Outcomes of critical illness: what is meaningful?

Gajić, Ognjen; Ahmad, Sumera; Wilson, Michael E.; Kaufman, David A.

doi:10.1097/mcc.0000000000000530

Cited by 41 publications

(41 citation statements)

References 57 publications

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“…13,14 Prior efforts to define better outcomes in ICU research have been guided by practitioners and researchers. More recent work has given a voice to patient stakeholders, [15][16][17] including the use of qualitative approaches to study patients' experiences in the ICU, perspectives on ICU-based palliative care, and services after ICU discharge. [18][19][20][21][22][23][24][25] However, perspectives of family caregivers, particularly those of patients who died in the hospital, have rarely been explored.…”

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confidence: 99%

What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

Auriemma

Harhay

Haines

et al. 2021

American Journal of Critical Care

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Background Despite increased emphasis on providing higher-quality patient- and family-centered care in the intensive care unit (ICU), there are no widely accepted definitions of such care in the ICU. Objectives To determine (1) aspects of care that patients and families valued during their ICU encounter, (2) outcomes that patients and families prioritized after hospital discharge, and (3) outcomes perceived as equivalent to or worse than death. Methods Semistructured interviews (n = 49) of former patients of an urban, academic medical ICU and their family members. Two investigators reviewed all transcripts line by line to identify key concepts. Codes were created and defined in a codebook with decision rules for their application and were analyzed using qualitative content analysis. Results Salient themes were identified and grouped into 2 major categories: (1) processes of care within the ICU— communication, patient comfort, and a sense that the medical team was “doing everything” (ie, providing exhaustive medical care) and (2) patient and surrogate outcomes after the ICU—survival, quality of life, physical function, and cognitive function. Several outcomes were deemed worse than death: severe cognitive/physical disability, dependence on medical machinery/equipment, and severe/constant pain. Conclusion Although survival was important, most participants qualified this preference. Simple measures of mortality rates may not represent patient- or family-centered outcomes in evaluations of ICU-based interventions, and new measures that incorporate functional outcomes and patients’ and family members’ views of life quality are necessary to promote patient-centered, evidence-based care.

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confidence: 99%

What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

Auriemma

Harhay

Haines

et al. 2021

American Journal of Critical Care

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“…7 ARDS survivors are estimated to have a mean post-hospitalization cost of US$43,200 per person. 8 The cost burden of COVID-19 survivors is expected to be higher.…”

Section: ■ Picsmentioning

confidence: 99%

Post-intensive care syndrome and COVID-19 — Implications post pandemic

Biehl

Sese

2020

CCJM

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“…The importance of muscle insufficiency may be disregarded by clinicians when the initial focus of care is on survival. However, it is always important to consider the wishes of the patient themselves, since for many, survival with good physical function may be just as important, if not more important than survival itself [ 24 ]. Additionally, deprioritising the muscle within early clinical care risks further challenges as rehabilitation is likely to be prolonged and more difficult [ 25 ], leading to increased lengths of stay, and increased vulnerability to further illnesses, and a negative spiralling effect.…”

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confidence: 99%

COVID-19 and Acute Sarcopenia

Welch¹,

Greig²,

Masud³

et al. 2020

Aging and disease

125

142

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The COVID-19 pandemic has had a devastating global impact, with older adults being most at risk of death from the disease. However, acute sarcopenia occurs in survivors of COVID-19; older adults and the most critically unwell patients are the most at risk. Acute sarcopenia is an under-recognised condition of acute muscle insufficiency, defined by declines in muscle function and/or quantity within six months, usually following a stressor event. This commentary reviews definition and mechanisms of acute sarcopenia in COVID-19 and suggests recommendations for research and clinical practice. Research should now focus on the longer-term consequences of acute sarcopenia in patients who have suffered from COVID-19. At the same time, clinicians need to be increasingly aware of the condition, and measurements of muscle strength, quantity, and physical performance should be embedded into clinical practice. Clinicians should consider the risks of acute sarcopenia when weighing up the risks and benefits of treatment (e.g. dexamethasone), and instigate multidisciplinary treatment including dietetics input.

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Outcomes of critical illness: what is meaningful?

Abstract: A theoretical framework is outlined to help understand the impact of critical care interventions on outcomes that are meaningful to patients, families and healthcare providers.

Cited by 41 publications

References 57 publications

What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study

Post-intensive care syndrome and COVID-19 — Implications post pandemic

COVID-19 and Acute Sarcopenia

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