A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year

Tarek Sharshar¹, Lamiae Grimaldi-Bensouda², Shidasp Siami³, Alain Cariou⁴, Abdel Ben Salah⁵, Pierre Kalfon⁵, Romain Sonneville⁶, Nicolas Meunier-Beillard⁷, Jean-Pierre Quenot^{7

8}, Bruno Megarbane⁹, Stephane Gaudry^{10

11}, Haikel Oueslati¹², Segolene Robin-Lagandre¹³, Carole Schwebel¹⁴, Aurelien Mazeraud¹⁵, Djillali Annane¹⁶, Lionelle Nkam¹⁷, Diane Friedman¹⁶; Suivi-Rea Investigators

Affiliations

¹ Anesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Paris, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France. t.sharshar@ghu-paris.fr.
² Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, UMR1018 Anti-Infective Evasion and Pharmacoepidemiology Team, University of Versailles Saint-Quentin en Yvelines, INSERM, Versailles, France.
³ General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France.
⁴ Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris Paris-Cardiovascular-Research-Center, INSERM U970, 75014, Paris, France.
⁵ Réanimation Polyvalente, Hôpital Louis Pasteur Hospital, Centre Hospitalier de Chartres, 28018, Chartres Cedex, France.
⁶ France Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Université de Paris, INSERM UMR1148, Team 6, 7501875018, Paris, France.
⁷ INSERM CIC 1432, Clinical Epidemiology, DRCI, USMR, Francois Mitterrand University Hospital, University of Burgundy, Dijon, France.
⁸ Department of Intensive Care, François Mitterrand University Hospital: INSERM LNC-UMR1231, INSERM CIC 1432, Clinical Epidemiology University of Burgundy, Dijon, France.
⁹ Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Université de Paris, Paris, France.
¹⁰ Réanimation Médico-Chirurgicale, Louis Mourier Hospital, Assistance-Publique-Hôpitaux de Paris, 92700, Colombes, France.
¹¹ Université de Paris. Epidémiologie Clinique-Évaluation Économique Appliqué Aux Populations Vulnérables (ECEVE, INSERM et, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425, Paris, France.
¹² Department of Anesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisiere University Hospitals, 75010, Paris, France.
¹³ Anesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, Université de Paris, 75015, Paris, France.
¹⁴ UJF-Grenoble I, Medical Intensive Care Unit, University Hospital Albert Michallon, 38041, Grenoble, France.
¹⁵ Anesthesia and Intensive Care Department, Département Neurosciences, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institut Pasteur, Unité Perception et Mémoire, Université de Paris, Paris, France.
¹⁶ General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, 92380, Garches, France.
¹⁷ Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France.

PMID: 38587553
DOI: 10.1007/s00134-024-07359-x

Randomized Controlled Trial

A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year

Tarek Sharshar et al. Intensive Care Med. 2024 May.

. 2024 May;50(5):665-677.

doi: 10.1007/s00134-024-07359-x. Epub 2024 Apr 8.

Authors

Affiliations

¹ Anesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Paris, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France. t.sharshar@ghu-paris.fr.
² Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, UMR1018 Anti-Infective Evasion and Pharmacoepidemiology Team, University of Versailles Saint-Quentin en Yvelines, INSERM, Versailles, France.
³ General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France.
⁴ Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris Paris-Cardiovascular-Research-Center, INSERM U970, 75014, Paris, France.
⁵ Réanimation Polyvalente, Hôpital Louis Pasteur Hospital, Centre Hospitalier de Chartres, 28018, Chartres Cedex, France.
⁶ France Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Université de Paris, INSERM UMR1148, Team 6, 7501875018, Paris, France.
⁷ INSERM CIC 1432, Clinical Epidemiology, DRCI, USMR, Francois Mitterrand University Hospital, University of Burgundy, Dijon, France.
⁸ Department of Intensive Care, François Mitterrand University Hospital: INSERM LNC-UMR1231, INSERM CIC 1432, Clinical Epidemiology University of Burgundy, Dijon, France.
⁹ Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Université de Paris, Paris, France.
¹⁰ Réanimation Médico-Chirurgicale, Louis Mourier Hospital, Assistance-Publique-Hôpitaux de Paris, 92700, Colombes, France.
¹¹ Université de Paris. Epidémiologie Clinique-Évaluation Économique Appliqué Aux Populations Vulnérables (ECEVE, INSERM et, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425, Paris, France.
¹² Department of Anesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisiere University Hospitals, 75010, Paris, France.
¹³ Anesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, Université de Paris, 75015, Paris, France.
¹⁴ UJF-Grenoble I, Medical Intensive Care Unit, University Hospital Albert Michallon, 38041, Grenoble, France.
¹⁵ Anesthesia and Intensive Care Department, Département Neurosciences, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institut Pasteur, Unité Perception et Mémoire, Université de Paris, Paris, France.
¹⁶ General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, 92380, Garches, France.
¹⁷ Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France.

PMID: 38587553
DOI: 10.1007/s00134-024-07359-x

Abstract

Purpose: Critical illness is associated with long-term increased mortality and impaired quality of life (QoL). We assessed whether multidisciplinary consultations would improve outcome at 12 months (M12) after intensive care unit (ICU) discharge.

Methods: We performed an open, multicenter, parallel-group, randomized clinical trial. Eligible are patients discharged alive from ICU in 11 French hospitals between 2012 and 2018. The intervention group had a multidisciplinary face-to-face consultation involving an intensivist, a psychologist, and a social worker at ICU discharge and then at M3 and M6 (optional). The control group had standard post-ICU follow-up. A consultation was scheduled at M12 for all patients. The QoL was assessed using the EuroQol-5 Dimensions-5 Level (Euro-QoL-5D-5L) which includes five dimensions (mobility, self-care, usual activities, pain, and anxiety/depression), each ranging from 1 to 5 (1: no, 2: slight, 3: moderate, 4: severe, and 5: extreme problems). The primary endpoint was poor clinical outcome defined as death or severe-to-extreme impairment of at least one EuroQoL-5D-5L dimension at M12. The information was collected by a blinded investigator by phone. Secondary outcomes were functional, psychological, and cognitive status at M12 consultation.

Results: 540 patients were included (standard, n = 272; multidisciplinary, n = 268). The risk for a poor outcome was significantly greater in the multidisciplinary group than in the standard group [adjusted odds ratio 1.49 (95% confidence interval, (1.04-2.13)]. Seventy-two (13.3%) patients died at M12 (standard, n = 32; multidisciplinary, n = 40). The functional, psychological, and cognitive scores at M12 did not statistically differ between groups.

Conclusions: A hospital-based, face-to-face, intensivist-led multidisciplinary consultation at ICU discharge then at 3 and 6 months was associated with poor outcome 1 year after ICU.

Keywords: Critical illness; Mortality; Post-ICU syndrome; Quality of life.

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References

1. Herridge MS, Azoulay É. Outcomes after Critical Illness. New England Journal of Medicine 2023; published online March 8. DOI: https://doi.org/10.1056/NEJMra2104669 .
1. Gayat E, Cariou A, Deye N et al (2018) Determinants of long-term outcome in ICU survivors: results from the FROG-ICU study. Crit Care 22:8 - DOI - PubMed - PMC
1. Granja C, Teixeira-Pinto A, Costa-Pereira A (2002) Quality of life after intensive care–evaluation with EQ-5D questionnaire. Intensive Care Med 28:898–907 - DOI - PubMed
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1. Beumeler LFE, van Wieren A, Buter H et al (2020) Patient-reported physical functioning is limited in almost half of critical illness survivors 1-year after ICU-admission: A retrospective single-centre study. PLoS ONE 15:e0243981 - DOI - PubMed - PMC

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A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year

Affiliations

A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources