Characteristics and Outcomes of Intensive Care Unit Survivors: Experience of a Multidisciplinary Outpatient Clinic in a Teaching Hospital

Abstract

OBJECTIVES:To describe the experience of an outpatient clinic with the multidisciplinary evaluation of intensive care unit survivors and to analyze their social, psychological, and physical characteristics in a low-income population and a developing country.METHODS:Retrospective cohort study. Adult survivors from a general intensive care unit were evaluated three months after discharge in a post-intensive care unit outpatient multidisciplinary clinic over a period of 6 years (2008-2014) in a University Hospital in southern Brazil.RESULTS:A total of 688 out of 1945 intensive care unit survivors received care at the clinic. Of these, 45.2% had psychological disorders (particularly depression), 49.0% had respiratory impairments (abnormal spirometry), and 24.6% had moderate to intense dyspnea during daily life activities. Patients experienced weight loss during hospitalization (mean=11.7%) but good recovery after discharge (mean gain=9.1%), and 94.6% were receiving nutrition orally. One-third of patients showed a reduction of peripheral muscular strength, and 5.7% had moderate to severe tetraparesis or tetraplegia. There was a significant impairment in quality of life (SF-36), particularly in the physical and emotional aspects and in functional capacity. The economic impacts on the affected families, which were mostly low-income families, were considerable. Most patients did not have full access to rehabilitation services, even though half of the families were receiving financial support from the government.CONCLUSIONS:A significant number of intensive care unit survivors evaluated 3 months after discharge had psychological, respiratory, motor, and socioeconomic problems; these findings highlight that strategies aimed to assist critically ill patients should be extended to the post-hospitalization period and that this problem is particularly important in low-income populations.

Experience of Post-ICU Syndrome in Critical Disease Survivors

“…These results are consistent with those provided by other studies in which survivors expressed psychological disorders (particularly depression), respiratory problems (abnormal spirometry), and moderate to severe dyspnea during daily life activities. Significant deterioration in the quality of life and functional capacity were also noted (21,22). These aspects were recognized by the participants, remarking by their dependence on other family members to carry out life activities, such as managing money.…”

Musculoskeletal complications following critical illness: A scoping review

“… Nedegaard et al [ 22 ] 2021 Scandinavia Muscle strength, mass and function Single centre Nested randomised clinical trial n = 116 3 months 93.8% Handgrip MVC; rectus femoris CSA; knee-extension MVC, RFD and endurance at 25% of MVC. Fan et al [ 7 ] 2014 USA Muscle strength Multicentre Longitudinal prospective cohort n = 127 24 months 83.3% MRC SS; hand grip dynamometry Borges et al [ 36 ] 2015 Brazil Muscle strength Single centre Prospective cohort n = 51 3 months 63.6% Maximal isometric voluntary contraction (quadriceps); hand grip dynamometer; Pfoh et al [ 35 ] 2016 USA Muscle strength Multicentre Longitudinal prospective cohort n = 115 5 years 90.3% MRC SS Duarte et al [ 38 ] 2017 Brazil Muscle strength Single centre Retrospective cohort n = 591 3 months 56.6% MRCSS Dinglas et al [ 32 ] 2018 USA Muscle strength Multicentre Longitudinal prospective cohort n = 103 4 years 81.8% MRCSS Van Aerde et al [ 27 ] 2020 Belgium Muscle strength Multicentre Sub-analysis of prospective cohort n = 205 5 years 84.8% Hand grip dynamometry; Hand held dynamometry for peripheral muscle groups; MRC SS; Poulsen et al [ 39 ] 2013 Denmark Muscle function Single centre Case-control n = 16 12 months 83.8% Biomechanical testing during isometric knee extension; EMG. Kiriella et al [ 31 ] 2018 Canada Muscle function, gait and postural control …”

“…The majority of the studies ( n = 25) evaluated an aspect of muscle impairment [ 7 , 22 , 27 , 29 , 31 , 32 , [34] , [35] , [36] , [38] , [39] , [40] ] or chronic pain [ 26 , 28 , 37 , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ]. There was also evaluation of neuromuscular function [ 21 , 23 , 30 , 50 ], peripheral joint impairment [ 33 , 51 ], fracture risk [ 24 ] and femoral head necrosis [ 25 ].…”

“…Muscle impairment was reported as atrophy [ 29 , 34 ], weakness [ 7 , 27 , 29 , 35 , 36 , 38 ] or reduced muscle function [ 31 , 39 ], with reported prevalence varying greatly (9–73%). Neuromuscular impairment was described as motor sensory deficits [ 30 ], mononeuropathies [ 23 ] and critical illness polyneuropathy (CIP) [ 21 ].…”

One Month Post Intensive Care Unit Discharge Outcome

“…In another study done by Duarte et al it was seen that after ICU discharge there were a number of limitations in the activities. Reduction in peripheral muscle strength was seen in 5.7%, weight loss in 11.7%, abnormal spirometry in 49% and psychological issues in 49% of the cases 16 . Post ICU discharge psychosis, delirium, myopathies and neuropathies are well known entities and one important cause of bed bound state.…”