Enduring burden of intensive care

Abstract

Background: Existing literature on PICS and PICS-F focuses predominantly on intubated ICU survivors, limiting understanding of non-intubated survivors' outcomes. Gaps remain in local epidemiology of long-term psychological/QOL outcomes, dyadic interactions, and ward rehabilitation barriers for survivors and families. Objectives: 1. To determine long-term psychological and QOL outcomes of ICU survivors 2. To determine long-term psychological and QOL outcomes of family members of ICU survivors 3. To investigate dyadic influences between survivor-family pairs 4. To assess ward-based rehabilitation practices and to identify barriers to delivering effective post-ICU rehabilitation care Methods: A prospective, multicentre observational cohort study was conducted across four Australian ICUs. Adult survivors and their paired family members were recruited and longitudinally followed up post-ICU discharge. Participants were screened for persistent psychological (post-traumatic stress disorder [PTSD], depression, anxiety) symptoms and QOL impairments. Clinically significant psychological symptoms were defined according to established cut-off scores for validated screening instruments. Dyadic analyses were performed to examine associations between psychological symptoms and QOL impairments within the survivor-family pairs. Additionally, a locally developed, single-centre survey of multidisciplinary healthcare professionals caring for ICU survivors was used to address the final study objective. Results: Patients: Of the 133 ICU survivors, 47 % had at least one clinically significant psychological symptom at follow-up. There was no difference in the clinically significant scores for psychological symptoms at 3-months (p=0.38) or 12-months (p=0.57) between the intubated and non-intubated survivors. Usual activities and mobility were the most commonly affected QOL domains, with > 30 % at 3 months and > 20 % at 12-months of overall survivors reporting >/= moderate problems in these domains. Families: In family members of intubated vs non-intubated survivors, clinically significant psychological symptoms (PTSD/depression/anxiety) were reported by 48% vs 33% at 3-months (p = 0.15); and 39% vs 25% at 12-months (p = 0.23). With regards to QOL, > 30% of the family members, reported problems in pain/discomfort or anxiety/depression domains at 12-months. Dyads: Family members were more likely to have persistent psychological symptoms of PTSD (p = 0.01) or depression (p = 0.001); or QoL domain problems with pain/discomfort (p = 0.03) or anxiety/depression (p = 0.04), when the paired survivor also reported the same symptoms. Barriers to rehabilitation: Most respondents (66%, 126/190) were unfamiliar with the term post-intensive care syndrome (PICS). There were multifaceted barriers to patient mobilisation, with inadequate multidisciplinary staffing, lack of medical order for mobilisation, and inadequate physical space near the bed as common institutional barriers and patient frailty and cardiovascular instability as the commonly perceived patient-related barriers. Conclusions: Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. The presence of psychological symptoms and HRQOL impairments was similar between the survivor groups. Almost one-third of the family members of ICU survivors also reported persistent psychological symptoms and QoL problems at 12-months. There was a noticeable dyad effect with family members more likely to have persistent symptoms of PTSD, depression, and problems in QoL domains when the paired ICU survivors experienced similar symptoms. Future long-term follow-up should include non-intubated ICU survivors and recovery intervention trials should be aimed at ICU family-survivor dyads. Additionally, there are multiple potentially modifiable barriers to the ongoing rehabilitation of ICU survivors. Show more