Functional and psychological features immediately after discharge from an intensive care unit: prospective cohort study

Abstract

Objective: To assess the functional and psychological features of patients immediately after discharge from the intensive care unit.

Methods: Prospective cohort study. Questionnaires and scales assessing the degree of dependence and functional capacity (modified Barthel and Karnofsky scales) and psychological problems (Hospital Anxiety and Depression Scale), in addition to the Epworth Sleepiness Scale, were administered during interviews conducted over the first week after intensive care unit discharge, to all survivors who had been admitted to this service from August to November 2012 and had remained longer than 72 hours.

Results: The degree of dependence as measured by the modified Barthel scale increased after intensive care unit discharge compared with the data before admission (57 ± 30 versus 47 ± 36; p < 0.001) in all 79 participants. This impairment was homogeneous among all the categories in the modified Barthel scale (p < 0.001) in the 64 participants who were independent or partially dependent (Karnofsky score ≥ 40) before admission. The impairment affected the categories of personal hygiene (p = 0.01) and stair climbing (p = 0.04) only in the 15 participants who were highly dependent (Karnofsky score < 40) before admission. Assessment of the psychological changes identified mood disorders (anxiety and/or depression) in 31% of the sample, whereas sleep disorders occurred in 43.3%.

Conclusions: Patients who remained in an intensive care unit for 72 hours or longer exhibited a reduced functional capacity and an increased degree of dependence during the first week after intensive care unit discharge. In addition, the incidence of depressive symptoms, anxiety, and sleep disorders was high among that population.

Figure 1

Patient recruitment. ICU - intensive care unit.

Figure 2

Comparison of the scores on the modified Barthel scale before and after the intensive care unit admission of patients who were previously dependent (Karnofsky score ≤40) or independent (Karnofsky score >40). ICU - intensive care unit; *p relative to intergroup (Karnofsky score >40 and ≤40), comparison before and after the intensive care unit admission.

Figure 3

Variation of the scores on the modified Barthel scale categories before and after the intensive care unit admission of the partially or totally independent patients (Karnofsky score >40) before admission. ICU - intensive care unit; *p corresponding to the comparison of all categories before and after the intensive care unit admission. Categories in the modified Barthel scale: PH - personal hygiene; B - bathing; F - feeding; TU - toilet use; CS - climbing stairs; D - dressing; BSC - sphincter control (bladder); ASC - sphincter control (anal); W - walking; T - bed-to-chair transfer.

Figure 4

Variation of the scores from the modified Barthel scale categories before and after the intensive care unit admission of the highly dependent patients (Karnofsky score ≤40) before admission. ICU - intensive care unit. *p corresponding to the comparison of items PH and CS before and after the intensive care unit admission. Categories on the modified Barthel scale: PH - personal hygiene; B - bathing; F - feeding; TU - toilet use; CS - climbing stairs; D - dressing; BSC - sphincter control (bladder); ASC - sphincter control (anal); W - walking; T - bed-to-chair transfer.