A Feasibility Study of Functional Status and Follow-Up Clinic Preferences of Patients at High Risk of Post Intensive Care Syndrome

Abstract

After prolonged mechanical ventilation patients may experience the 'post intensive care syndrome' (PICS) and may be candidates for post-discharge follow-up clinics. We aimed to ascertain the incidence and severity of PICS symptoms in patients surviving prolonged mechanical ventilation and to describe their views regarding follow-up clinics. In a teaching hospital, we conducted a cohort study of all adult patients discharged alive after ventilation in ICU for ≥7 days during 2013. We administered the EuroQol-5D (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) via telephone interview and asked patients their views about the possible utility of a follow-up clinic. We studied 48 patients. At follow-up (average 19.5 months), seven (15%) patients had died and 14 (29%) did not participate (eight declined; two were non-English speakers; four were non-contactable). Among the 27 responders, 16 (59%) reported at least moderate problems in ≥1 EQ-5D dimension; 10 (37%) in ≥2 dimensions, and 8 (30%) in ≥3 dimensions. Moreover, 10 (37%) patients reported marked psychological symptoms; six (22%) scored borderline or abnormal on the HADS for both anxiety and depression; and four (15%) scored borderline or abnormal for one component. Finally, 21/26 (81%) patients stated that an ICU follow-up clinic would have been beneficial. At long-term follow-up, the majority of survivors of prolonged mechanical ventilation reported impaired quality of life and significant psychological symptoms. Most believed that a follow-up clinic would have been beneficial.

SurvivingICU: Stories of recovery

“…As well as written information, support from a specialised support person was identified as important rather than just from their family and friends who did not have a deep understanding of ICU experiences and recovery. Farley () and Jónasdóttir, Klinke, and Jónsdóttir () have identified that survivors value some kind of follow up provision from practitioners who can empathise with their experiences during recovery and provide expert advice.…”

Customised Care: Post Intensive Care Syndrome

“…This patient met the previously described PICS symptomatology. Patients treated in an ICU have a wide range of baseline situations before admission, primary diagnoses, comorbidities and other factors that may influence burden and coping capacity [29] Known factors present that influence the outcome of the patient’s recovery programme were: old age, extensive medical history, unknown baseline situation and good support from the patient’s wife and family [12, 30-33]. The significant medical history and unknown preoperative coping capacity made it difficult to estimate the patient’s postoperative function and the feasibility of achieving the ultimately desired function.…”

Hand- och benstyrka vid intensivvårdsavdelning (IVA)-mottagning, -en retrospektiiv studie

“…I en systematisk litteraturgenomgång konstaterades att det är osäkert om uppföljning efter intensivvård har någon påverkan på bland annat livskvalitet och fysisk funktion, där fysisk funktion studerades genom patientformulär (Schofield-Robinson, Lewis, Smith, McPeake, & Alderson, 2018). Vid en uppföljning två år efter intensivvård konstaterades att patienter uppgav nedsatt livskvalitet i form av ångest och depression och patienterna beskrev att det hade varit fördelaktigt med uppföljning efter intensivvården (Farley, Eastwood, & Bellomo, 2016). I en beskrivande studie av en multidisciplinär postIVA-mottagning konstaterades att uppföljningen kunde bidra till att identifiera obehandlade psykologiska och fysiska nedsättningar (Schandl, Brattström, Svensson-Raskh, Hellgren, Falkenhav, & Sackey, 2011).…”