scholarly journals Post-intensive care syndrome as a predictor of mortality in patients with critical illness: A cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0244564
Author(s):  
Naoya Yanagi ◽  
Kentaro Kamiya ◽  
Nobuaki Hamazaki ◽  
Ryota Matsuzawa ◽  
Kohei Nozaki ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Physical Disability ◽  
Cox Regression ◽  
Apache Ii Score ◽  
All Cause Mortality ◽  
Patient Health ◽  
Post Intensive Care Syndrome

Introduction The post-intensive care syndrome (PICS) encompasses multiple, diverse conditions, such as physical disability, cognitive impairment, and depression. We sought to evaluate whether conditions within PICS have similar associations with mortality among survivors of critical illness. Materials and methods In this retrospective cohort study, we identified 248 critically ill patients with intensive care unit stay ≥72 hours, who underwent PICS evaluation. Patients with disability in activities of daily living, cognitive impairment, or depression before hospitalization were excluded. We defined PICS using established measures of physical disability (usual gait speed), cognitive impairment (Mini-Cog test), and depression (Patient Health Questionnaire-2) at hospital discharge. The endpoint was all-cause mortality. Results Patients had a median age of 69 years and Acute Physiology and Chronic Health Evaluation (APACHE) II score of 16. One hundred thirty-two patients were classified as having PICS, and 19 patients died. 81/248 (34%) patients had physical disability, 42/248 (19%) had cognitive impairment, and 44/248 (23%) had depression. After adjusting for covariates on multivariable Cox regression analyses, PICS was significantly associated with all-cause mortality (hazard ratio [HR] 3.78, 95% confidence interval [CI] 1.02 – 13.95; P = 0.046). However, the association between PICS and all-cause mortality was related to physical disability and cognitive impairment (P = 0.001 and P = 0.027, respectively), while depression was not (P = 0.623). Conclusion While PICS as a syndrome has been useful in gaining attention to the sequelae of critical illness, its relationship with long-term mortality is driven largely by physical disability and cognitive impairment and not depression.

Testimonies in Understanding the Psychological and Cognitive Problems Faced by Survivors of Critical Illness

2017 ◽  
Author(s):  
Christina Jones ◽  
Peter Gibb ◽  
Ramona O. Hopkins
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Physical Therapy ◽  
Cognitive Impairments ◽  
Impaired Memory ◽  
Cognitive Problems ◽  
Substantial Morbidity ◽  
Post Intensive Care Syndrome

Millions of patients are treated in intensive care units (ICUs) each year, and the number of survivors is growing as a result of advances in critical care medicine. Unfortunately, many survivors of critical illness have substantial morbidity. Physical, psychological, and cognitive impairments are particularly common—so much so that a group of clinicians coined the term “post-intensive care syndrome” (PICS) to help raise awareness. Patients surviving critical illnesses are often quite weak, and physical therapy, hopefully starting in the ICU, is vital. But weakness is only one of the problems critical-illness survivors and their loved ones face. Unfortunately, many survivors are left with cognitive impairment (e.g., impaired memory, attention, and executive functioning), as well as distress-related psychiatric phenomena such as posttraumatic stress and depression. Importantly, these problems are not limited to adult patients, and loved ones also suffer. In this chapter the authors describe their personal journeys in coming to understand the suffering and issues that critical-illness survivors and their families face.

Persistent problems and recovery after critical illness

2020 ◽  
pp. 3925-3930
Author(s):  
Mark E. Mikkelsen ◽  
Theodore J. Iwashyna
Keyword(s):  
Mental Health ◽  
Intensive Care ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Side Effects ◽  
Physical Function ◽  
Critically Ill Patients ◽  
Organ Injury ◽  
Post Intensive Care Syndrome ◽  
Functional Problems

Post-intensive care syndrome is defined as new or worsening impairment in cognition, mental health, or physical function that persists after a critical illness. The complexities of post-intensive care syndrome come from the interactions of the patient’s premorbid mental health and physical function, the acute physiologic derangements and acute organ injury of the critical illness, and the side effects of procedures, treatments, and potential complications incurred during the critical illness. Problems are better described as challenging syndromes rather than specific actionable diagnoses, with the four major functional problems for patients being weakness, cognitive impairment, psychological problems, and new or worsened organ dysfunction. The sequelae of critical illness often extend beyond patients and impact the families of critically ill patients.

Clinical outcomes and risk factors for mortality from ventilator-associated events: A registry-based cohort study among 30,830 intensive care unit patients

2021 ◽  
pp. 1-8
Author(s):  
Shichao Zhu ◽  
Wen Wang ◽  
Yan Kang ◽  
Qiao He ◽  
Hui Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Central Line ◽  
Immunosuppressive Drugs ◽  
Apache Ii Score ◽  
All Cause Mortality

Abstract Objective: To investigate the clinical impact of ventilator-associated events (VAEs) on adverse prognoses and risk factors for mortality among intensive care unit (ICU) patients receiving invasive mechanical ventilation (IMV) based on an ICU healthcare-associated infection (ICU-HAI) registry. Design: A cohort study was conducted based on an ICU-HAI registry including 30,830 patients between 2015 and 2018. Setting: The study was conducted using data from 5 adult ICUs of a referral hospital. Patients: Adult patients in the ICU-HAI registry who received ≥4 consecutive IMV days. Methods: Clinical outcomes and mortality risk factors for VAEs were analyzed using propensity score matching (PSM), multivariate regression models, and sensitivity analyses. Results: Of 6,426 included patients, 1,803 developed 1,899 VAEs. After PSM, patients with VAEs did have prolonged length of stay in the ICU and in the hospital, increased hospitalization costs, longer days on mechanical ventilation, higher proportion of ≥9 days on mechanical ventilation, higher rate of failure in extubating mechanical ventilation, and excess all-cause mortality in the ICU. Older age (adjusted OR [aOR], 1.02), higher APACHE II score on ICU admission (aOR, 1.06), pneumonia (aOR, 1.49), blood transfusion (aOR 1.43), immunosuppressive drugs (aOR, 1.69), central-line catheter (aOR, 2.06), and ≥2 VAEs in the ICU (aOR, 1.99) were associated with higher risks for all-cause mortality in an ICU. Conclusions: Patients with VAEs indeed had poorer clinical outcomes. Older age, higher APACHE II score on ICU admission, pneumonia, blood transfusion, immunosuppressive drugs, central-line catheter, and ≥2 VAEs in the ICU were risk factors for all-cause mortality of VAE patients in the ICU.

Cognitive Impairment and Physical Activity in Old Age: The Impact on All-Cause Mortality in a 15-Year Follow-Up of the Bambuí Cohort Study of Aging

2020 ◽  
Author(s):  
Erico Castro-Costa ◽  
Jerson Laks ◽  
Cecilia Godoi Campos ◽  
Josélia OA Firmo ◽  
Maria Fernanda Lima-Costa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Old Age ◽  
All Cause Mortality ◽  
The Impact

scholarly journals Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anne-Françoise Rousseau ◽  
Pauline Minguet ◽  
Camille Colson ◽  
Isabelle Kellens ◽  
Sourour Chaabane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Inpatient Rehabilitation ◽  
Quadriceps Strength ◽  
Biological Parameters ◽  
Icu Stay ◽  
Icu Discharge ◽  
Prolonged Icu Stay ◽  
Post Intensive Care Syndrome

Abstract Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

scholarly journals The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative

2021 ◽  
pp. 175114372098870
Author(s):  
Zudin Puthucheary ◽  
Craig Brown ◽  
Evelyn Corner ◽  
Sarah Wallace ◽  
Julie Highfield ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Inpatient Rehabilitation ◽  
Service Evaluation ◽  
Language Therapy ◽  
Initial Development ◽  
Related Data ◽  
Acute Hospitals ◽  
Rehabilitation Needs ◽  
Post Intensive Care Syndrome

Background Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result. Methods Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour. Results No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = −1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted. Conclusions The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.

scholarly journals Sleep duration and all-cause mortality in the elderly in China: a population-based cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanfeng Ren ◽  
Maohua Miao ◽  
Wei Yuan ◽  
Jiangwei Sun
Keyword(s):  
Cohort Study ◽  
Sleep Duration ◽  
Dose Response ◽  
Cox Regression ◽  
Oldest Old ◽  
The Elderly ◽  
Response Analysis ◽  
Short Sleep Duration ◽  
All Cause Mortality

Abstract Background Although a U-shaped association between sleep duration and all-cause mortality has been found in general population, its association in the elderly adults, especially in the oldest-old, is rarely explored. Methods In present cohort study, we prospectively explore the association between sleep duration and all-cause mortality among 15,092 participants enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2019. Sleep duration and death information was collected by using structured questionnaires. Cox regression model with sleep duration as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). The dose-response association between them was explored via a restricted cubic spline function. Results During an average follow-up of 4.51 (standard deviation, SD: 3.62) years, 10,768 participants died during the follow-up period. The mean (SD) age of the participants was 89.26 (11.56) years old. Compared to individuals with moderate sleep duration (7–8 hours), individuals with long sleep duration (> 8 hours) had a significantly higher risk of all-cause mortality (HR: 1.13, 95%CI: 1.09–1.18), but not among individuals with short sleep duration (≤ 6 hours) (HR: 1.02, 95%CI: 0.96–1.09). Similar results were observed in subgroup analyses based on age and gender. In the dose-response analysis, a J-shaped association was observed. Conclusions Sleep duration was associated with all-cause mortality in a J-shaped pattern in the elderly population in China.

scholarly journals Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Yeop Lee ◽  
Hun Lee ◽  
Ji Sung Lee ◽  
Sol Ah Han ◽  
Yoon Jeon Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Cox Regression ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Population Based ◽  
Angle Closure ◽  
Charlson Comorbidity Index Score ◽  
All Cause Mortality ◽  
Specific Mortality

AbstractThis population-based, retrospective cohort study aimed to evaluate the association between glaucoma surgery and all-cause and cause-specific mortality among Korean elderly patients with glaucoma. A total of 16210 elderly patients (aged ≥ 60 years) diagnosed with glaucoma between 2003 and 2012 were included, and their insurance data were analyzed. The participants were categorized into a glaucoma surgery cohort (n = 487), which included individuals who had diagnostic codes for open angle glaucoma (OAG) or angle closure glaucoma (ACG) and codes for glaucoma surgery, and a glaucoma diagnosis cohort (n = 15,723), which included patients who had codes for OAG and ACG but not for glaucoma surgery. Sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities were included as covariates. Cox regression models were used to assess the association between glaucoma surgery and mortality. The incidence of all-cause mortality was 34.76/1,000 person-years and 27.88/1,000 person-years in the glaucoma surgery and diagnosis groups, respectively. The adjusted hazard ratio (HR) for all-cause mortality associated with glaucoma surgery was 1.31 (95% confidence interval [CI], 1.05–1.62, P = 0.014). The adjusted HR for mortality due to a neurologic cause was significant (HR = 2.66, 95% CI 1.18–6.00, P = 0.018). The adjusted HRs for mortality due to cancer (HR = 2.03, 95% CI 1.07–3.83, P = 0.029) and accident or trauma (HR = 4.00, 95% CI 1.55–10.34, P = 0.004) associated with glaucoma surgery for ACG were significant as well. Glaucoma surgery was associated with an increase of mortality in elderly patients with glaucoma. In particular, the risk of mortality associated with glaucoma surgery due to neurologic causes was significant.

488: DESCRIBING POST-INTENSIVE CARE SYNDROME IN PEDIATRIC SURVIVORS OF CRITICAL ILLNESS

2016 ◽  
Vol 44 (12) ◽  
pp. 198-198
Author(s):  
Christopher Schneller ◽  
Briseyda Morales ◽  
Laura Campbell ◽  
Meredith Bone
Keyword(s):  
Intensive Care ◽  
Critical Illness ◽  
Post Intensive Care Syndrome

scholarly journals Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study

2018 ◽  
Vol 6 (3) ◽  
pp. 213-222 ◽  
Author(s):  
Timothy D Girard ◽  
Jennifer L Thompson ◽  
Pratik P Pandharipande ◽  
Nathan E Brummel ◽  
James C Jackson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cognitive Impairment ◽  
Critical Illness ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Phenotypes
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