Tracking Outcomes Post Intensive Care: Findings of a longitudinal observational study

Area of Science:

• Critical Care Medicine
• Patient Outcomes
• Health Services Research

Background:

• Intensive care unit (ICU) survivors frequently experience new or worsening impairments, known as post-intensive care syndrome (PICS).
• Existing research on risk identification and interventions for PICS shows equivocal evidence, necessitating a deeper understanding of patient risk and outcomes.
• A nuanced approach is required to address the complex health challenges faced by ICU survivors.

Purpose of the Study:

• To describe the health status of patients six months after ICU discharge.
• To characterize patients with and without clinically significant physical, cognitive, or psychological impairments post-ICU.
• To identify factors associated with these impairments.

Main Methods:

• Prospective, multisite observational study involving patients discharged from four ICUs.
• Telephone-based questionnaire surveys assessing pre-admission characteristics and validated self-report measures of physical, cognitive, and psychological function (anxiety, depression, PTSD).
• Comparison of participants with and without significant impairments based on demographics and hospital data, including routine ICU data.

Main Results:

• 30% of 132 participants reported impairments in at least one domain six months post-ICU discharge; 43% of those had impairments in two or more domains.
• Impairment rates varied significantly between study sites (21% to 88%).
• Depression was the most common impairment, followed by physical, anxiety, and cognitive impairments; PTSD was least common. No significant differences in severity scores, delirium, or ventilation were found between impaired and unimpaired groups.

Conclusions:

• Significant heterogeneity exists among ICU survivors experiencing post-ICU impairments, underscoring the need for personalized risk assessment and support.
• Patient-specific circumstances, including individual characteristics and treatment factors, are vital for assessing risk and planning interventions.
• Findings support a comprehensive, whole-of-health service approach to optimize post-ICU recovery.