Impact of a Prolonged Surgical Critical Illness on Patients’ Families

2002 ◽  
Vol 11 (5) ◽  
pp. 459-466 ◽  
Author(s):  
Sandra M. Swoboda ◽  
Pamela A. Lipsett

• Background Long-term effects on patients’ families after a prolonged stay in a surgical intensive care unit are unclear. We hypothesized that illnesses requiring more than 7 days’ stay in the surgical intensive care unit would have significant, long-lasting effects on patients’ families that would be related to patients’ functional outcome. • Methods All patients who stayed in the general surgery intensive care unit 7 days or more between July 1, 1996, and June 30, 1997, were enrolled. A total of 128 patients met the entry criteria, and families of surviving patients were interviewed at baseline and 1, 3, 6, and 12 months later. Maximum dysfunction/impact was compared with patients’ functional outcome. • Results Significant disturbances in the families’ lives occurred throughout the 12 months of this study. Almost 60% of responding families provided a moderate or large amount of caregiving between 1 and 9 months after a prolonged illness, 44.9% had to quit work after 1 month, and more than 36.7% of families had lost savings after 1 year. Some families moved to a less expensive home, delayed educational plans, or delayed medical care for another family member. • Conclusions An acute surgical illness that results in a prolonged stay in an intensive care unit has a substantial effect on patients’ families that is maximal between 1 and 3 months and parallels the patient’s functional outcome. Systems that provide support to both patients and their families should be emphasized in the hospital and after discharge.

2012 ◽  
Vol 21 (6) ◽  
pp. e120-e128 ◽  
Author(s):  
T. K. Timmers ◽  
M. H. J. Verhofstad ◽  
K. G. M. Moons ◽  
L. P. H. Leenen

Background Readmission within 48 hours is a leading performance indicator of the quality of care in an intensive care unit. Objective To investigate variables that might be associated with readmission to a surgical intensive care unit. Methods Demographic characteristics, severity-of-illness scores, and survival rates were collected for all patients admitted to a surgical intensive care unit between 1995 and 2000. Long-term survival and quality of life were determined for patients who were readmitted within 30 days after discharge from the unit. Quality of life was measured with the EuroQol-6D questionnaire. Multivariate logistic analysis was used to calculate the independent association of expected covariates. Results Mean follow-up time was 8 years. Of the 1682 patients alive at discharge, 141 (8%) were readmitted. The main causes of readmission were respiratory decompensation (48%) and cardiac conditions (16%). Compared with the total sample, patients readmitted were older, mostly had vascular (39%) or gastrointestinal (26%) disease, and had significantly higher initial severity of illness (P = .003, .007) and significantly more comorbid conditions (P = .005). For all surgical classifications except general surgery, readmission was independently associated with type of admission and need for mechanical ventilation. Long-term mortality was higher among patients who were readmitted than among the total sample. Nevertheless, quality-of-life scores were the same for patients who were readmitted and patients who were not. Conclusion The adverse effect of readmission to the intensive care unit on survival appears to be long-lasting, and predictors of readmission are scarce.


2014 ◽  
Vol 05 (09) ◽  
pp. 376-383
Author(s):  
Eileen Eggenberger ◽  
Samuel Marquez ◽  
Thu Doan ◽  
David M. Radosevich ◽  
Jeffrey G. Chipman ◽  
...  

Surgery ◽  
2017 ◽  
Vol 161 (5) ◽  
pp. 1367-1375 ◽  
Author(s):  
Michelle C. Nguyen ◽  
David S. Strosberg ◽  
Teresa S. Jones ◽  
Ankur Bhakta ◽  
Edward L. Jones ◽  
...  

2012 ◽  
Vol 397 (6) ◽  
pp. 995-999 ◽  
Author(s):  
Nina Weiler ◽  
Jens Waldmann ◽  
Detlef K. Bartsch ◽  
Caroline Rolfes ◽  
Volker Fendrich

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ming-Jen Kuo ◽  
Ruey-Hsing Chou ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Yi-Lin Tsai ◽  
...  

Abstract Background β-blockers may protect against catecholaminergic myocardial injury in critically ill patients. Long-term β-blocker users are known to have lower lactate concentrations and favorable sepsis outcomes. However, the effects of β1-selective and nonselective β-blockers on sepsis outcomes have not been compared. This study was conducted to investigate the impacts of different β-blocker classes on the mortality rate in septic patients. Methods We retrospectively screened 2678 patients admitted to the medical or surgical intensive care unit (ICU) between December 2015 and July 2017. Data from patients who met the Sepsis-3 criteria at ICU admission were included in the analysis. Premorbid β-blocker exposure was defined as the prescription of any β-blocker for at least 1 month. Bisoprolol, metoprolol, and atenolol were classified as β1-selective β-blockers, and others were classified as nonselective β-blockers. All patients were followed for 28 days or until death. Results Among 1262 septic patients, 209 (16.6%) patients were long-term β-blocker users. Patients with premorbid β-blocker exposure had lower heart rates, initial lactate concentrations, and ICU mortality. After adjustment for disease severity, comorbidities, blood pressure, heart rate, and laboratory data, reduced ICU mortality was associated with premorbid β1-selective [adjusted hazard ratio, 0.40; 95% confidence interval (CI), 0.18–0.92; P = 0.030], but not non-selective β-blocker use. Conclusion Premorbid β1-selective, but not non-selective, β-blocker use was associated with improved mortality in septic patients. This finding supports the protective effect of β1-selective β-blockers in septic patients. Prospective studies are needed to confirm it.


2021 ◽  
Author(s):  
Ming-Jen Kuo ◽  
Ruey-Hsing Chou ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Yi-Lin Tsai ◽  
...  

Abstract Background β blockers may protect against catecholaminergic myocardial injury in critically ill patients. Long-term β-blocker users are known to have lower lactate concentrations and favorable sepsis outcomes. However, the effects of cardioselective and nonselective β-blockers on sepsis outcomes have not been compared. This study was conducted to investigate the impacts of different β-blocker classes on the mortality rate in septic patients. Methods We retrospectively screened 2678 patients admitted to the medical or surgical intensive care unit (ICU) between December 2015 and July 2017. Data from patients who met the Sepsis-3 criteria at ICU admission were included in the analysis. Premorbid β-blocker exposure was defined as the prescription of any β-blocker for at least 1 month. Bisoprolol, metoprolol, and atenolol were classified as cardioselective β-blockers, and others were classified as nonselective β-blockers. All patients were followed for 28 days or until death. Results Among 1262 septic patients, 209 (16.6%) patients were long-term β-blocker users. Patients with premorbid β-blocker exposure had lower heart rates, initial lactate concentrations, and ICU mortality. After adjustment for disease severity, comorbidities, blood pressure, heart rate, and laboratory data, reduced ICU mortality was associated with premorbid cardioselective [adjusted hazard ratio (HR), 0.28; 95% confidence interval (CI), 0.11–0.74; P = 0.010], but not non-selective (adjusted HR, 0.78; 95% CI, 0.30–2.05; P = 0.611), β-blocker use. Conclusion Premorbid cardioselective, but not non-selective, β-blocker use was associated with improved mortality in septic patients. This finding supports the protective effect of cardioselective β-blockers in septic patients. Prospective studies are needed to confirm it.


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