Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 26 , ISSUE 10 ( October, 2022 ) > List of Articles

Original Article

Long-term Survival and Quality of Life among Survivors Discharged from a Respiratory ICU in North India: A Prospective Study

Rakesh Kodati, Valliappan Muthu, Ritesh Agarwal, Sahajal Dhooria, Ashutosh Nath Aggarwal, Kuruswamy Thurai Prasad, Digambar Behera, Inderpaul Singh Sehgal

Keywords : Acute respiratory distress syndrome, Neuromuscular weakness, Critical care, Critically ill, Critically ill patients, Domiciliary ventilation, Delirium

Citation Information : Kodati R, Muthu V, Agarwal R, Dhooria S, Aggarwal AN, Prasad KT, Behera D, Sehgal IS. Long-term Survival and Quality of Life among Survivors Discharged from a Respiratory ICU in North India: A Prospective Study. Indian J Crit Care Med 2022; 26 (10):1078-1085.

DOI: 10.5005/jp-journals-10071-24321

License: CC BY-NC 4.0

Published Online: 30-09-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Advancements in the intensive care unit (ICU) have improved critically ill subjects’ short-term outcomes. However, there is a need to understand the long-term outcomes of these subjects. Herein, we study the long-term outcomes and factors associated with poor outcomes in critically ill subjects with medical illnesses. Materials and methods: All subjects (≥12 years) discharged after an ICU stay of at least 48 hours were included. We evaluated the subjects at 3 and 6 months after ICU discharge. At each visit, subjects were administered the World Health Organization Quality of Life Instrument (WHO-QOL-BREF) questionnaire. The primary outcome was mortality at 6 months after ICU discharge. The key secondary outcome was quality of life (QOL) at 6 months. Results: In total, 265 subjects were admitted to the ICU, of whom 53 subjects (20%) died in the ICU, and 54 were excluded. Finally, 158 subjects were included: 10 (6.3%) subjects were lost to follow-up. The mortality at 6 months was 17.7% (28/158). Most subjects [16.5% (26/158)] died within the initial 3 months after ICU discharge. Quality of life scores were low in all the domains of WHO-QOL-BREF. About 12% (n = 14) of subjects could not perform the activity of daily living at 6 months. After adjusting for covariates, ICU-acquired weakness at the time of discharge (OR 15.12; 95% CI, 2.08–109.81, p <0.01) and requirement for home ventilation (OR 22; 95% CI, 3.1–155, p <0.01) were associated with mortality at 6 months. Conclusion: Intensive care unit survivors have a high risk of death and a poor QOL during the initial 6 months following discharge.

PDF Share
  1. Angus DC, Pereira CAP, Silva E. Epidemiology of severe sepsis around the world. Endocr Metab Immune Disord Drug Targets 2006;6(2): 207–212. DOI: 10.2174/187153006777442332.
  2. Williams TA, Dobb GJ, Finn JC, Knuiman MW, Geelhoed E, Lee KY, et al. Determinants of long-term survival after intensive care. Crit Care Med 2008;36(5):1523–1530. DOI: 10.1097/CCM.0b013e318170a405.
  3. Modrykamien AM. The ICU follow-up clinic: A new paradigm for intensivists. Respir Care 2012;57(5):764–772. DOI: 10.4187/respcare.01461.
  4. Steenbergen S, Rijkenberg S, Adonis T, Kroeze G, van Stijn I, Endeman H. 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;15:142. DOI: 10.1186/s12871-015-0121-x.
  5. Damuth E, Mitchell JA, Bartock JL, Roberts BW, Trzeciak S. Long-term survival of critically ill patients treated with prolonged mechanical ventilation: A systematic review and meta-analysis. Lancet Respir Med 2015;3(7):544–553. DOI: 10.1016/S2213-2600(15)00150-2.
  6. Moitra VK, Guerra C, Linde-Zwirble WT, Wunsch H. Relationship between ICU length of stay and long-term mortality for elderly ICU survivors. Crit Care Med 2016;44(4):655–662. DOI: 10.1097/CCM.0000000000001480.
  7. Brinkman S, de Jonge E, Abu-Hanna A, Arbous MS, de Lange DW, de Keizer NF. Mortality after hospital discharge in ICU patients. Crit Care Med 2013;41(5):1229–1236. DOI: 10.1097/CCM.0b013e31827ca4e1.
  8. Mani RK. Postintensive care syndrome: The aftermath. Indian J Crit Care Med 2020;24(5):293–294. DOI: 10.5005/jp-journals-10071-23437.
  9. 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.
  10. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz- Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003;348(8): 683–693. DOI: 10.1056/NEJMoa022450.
  11. Pandharipande PP, Girard TD, Ely EW. Long-term cognitive impairment after critical illness. N Engl J Med 2014;370(2):185–186. DOI: 10.1056/NEJMc1313886.
  12. Prescott HC, Langa KM, Liu V, Escobar GJ, Iwashyna TJ. Increased 1-year healthcare use in survivors of severe sepsis. Am J Respir Crit Care Med 2014;190(1):62–69. DOI: 10.1164/rccm.201403-0471OC.
  13. Vesz PS, Cremonese RV, Rosa RG, Maccari JG, Teixeira C. Impact of mechanical ventilation on quality of life and functional status after ICU discharge: A cross-sectional study. Rev Assoc Med Bras (1992) 2018;64:47–53. DOI: 10.1590/1806-9282.64.01.47.
  14. Treggiari MM, Romand J-A, Yanez ND, Deem SA, Goldberg J, Hudson L, et al. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med 2009;37(9): 2527–2534. DOI: 10.1097/CCM.0b013e3181a5689f.
  15. Angus DC, Carlet J. Surviving intensive care: A report from the 2002 Brussels Roundtable. Intensive Care Med 2003;29(3):368–377. DOI: 10.1007/s00134-002-1624-8.
  16. Robinson CC, Rosa RG, Kochhann R, Schneider D, Sganzerla D, Dietrich C, et al. Quality of life after intensive care unit: A multicenter cohort study protocol for assessment of long-term outcomes among intensive care survivors in Brazil. Rev Bras Ter Intensiva 2018;30(4):405–413. DOI: 10.5935/0103-507X.20180063.
  17. Mishra SB, Poddar B, Kasimahanti R, Azim A, Singh RK, Gurjar M, et al. Quality of life after intensive care unit discharge in a Tertiary Care Hospital in India: Cost effectiveness analysis. Indian J Crit Care Med 2019;23(3):122–126. DOI: 10.5005/jp-journals-10071-23133.
  18. Balasubramanian V, Suri JC, Ish P, Gupta N, Behera D, Gupta P, et al. Neurocognitive and quality-of-life outcomes following intensive care admission: A prospective 6-month follow-up study. Indian J Crit Care Med 2020;24(10):932–937. DOI: 10.5005/jp-journals-10071-23576.
  19. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet 2007;370(9596):1453–1457. DOI: 10.1016/S0140-6736(07)61602-X.
  20. Aggarwal AN, Agarwal R, Gupta D, Jindal SK. Nonpulmonary organ dysfunction and its impact on outcome in patients with acute respiratory failure. Chest 2007;132(3):829–835. DOI: 10.1378/chest. 06-2783.
  21. Muthu V, Dhooria S, Aggarwal AN, Behera D, Sehgal IS, Agarwal R. Acute respiratory distress syndrome due to tuberculosis in a respiratory ICU over a 16-year period. Crit Care Med 2017;45(10):e1087–e1090. DOI: 10.1097/CCM.0000000000002479.
  22. Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, et al. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999;25(7):686–696. DOI: 10.1007/s001340050931.
  23. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis 1987;40(5):373–383. DOI: 10.1016/0021-9681(87)90171-8.
  24. Muthu V, Dhooria S, Agarwal R, Prasad KT, Aggarwal AN, Behera D, et al. Profile of patients with active tuberculosis admitted to a respiratory intensive care unit in a Tertiary Care Center of North India. Indian J Crit Care Med 2018;22(2):63–66. DOI: 10.4103/ijccm.IJCCM_491_17.
  25. Sehgal IS, Agarwal R, Dhooria S, Prasad KT, Muthu V, Aggarwal AN. Etiology and outcomes of ARDS in the elderly population in an intensive care unit in North India. Indian J Crit Care Med 2021;25(6):648–654. DOI: 10.5005/jp-journals-10071-23878.
  26. Sehgal IS, Chaudhuri S, Dhooria S, Agarwal R, Chaudhry D. A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome. Indian J Crit Care Med 2015;19(10): 593–599. DOI: 10.4103/0972-5229.167037.
  27. Sehgal IS, Dhooria S, Behera D, Agarwal R. Acute respiratory distress syndrome: Pulmonary and extrapulmonary not so similar. Indian J Crit Care Med 2016;20(3):194–197. DOI: 10.4103/0972-5229.178188.
  28. Stevens RD, Marshall SA, Cornblath DR, Hoke A, Needham DM, de Jonghe B, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med 2009;37 (10 Suppl):S299–S308. DOI: 10.1097/CCM.0b013e3181b6ef67.
  29. Aggarwal AN, Agarwal R, Gupta D. Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) in North Indian patients with bronchial asthma: An evaluation using Rasch analysis. NPJ Prim Care Respir Med 2014;24:14001. DOI: 10.1038/npjpcrm.2014.1.
  30. Saxena S, Chandiramani K, Bhargava R. WHOQOL-Hindi: A questionnaire for assessing quality of life in health care settings in India. World Health Organization Quality of Life. Natl Med J India 1998;11(4): 160–165. PMID: 9808970.
  31. Saxena S, Quinn K, Sharan P, Naresh B, Yuantao H, Power M. Cross-linguistic equivalence of WHOQOL-100: A study from North India. Qual Life Res 2005;14(3):891–897. DOI: 10.1007/s11136-004- 1084-4.
  32. Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004;13(2):299–310. DOI: 10.1023/B:QURE.0000018486.91360.00.
  33. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166(1):111–117. DOI: 10.1164/ajrccm.166.1.at1102.
  34. Chan YH. Biostatistics 201: Linear regression analysis. Singapore Med J 2004;45(2):55–61. PMID: 14985842.
  35. Hawthorne G, Herrman H, Murphy B. Interpreting the WHOQOL-Brèf: Preliminary population norms and effect sizes. Social Indic Res 2006;77:37–59.
  36. Brinkman S, Abu-Hanna A, de Jonge E, de Keizer NF. Prediction of long-term mortality in ICU patients: Model validation and assessing the effect of using in-hospital versus long-term mortality on benchmarking. Intensive Care Med 2013;39(11):1925–1931. DOI: 10.1007/s00134-013-3042-5.
  37. Groeneveld JA. Mortality as an endpoint in studies in critically ill patients: A reappraisal of definitions. Minerva Anestesiol 2016;82(7):785–790. PMID: 27003704
  38. Williams TA, Dobb GJ, Finn JC, Webb SA. Long-term survival from intensive care: A review. Intensive Care Med 2005;31(10):1306–1315. DOI: 10.1007/s00134-005-2744-8.
  39. Rydingsward JE, Horkan CM, Mogensen KM, Quraishi SA, Amrein K, Christopher KB. Functional status in ICU survivors and out of hospital outcomes: A cohort study. Crit Care Med 2016;44(5):869–879. DOI: 10.1097/CCM.0000000000001627.
  40. Kawakami D, Fujitani S, Morimoto T, Dote H, Takita M, Takaba A, et al. Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: A prospective, multicenter, observational J-PICS study. Crit Care 2021;25(1):69. DOI: 10.1186/s13054-021-03501-z.
  41. Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med 2014;190(4):410–420. DOI: 10.1164/rccm.201312-2257OC.
  42. Gehlbach BK, Salamanca VR, Levitt JE, Sachs GA, Sweeney MK, Pohlman AS, et al. Patient factors associated with hospital discharge to care facility following critical illness. Am J Crit Care 2011;20(5): 378–386. DOI: 10.4037/ajcc2011827.
  43. King AC. Long-term home mechanical ventilation in the United States. Respir Care 2012;57(6):921–930. DOI: 10.4187/respcare.01741.
  44. Heinemann F, Budweiser S, Jorres RA, Arzt M, Rosch F, Kollert F, et al. The role of non-invasive home mechanical ventilation in patients with chronic obstructive pulmonary disease requiring prolonged weaning. Respirology 2011;16(8):1273–1280. DOI: 10.1111/j.1440-1843.2011.02054.x.
  45. Dowdy DW, Eid MP, Dennison CR, Mendez-Tellez PA, Herridge MS, Guallar E, et al. Quality of life after acute respiratory distress syndrome: A meta-analysis. Intensive Care Med 2006;32(8):1115–1124. DOI: 10.1007/s00134-006-0217-3.
  46. Dowdy DW, Eid MP, Sedrakyan A, Mendez-Tellez PA, Pronovost PJ, Herridge MS, et al. Quality of life in adult survivors of critical illness: A systematic review of the literature. Intensive Care Med 2005;31(5): 611–620. DOI: 10.1007/s00134-005-2592-6.
  47. Sacanella E, Perez-Castejon JM, Nicolas JM, Masanes F, Navarro M, Castro P, et al. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: A prospective observational study. Crit Care 2011;15(2):R105. DOI: 10.1186/cc10121.
  48. Orwelius L, Fredrikson M, Kristenson M, Walther S, Sjoberg F. Health-related quality of life scores after intensive care are almost equal to those of the normal population: A multicenter observational study. Crit Care 2013;17(5):R236. DOI: 10.1186/cc13059.
  49. Yernault JC, Englert M, Sergysels R, De Coster A. Pulmonary mechanics and diffusion after ‘shock lung’. Thorax 1975;30(3):252–257. DOI: 10.1136/thx.30.3.252.
  50. Yahav J, Lieberman P, Molho M. Pulmonary function following the adult respiratory distress syndrome. Chest 1978;74(3):247–250. DOI: 10.1378/chest.74.3.247.
  51. Konig C, Matt B, Kortgen A, Turnbull AE, Hartog CS. What matters most to sepsis survivors: A qualitative analysis to identify specific health-related quality of life domains. Qual Life Res 2019;28(3):637–647. DOI: 10.1007/s11136-018-2028-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.