Long-term psychological outcome after discharge from intensive care

Abstract

ObjectiveTo investigate the longterm psychological outcome in survivors of critical illness after intensive care unit discharge.MethodsA prospective cohort of survivors admitted to a mixed intensive care unit between January and September 2010 was evaluated six months and five years after hospital discharge. The Dementia Rating Scale-2, the Hospital Anxiety and Depression Scale, the Posttraumatic stress syndrome 14-questions inventory, the Euro Quality of Life 5 Dimensions (EQ-5-D), and the Visual Analogue Scale (EQ VAS) were assessed at both follow-up periods.ResultsOf 267 patients, 25 patients were evaluated at 6 months after discharge (62 ± 16 years); 12 (48%) presented cognitive impairment, 6 (24%) anxiety, 4 (16%) depression, and 4 (16%) post-traumatic stress disorder. Among those re-evaluated five years after discharge (n = 17; 65 ± 15 years), the frequency of cognitive impairment dropped from 8 (47%) to 3 (18%) (p = 0.063), due to improvement in these patients over time, and other patients did not acquire any dysfunction after discharge. At five years after discharge, only two patients (12%) reported anxiety, and none had depression or post-traumatic stress disorder. No differences were found between the six-month and five-year follow-ups regarding EQ-5-D and EQ VAS.ConclusionSurvivors do not show a progressive decline in cognitive function or quality of life within five years after intensive care unit discharge. Psychopathological symptoms tend to decrease with time.

Health‐related quality of life, anxiety and depression and physical recovery after critical illness – A prospective cohort study

“…After discharge from the intensive care unit (ICU), patients may experience anxiety with recurring painful memories, depressive symptoms, and sleep disorders mimicking post-traumatic stress disorder symptoms. [2][3][4][5][6] Also, studies show that cognitive function may be impaired, especially for those experiencing delirium in the intensive care unit. [7][8][9][10] Consequently, such impairments may affect the mental health aspects of health-related quality of life.…”

To: Long-term psychological outcome after discharge from intensive care

“…We read with great interest the article "Long-term psychological outcome after discharge from intensive care", by Pereira et al The authors performed a follow-up study of patients admitted to an intensive care unit (ICU) and evaluated the prevalence of long-term mental health outcomes as well as possible predictors during hospitalization. ( 1 ) The importance of the newly described post-intensive care syndrome is undeniable, ( 2 ) and studies that focus on long-term outcomes that are centered on patients are very relevant. ( 3 ) However, caution is needed when analyzing the results presented.…”

Reply to: Long-term psychological outcome after discharge from intensive care

“…We agree that the importance of posthospitalization syndrome in intensive care is undeniable and that the article "Long-term psychological outcomes after discharge from intensive care" represents a pilot study, which will be further developed in the future and in which we intend to increase the sample size and draw solid conclusions. (2) Considering the previously described limitations of this study, we do not intend to lead professionals to change their decisions or to interfere with clinical practice. Our intent is to draw the attention of the community working in intensive care medicine to the relevance of this topic and to its consequences.…”

“…Fortunately, medicine has evolved to recognize the patient at risk and prevent disease, and it is also important to follow this path with regard to this syndrome. The chosen methodology included the study of the probability of developing cognitive deficit, whether or not each of the chosen variables was present, by simple logistic regression; thus, the odds ratio in table 3 (3) is crude and not adjusted. As Lima-Setta et al (1) have emphasized, considering the limited number of patients, progression of the study with multivariate logistic regression would not be adequate.…”