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Am J Respir Crit Care Med. 2016 Oct 1;194(7):831-844.

The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation.

Author information

1
1 Department of Medicine.
2
2 Medical-Surgical Intensive Care.
3
4 Institute of Medical Science.
4
5 Toronto General Research Institute.
5
3 Interdepartmental Division of Critical Care Medicine.
6
6 Institute of Health Policy, Management and Evaluation.
7
7 Dalla Lana School of Public Health.
8
8 Department of Medicine.
9
9 Department of Medicine.
10
10 Division of Critical Care Medicine, and.
11
11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
12
12 Department of Medicine and Anesthesia, Mount Sinai Hospital, Toronto, Canada.
13
13 Centre de Recherche du CHU de Sherbrooke, Sherbrooke, Canada.
14
14 Ecole de Réadaptation, Institut Universitaire de Gériatrie de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada.
15
15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
16
16 Department of General Internal Medicine and.
17
17 Department of Critical Care, St. Joseph's Healthcare.
18
18 Department of Critical Care, University of Ottawa, Ottawa, Canada.
19
19 Department of Medicine and.
20
20 Division of Critical Care, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, Canada.
21
21 Toronto Rehabilitation Institute.
22
22 Interdepartmental Division of Physiatry.
23
23 Department of Psychiatry, and.
24
24 Department of Physical Therapy.
25
25 Rehabilitation Science Institution, and.
26
26 Department of Medicine, St. Paul's Hospital, British Columbia, Vancouver, Canada.
27
27 Department of Clinical Epidemiology and Biostatistics, and.
28
28 Division of Thoracic Surgery and Lung Transplant, University Health Network, Toronto, Canada.
29
29 Centre de recherche du Centre hospitalier de l'Université de Montreal, Montreal, Canada; and.
30
30 Department of Medicine of the Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
31
31 Department of Medicine and Pediatrics, McMaster University, Hamilton, Canada.
32
32 Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.

Abstract

RATIONALE:

Disability risk groups and 1-year outcome after 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:

We evaluated 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 MV may 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. Clinical trial registered with www.clinicaltrials.gov (NCT 00896220).

KEYWORDS:

ICU; critical care; patient outcome assessment

PMID:
26974173
DOI:
10.1164/rccm.201512-2343OC

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