The frailty, outcomes, recovery and care steps of critically ill patients (FORECAST) study: pilot study results

Intensive Care Medicine Experimental

Research Articles

John Muscedere¹  Stephanie Sibley¹  Miranda Hunt¹  Gordon Boyd¹  Sean M. Bagshaw²  Patrick Norman³  Andrew Day³  Darryl Rolfson⁴ 

[1] Department of Critical Care Medicine, Queens University, Kingston Health Sciences Center, 76 Stuart Street, K7L 2V7, Kingston, ON, Canada;Department of Critical Care Medicine, University of Alberta, Edmonton, Canada;Kingston Health Sciences Center, Kingston, ON, Canada;University of Alberta, Edmonton, Canada;

关键词: Frailty;    Clinical frailty scale;    Frailty index;    Critical care outcomes;    Adverse events;    Care processes;   

DOI  :  10.1186/s40635-022-00446-7

 received in 2022-01-21, accepted in 2022-05-09,  发布年份 2022

来源: Springer

【 摘 要 】

IntroductionFrailty is common in critically ill patients and is associated with increased morbidity and mortality. There remains uncertainty as to the optimal method/timing of frailty assessment and the impact of care processes and adverse events on outcomes is unknown. We conducted a pilot study to inform on the conduct, design and feasibility of a multicenter study measuring frailty longitudinally during critical illness, care processes, occurrence of adverse events, and resultant outcomes.MethodsSingle-center pilot study enrolling patients over the age of 55 admitted to an Intensive Care Unit (ICU) for life-support interventions including mechanical ventilation, vasopressor therapy and/or renal replacement therapy. Frailty was measured on ICU admission and hospital discharge with the Clinical Frailty Scale (CFS), the Frailty Index (FI) and CFS at 6-month follow-up. Frailty was defined as CFS ≥ 5 and a FI ≥ 0.20. Processes of care and adverse events were measured during their ICU and hospital stay including nutritional support, mobility, nosocomial infections and delirium. ICU, hospital and 6 months were determined.ResultsIn 49 patients enrolled, the mean (SD) age was 68.7 ± 7.9 with a 6-month mortality of 29%. Enrollment was 1 patient/per week. Frailty was successfully measured at different time points during the patients stay/follow-up and varied by method/timing of assessment; by CFS and FI, respectively, in 17/49 (36%), 23/49 (47%) on admission, 22/33 (67%), 21/33 (63%) on hospital discharge and 11/30 (37%) had a CFS ≥ 5 at 6 months. Processes of care and adverse events were readily captured during the ICU and ward stay with the exception of ward nutritional data. ICU, hospital outcomes and follow-up outcomes were worse in those who were frail irrespective of ascertainment method. Pre-existing frailty remained static in survivors, but progressed in non-frail survivors.DiscussionIn this pilot study, we demonstrate that frailty measurement in critically ill patients over the course and recovery of their illness is feasible, that processes of care and adverse events are readily captured, have developed the tools and obtained data necessary for the planning and conduct of a large multicenter trial studying the interaction between frailty and critical illness.

【 授权许可】

CC BY   
© The Author(s) 2022

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