Factors influencing physical functional status in intensive care unit survivors two years after discharge

BMC Anesthesiology

Research Article

Márcio P Hetzel¹  Alessandra H D Fleig¹  Ana Paula R Freitas¹  Erika C Treptow¹  Claudia R Cabral¹  Márcia IB Rizzotto¹  Daniele M Dallegrave¹  André S Machado²  Patrícia C Balzano²  Roselaine P Oliveira²  Augusto Savi²  Cassiano Teixeira³  Silvia RR Vieira⁴  Jaqueline S Haas⁴ 

[1] Department of Critical Care – Central-ICU of Complexo, Hospitalar da Santa Casa, Porto Alegre, Brazil;Department of Critical Care, Hospital Moinhos de Vento, Porto Alegre, Brazil;Medical School - Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil;Postgraduate Program in Medical Science, Medical School, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil;

关键词: Activities of Daily Living;    Physical Functional Status;    Intensive Care Unit;    Long-term Care;    Mortality;    Prognosis;    Health-related Quality of Life;   

DOI  :  10.1186/1471-2253-13-11

 received in 2012-03-03, accepted in 2013-06-04,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundStudies suggest that in patients admitted to intensive care units (ICU), physical functional status (PFS) improves over time, but does not return to the same level as before ICU admission. The goal of this study was to assess physical functional status two years after discharge from an ICU and to determine factors influencing physical status in this population.MethodsThe study reviewed all patients admitted to two non-trauma ICUs during a one-year period and included patients with age ≥ 18 yrs, ICU stay ≥ 24 h, and who were alive 24 months after ICU discharge. To assess PFS, Karnofsky Performance Status Scale scores and Lawton-Instrumental Activities of Daily Living (IADL) scores at ICU admission (K-ICU and L-ICU) were compared to the scores at the end of 24 months (K-24mo and L-24mo). Data at 24 months were obtained through telephone interviews.ResultsA total of 1,216 patients were eligible for the study. Twenty-four months after ICU discharge, 499 (41.6%) were alive, agreed to answer the interview, and had all hospital data available. PFS (K-ICU: 86.6 ± 13.8 vs. K-24mo: 77.1 ± 19.6, p < 0.001) and IADL (L-ICU: 27.0 ± 11.7 vs. L-24mo: 22.5 ± 11.5, p < 0.001) declined in patients with medical and unplanned surgical admissions. Most strikingly, the level of dependency increased in neurological patients (K-ICU: 86 ± 12 vs. K-24mo: 64 ± 21, relative risk [RR] 2.6, 95% CI, 1.8–3.6, p < 0.001) and trauma patients (K-ICU: 99 ± 2 vs. K-24mo: 83 ± 21, RR 2.7, 95% CI, 1.6–4.6, p < 0.001). The largest reduction in the ability to perform ADL occurred in neurological patients (L-ICU: 27 ± 7 vs. L-24mo: 15 ± 12, RR 3.3, 95% CI, 2.3–4.6 p < 0.001), trauma patients (L-ICU: 32 ± 0 vs. L-24mo: 25 ± 11, RR 2.8, 95% CI, 1.5–5.1, p < 0.001), patients aged ≥ 65 years (RR 1.4, 95% CI, 1.07–1.86, p = 0.01) and those who received mechanical ventilation for ≥ 8 days (RR 1.48, 95% CI, 1.02–2.15, p = 0.03).ConclusionsTwenty-four months after ICU discharge, PFS was significantly poorer in patients with neurological injury, trauma, age ≥ 65 tears, and mechanical ventilation ≥ 8 days. Future studies should focus on the relationship between PFS and health-related quality of life in this population.

【 授权许可】

CC BY   
© Haas et al.; licensee BioMed Central Ltd. 2013