Citation

Herridge MS, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehta S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NKJ, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, Dos Santos C, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hebert P, Slutsky AS, Marshall JC, Cook D, Cameron JI. Am. J. Respir. Crit. Care Med. 2016; 194(7): 831-844.

Copyright

(Copyright © 2016, American Thoracic Society)

DOI

10.1164/rccm.201512-2343OC

PMID

unavailable

Abstract

Rationale: Disability risk groups and 1-year outcomeafter greater than or equal to 7 days of mechanical ventilation (MV) in medical/surgical intensive care unit (ICU) patients are unknown and may inform education, prognostication, rehabilitation, and study design.

OBJECTIVES: To stratify patients for post-ICU disability and recovery to 1 year after critical illness.

METHODS:Weevaluated a multicenter cohort of 391 medical/surgical ICU patients who received greater than or equal to 1 week of MV at 7 days and 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling. Measurements and Main Results: The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to 1-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay. By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post-ICU healthcare use, and disposition. Patients less than 42 years with ICU length of stay less than 2 weeks had the best function and fewest deaths at 1 year compared with patients greater than 66 years with ICU length of stay greater than 2 weeks who sustained the worst disability and 40% 1-year mortality. Depressive symptoms (17%) and post-traumatic stress disorder (18%) persisted at 1 year.

CONCLUSIONS: ICU survivors of greater than or equal to 1 week of MVmay be stratified into four disability groups based on age and ICU length of stay. These groups determine 1-year recovery and healthcare use and are independent of admitting diagnosis and illness severity. Copyright © 2016 by the American Thoracic Society.

Language: en

Keywords

adult; disability; human; age; female; male; aged; suicidal ideation; depression; acute lung injury; mortality; suicide attempt; risk assessment; disease severity; Critical care; posttraumatic stress disorder; major clinical study; length of stay; cognitive defect; high risk population; priority journal; sepsis; survivor; multicenter study; artificial ventilation; critical illness; cohort analysis; prospective study; health care utilization; pneumonia; adult respiratory distress syndrome; Article; outcome assessment; ICU; Functional Independence Measure; predictive value; clinical outcome; surgical intensive care unit; Patient outcome assessment