving Intensive Care' 2002 Roundtable Conference held in Brussels, the need for future investigations in neuro-cognitive abnormalities among survivors of intensive care received the strongest recommendation from the panel of experts. 14 Since many aspects of delirium in the ICU may be preventable (e.g. hypoxaemia, electrolyte disturbances, sleep deprivation, overzealous use of sedative agents), routine daily monitoring may be justified if adverse outcomes could be demonstrated within this population, and more importantly, if prevention and treatment of delirium could improve these adverse outcomes.…”