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VOLUME 24 , ISSUE 5 ( May, 2020 ) > List of Articles


Impact of Critical Illness on Quality of Life after Intensive Care Unit Discharge

Richa Rai, Arti Agarwal

Keywords : Acute physiology and chronic health evaluation II, Critical illness, Quality of Life

Citation Information : Rai R, Agarwal A. Impact of Critical Illness on Quality of Life after Intensive Care Unit Discharge. Indian J Crit Care Med 2020; 24 (5):299-306.

DOI: 10.5005/jp-journals-10071-23433

License: CC BY-NC 4.0

Published Online: 27-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Objective: To assess the quality of life (QoL) following intensive care unit (ICU) discharge using 6 months’ prospective follow-up and to analyze the risk factors affecting quality-of-life post-discharge. Design: A prospective observational cohort study. Conducted on adult patients, discharged from ICU after more than 7 days’ stay. Study duration is from January 2017 to October 2018. Patients <18 years, nonconsenting, preexisting neurological illness, and lost to follow-up were excluded. Follow-up was done at 1 and 6 months using the SF-36 questionnaire. The pre-ICU functional status, patient demographics, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE II) score, New York Health Evaluation (NYHA) classification, and details of ICU stay were collected. Results: One hundred patients (M = 60, F = 40) with ICU stay (13.64 ± 3.75 days), days of mechanical ventilation (7.93 ± 3.89 days), admission APACHE II (18.88 ± 4.34) and SOFA (7.73 ± 1.54) scores. Comparison showed physical component summary (PCS) score and mental component summary (MCS) score at pre-ICU were 55.12 and 55.09 which decreased to 39.59 and 35.49 (p < 0.05) at 1 month post-discharge and 47.93 and 37.46 at 6 months. Age, APACHE II, and SOFA scores are the significant factors affecting PCS and MCS. Length of ICU stay and duration of mechanical ventilation did not affect significantly at 6 months. When compared with general population PCS and MCS showed significant deterioration at 1 and 6 months. Conclusion: Post-ICU discharge patients have significant functional impairment and compromised health-related QoL (HRQoL). Age and severity of illness significantly affects health quality parameters and decline is below the normal data of general population.

  1. Badia X, Diaz-Prieto A, Gorriz MT, Herdman M, Torrado H, Farrero E, et al. Using the Euro-Qol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 2001;27(12):1901–1907. DOI: 10.1007/s00134-001-1137-x.
  2. Orwelius L, Teixeira-Pinto A, Lobo C. The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy? Patient Relat Outcome Meas 2016;7:63–71. DOI: 10.2147/PROM.S89555.
  3. Steenbergen S, Rijkenberg S, Adonis T. Long-term treated intensive care patients outcomes: the one-year mortality rate, quality of life, health care use and long-term complications as reported by general practitioners. BMC Anesthesiol 2015;15(1):142. DOI: 10.1186/s12871-015-0121-x.
  4. Jackson J, Ely EW, Morey M, Anderson V, Denne L, Clune J, et al. Cognitive and physical rehabilitation of intensive care unit survivors: results of the return randomized controlled pilot investigation. Crit Care Med 2012;40(4):1088–1097. DOI: 10.1097/CCM.0b013e3182373115.
  5. Janice. R. Life after critical illness: an overview. J Clin Nurs 2013;23:623–663.
  6. Desai Sanjay V, Law TJ, Needham DM. Long term complications of critical care. Crit Care Med 2011;39(2):371–379. DOI: 10.1097/CCM.0b013e3181fd66e5.
  7. Sullivan M. Quality of life assessment in medicine: concepts, definitions, purposes and basic tools. Nord J Psychiatry 1992;46(2):79–83. DOI: 10.3109/08039489209103305.
  8. Guyuatt G. The philosophy of health-related quality of life translation. Qual Life Res 1993;2(6):461–465. DOI: 10.1007/BF00422220.
  9. Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G. Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 2004;161(1):45–52. DOI: 10.1176/appi.ajp.161.1.45.
  10. Ware J, Snow K, Kosinski M, Gandek B, SF-36 health survey: Manual and interpretation guide Boston, The health institute; 1993.
  11. Cuthbertson BH, Roughton S, Jenkinson D, Maclennan G, Vale L. Quality of life in the five years after intensive care: a cohort study. Crit Care 2010;14(1):R6. DOI: 10.1186/cc8848.
  12. Chelluri L, Im KA, Belle SH, Schulz R, Rotondi AJ, Donahoe MP, et al. Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 2004;32(1):619. DOI: 10.1097/01.CCM.0000098029.65347.F9.
  13. Tian ZM, Miranda DR. Quality of life after intensive care with the sickness impact profile. Intensive Care Med 1995;21(5):422–428. DOI: 10.1007/BF01707411.
  14. Myhren H, Ekeberg O, Toien K, Karlsson S, Stokland O. Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care 2010;14(1):125. DOI: 10.1186/cc8870.
  15. Hofhuis JG, Spronk PE, van Stel HF, Schrijvers GJ, Rommes JH, Bakker J. The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study. Chest 2008;133(2):377–385. DOI: 10.1378/chest.07-1217.
  16. Eddleston J, White P, Guthrie E. Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 2000;28(7): 2293–2299. DOI: 10.1097/00003246-200007000-00018unders Company; 1995.
  17. Ridley S. Non-mortality outcome measures. In Ridley S ed., Outcomes in critical care, Oxford: Butterworth-Heinemann; 2002. p. 32.
  18. Pettila V, Kaarlola A, Makelainen A. Health-related quality of life of multiple organ dysfunction patients one year after intensive care. Intensive Care Med 2000;26(10):1473–1479. DOI: 10.1007/s001340000629.
  19. Cuthbertson BH, Scott J, Strachan M. Quality of life before and after intensive care. Anaesthesia 2005;60(4):332–339. DOI: 10.1111/j.1365-2044.2004.04109.x.
  20. Wehler M, Geise A, Hadzionerovic D, Aljukic E, Reulbach U, Hahn EG, et al. Health-related quality of life of patients with multiple organ dysfunction: individual changes and comparison with normative population. Crit Care Med 2003;31(4):1094–1101. DOI: 10.1097/01.CCM.0000059642.97686.8B.
  21. Vedio A, Chinn S, Warburton F, Griffiths M, Leach R, Treacher D. Assessment of survival and quality of life after discharge from a teaching hospital general intensive care unit. Clin Intensive Care 2000;11(1):39–46. DOI: 10.3109/tcic.
  22. Sluys K, Häggmark T, Iselius L. Outcome and quality of life 5 years after major trauma. J Trauma 2005;59(1):223–232. DOI: 10.1097/01.ta.0000173832.01547.cb.
  23. Averill PM, Beck GJ. Post-traumatic stress disorder in older adults: a conceptual review. J Anxiety Disord 2000;14(2):133–156. DOI: 10.1016/s0887-6185(99)00045-6.
  24. Ely WE, Shintani A, Truman B, Speroff T, Gordon SM, Harrell F, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. J Am Med Associat 2004;29(14):1753–1762. DOI: 10.1001/jama.291.14.1753.
  25. Griffiths J, Hatch RA, Bishop J. An exploration of social and economic outcome and associated health-related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Crit Care 2013;17(3):R100. DOI: 10.1186/cc12745.
  26. Cheung AM, Tansey CM, Tomlinson G. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 2006;174(5):538–544. DOI: 10.1164/rccm.200505-693OC.
  27. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Washington DC: American Psychiatric Association; 1994.
  28. Hutchings A, Raine R, Brady A, Wildman M, Rowan K. Socioeconomic status and outcome from intensive care in England and Wales: a prospective cohort study. Med Care 2004;42(10):943–951. DOI: 10.1097/00005650-200410000-00002.
  29. Davydow D, Gifford J, Desai S, Bienvenue O, Needham D. Depression in general intensive care unit survivors: a systematic review. Intensive Care Med 2009;35(5):796–809. DOI: 10.1007/s00134-009-1396-5.
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