Tracking Outcomes Post Intensive Care: Findings of a longitudinal observational study

Abstract

Background: Many intensive care unit (ICU) survivors experience new or worsening impairments, termed post-intensive care syndrome. Substantial investment has been made in identifying patients at risk and developing interventions, but evidence remains equivocal. A more nuanced understanding of risk and outcomes is therefore warranted.

Objectives: This study aimed to describe patients' health status 6 months after ICU discharge and characterise those with, and without, clinically significant physical, cognitive, or psychological impairments.

Methods: In this prospective, multisite observational study, patients discharged from four ICUs were screened and invited to participate. Consenting participants completed a questionnaire-based survey by telephone that encompassed preadmission characteristics and validated self-report questionnaires of physical and cognitive function, anxiety, depression, and post-traumatic stress disorder. Routine ICU data were collected from hospital records. Participants reporting clinically significant impairments were compared with those not reporting impairments on demographics and hospital data.

Results: A total of 132 participants completed 6-month follow-up: 30% reported impairments in any domain. Of these, 43% reported impairments in two or more domains. The rates of impairment varied between sites, ranging from 21% to 88%. Depression was most common, followed by physical impairment, anxiety, and cognitive impairment, with post-traumatic stress disorder being the least common.

Participants: Reporting impairments did not differ significantly from others on Acute Physiology and Chronic Health Evaluation II scores, delirium rates, mechanical ventilation rates, or duration and length of stay. Planned admissions were less common in the impairment group, as was inotrope use. Mental health diagnosis was not associated with post-ICU impairments.

Conclusions: This study demonstrates the heterogeneity of patients experiencing impairments after ICU discharge and highlights the importance of attending to patients' unique circumstances, encompassing characteristics and treatment factors, when assessing risk and planning support. Whilst generalisability is uncertain, these findings support a whole of health service approach towards post-ICU recovery.

Keywords: Critical illness; PICS; Post–intensive care syndrome; Psychiatry.