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Intensive Care Med. 2017 Jul;43(7):992-1001. doi: 10.1007/s00134-017-4830-0. Epub 2017 May 22.

The impact of disability in survivors of critical illness.

Hodgson CL1,2,3,4, Udy AA5,6,7, Bailey M8,6,7, Barrett J7,9, Bellomo R8,6,10, Bucknall T5,11, Gabbe BJ6,7, Higgins AM8,6,7, Iwashyna TJ8,6,12, Hunt-Smith J13, Murray LJ8,5,6,7, Myles PS5,6,7, Ponsford J6,7, Pilcher D8,5,6,7, Walker C14, Young M8,5,6,7, Cooper DJ8,5,6,7.

Author information

1
Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia. carol.hodgson@monash.edu.
2
The Alfred Hospital, Melbourne, Australia. carol.hodgson@monash.edu.
3
Monash University, Melbourne, Australia. carol.hodgson@monash.edu.
4
Monash Partners Academic Health Science Centre, Prahran, Australia. carol.hodgson@monash.edu.
5
The Alfred Hospital, Melbourne, Australia.
6
Monash University, Melbourne, Australia.
7
Monash Partners Academic Health Science Centre, Prahran, Australia.
8
Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia.
9
Cabrini Hospital, Melbourne, Australia.
10
Austin Health, Melbourne, Australia.
11
Deakin University, Geelong, Australia.
12
University of Michigan, Michigan, USA.
13
Epworth Health, Melbourne, Australia.
14
Monash Medical Centre, Melbourne, Australia.

Abstract

PURPOSE:

To use the World Health Organisation's International Classification of Functioning to measure disability following critical illness using patient-reported outcomes.

METHODS:

A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been admitted to the ICU, received more than 24 h of mechanical ventilation and survived to hospital discharge. The primary outcome was measurement of disability using the World Health Organisation's Disability Assessment Schedule 2.0. The secondary outcomes included the limitation of activities and changes to health-related quality of life comparing survivors with and without disability at 6 months after ICU.

RESULTS:

We followed 262 patients to 6 months, with a mean age of 59 ± 16 years, and of whom 175 (67%) were men. Moderate or severe disability was reported in 65 of 262 (25%). Predictors of disability included a history of anxiety/depression [odds ratio (OR) 1.65 (95% confidence interval (CI) 1.22, 2.23), P = 0.001]; being separated or divorced [OR 2.87 (CI 1.35, 6.08), P = 0.006]; increased duration of mechanical ventilation [OR 1.04 (CI 1.01, 1.08), P = 0.03 per day]; and not being discharged to home from the acute hospital [OR 1.96 (CI 1.01, 3.70) P = 0.04]. Moderate or severe disability at 6 months was associated with limitation in activities, e.g. not returning to work or studies due to health (P < 0.002), and reduced health-related quality of life (P < 0.001).

CONCLUSION:

Disability measured using patient-reported outcomes was prevalent at 6 months after critical illness in survivors and was associated with reduced health-related quality of life. Predictors of moderate or severe disability included a prior history of anxiety or depression, separation or divorce and a longer duration of mechanical ventilation.

TRIAL REGISTRATION:

NCT02225938.

KEYWORDS:

Disability; Intensive care; Mechanical ventilation; Quality of life

Comment in

PMID:
28534110
DOI:
10.1007/s00134-017-4830-0
[Indexed for MEDLINE]

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