The impact of an intensive care unit admission on the health status of relatives of intensive care survivors: A prospective cohort study in primary care

Abstract

Background Relatives of intensive care unit (ICU) survivors may suffer from various symptoms after ICU admittance of their relative, known as post-intensive care syndrome-family (PICS-F). Studies regarding PICS-F have been performed but its impact in primary care is unknown. Objectives To explore health problems of relatives of ICU survivors in primary care. Methods This is an exploratory prospective cohort study in which we combined data from two hospitals and a primary care research network in the Netherlands. ICU survivors who had been admitted between January 2005 and July 2017 were identified and matched by sex and age with up to four chronically ill (e.g. COPD, cardiovascular disease) patients. In both groups, relatives living in the same household were identified and included in this study. Primary outcome was the number of new episodes of care (International Classification of Primary Care-2) for up to five years. Hazard ratios (HRs) for the total number of new episodes were calculated. Results Relatives of ICU survivors ( n = 267, mean age 38.1 years, 41.0% male) had significantly more new care episodes compared to the reference group ( n = 705, mean age 36.3 years, 41.1% male) 1–2 years (median 0.11 vs. 0.08, HR 1.26; 95% confidence interval (CI) 1.03–1.54) and 2–5 years (median 0.18 vs. 0.13, HR 1.28; 95%CI 1.06–1.56) after ICU discharge. No differences were found in the period before ICU admission. Conclusion Relatives of ICU survivors present more morbidity in primary care than relatives of chronically ill patients up to five years after ICU discharge.

Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation – a prospective cohort study

“…After three months, patients admitted to the ICU remain to have significant more GP consultations compared to the matched reference patients. A recent study with similar methods and the same database origin found that relatives of patients admitted to the ICU also present more morbidity in primary care compared to relatives of chronically ill patients after ICU admission, making the health aspects of critical illness far more wide-ranging than the diagnosis of ICU admission itself [ 34 ]. Additionally, a remarkable finding was that patients admitted to the ICU also encountered more new disease-episodes and GP contacts 1 year before ICU admission compared to patients without ICU admission.…”

Psychological Symptoms in Relatives of Critically Ill Patients: A Longitudinal Cohort Study

“…A recent Dutch study found that relatives of former ICU patients had a higher number of new episodes of primary care 2-5 years after ICU discharge, but not in the first year. They suggested that relatives might prioritize the health of the former ICU patient over their own in the first year after ICU discharge and develop a broad range of symptoms and diseases including psychologic morbidity more than 1 year after discharge (20).…”

Effect of a Standardized Family Participation Program in the ICU: A Multicenter Stepped-Wedge Cluster Randomized Controlled Trial*

“…Furthermore, measurement of mental health symptoms among relatives only after 3 months may not have been sufficient, as patients’ rehabilitation trajectories vary. Similar studies collected longitudinal data before admission, as the mental health status of relatives before ICU admission may be an important predictor of mental health outcomes of relatives after the patient’s ICU stay ( 37 ) and following admission ( 18 , 38 , 39 ). Furthermore, as shown in this Dutch study, facilitating the process of participation was shown to increase the odds of a neutral to positive attitude toward participation, which probably will facilitate participation in daily ICU practice.…”