Short- term impact of critical illness on health- related quality of life M. Dakoutrou, V. Gerovasili, G. Sidiras, I. Patsaki, A. Kouvarakos, S. Koutroumpi, S.Dimopoulos, C.Stefanou, C. Routsi, S. Nanas Evangelismos Hospital, National and Kapodistrian University of Athens, First Critical Care Department, Athens, Greece Study aims Methods Results Conclusions Please navigate using mouse/arrows or use buttons to jump to a specific slide

Background and Study aims There has been a rising interest in Health Related Quality of Life (HRQoL) of patients after Intensive Care Unit (ICU) discharge because more patients survive critical illness patients suffer from a wide range of serious physical and psychosocial impairments and reduced HRQoL Aim of this study was to evaluate changes in HRQoL of patients at ICU and hospital discharge, as compared to premorbid values J Rehabil Med 2009; 41: 1041–1048, BMC Research Notes 2009, 2:160 Chest 2008;133:377-385 Methods Results Conclusions

Methods 1 Flow chart of patients screened and included in the study 227 patients discharged from the ICU 195 patients were excluded from the study mechanical ventilation <72h disability of communication/collaboration 32 consecutive eligible patients 3 died after ICU discharge 1 refused follow up 3 ICU readmissions

Baseline characteristics of study patients Methods 2 Baseline characteristics of study patients n= 32 Gender (♂/ ♀ ) 26/6 (mean±SD) Age 56±14 Baseline APACHE score 14±5 Baseline SOFA score 7±3 Baseline SAPS score 59±12 ICU stay – days 22±21 Mechanical ventilation in ICU – days 18±21

Questionnaires used in assessment of HRQoL Quality of life assessment Methods 3 Questionnaires used in assessment of HRQoL Health related Quality of life assessment *Before ICU admission (baseline) At discharge from the ICU At discharge from the hospital Nottingham Health Profile (NHP) Go to Euro QOL 5d questionnaire Go to *Patients were asked after ICU discharge to recall their HRQoL before ICU admission Intensive Care Med 2001;27:1901-1907 Results

Nottingham Health Profile YES X NO 38 statements 6 Domains energy pain emotional reactions sleep social isolation physical mobility Each question assigned a weighted value Score for each domain ranges from 0 (normal health condition) to  100 (very poor health condition) NHP questionnaire has been adapted to the Greek language HIPPOKRATIA (2002), 6 Suppl. 1, 79-82

EQOL Visual Analogue Scale: self-rated health status Euro QOL 5d questionnaire 5 dimensions of quality of life EQOL Visual Analogue Scale: self-rated health status MOBILITY (walking) no problems some problems confined to bed SELF-CARE (washing or dressing) unable USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities) PAIN / DISCOMFORT no moderate extreme ANXIETY / DEPRESSION none EURO QoL questionnaire has been adapted to the Greek language Archives of Hellenic Medicine 2001;18(2):180-191

Results 1 Nottingham Health Profile domains assessed at ICU and hospital discharge compared to baseline values Table 2. NHP scores for each domain (mean ±SD) DOMAINS BASELINE (n=30) ICU DISCHARGE(n=31) HOSP. DISCHARGE(n=28) Phys. Mobility (p<0.001) 8±25 88±26 55±27 Energy (p<0.001) 10±22 70±39 40±34 Pain (p<0.001) 8±24 35±40 12±26 Sleep (p<0.05) 16±30 44±38 30±33 Social Isolation (p<0.01) 21±31 60±24 41±28 Emot.reactions (p<0.001) 14±25 33±33 17±21 Go to

Results 2 EURO QoL 5d questionnaire domains assessed at ICU and hospital discharge compared to baseline values Table 1. Proportions of patients reporting moderate to severe difficulties in each domain of EURO QoL 5d questionnaire and VAS score) DOMAINS BASELINE (n=30) ICU DISCHARGE(n=31) HOSP.DISCHARGE(n=28) MOBILITY 13.3% 100% 78.6% SELF-CARE 6.7% 92.9% USUAL ACTIVITIES 20% 96.8% 96.4% PAIN/ DISCOMFORT 16.1% 83.4% 71.4% ANXIETY/ DEPRESSION 43.3% 77.4% 60.7% EQ VAS score (mean±SD) P<0.001 79±22 56±23 67±17 Go to

NHP Score PHYSICAL MOBILITY ENERGY Figure 1. Nottingham Health Profile scores of phys.mobility and energy domains (baseline before ICU, at ICU discharge, at hosp.discharge) PHYSICAL MOBILITY ENERGY P<0.001 P<0.001 Baseline (n=30) ICU discharge(n=31) Hospital discharge (n=28) NHP Score Back (Boxplots represent median value, 25th-75th percentile and range) 10

Figure 2. Nottingham Health Profile scores of pain and sleep domains (baseline before ICU, at ICU discharge, at hosp.discharge) PAIN SLEEP P<0.001 P<0.05 NHP Score Baseline (n=30) ICU discharge(n=31) Hospital discharge (n=28) Back (Boxplots represent median value, 25th-75th percentile and range)

NHP Score EMOTIONAL REACTIONS SOCIAL ISOLATION Figure 3. Nottingham Health Profile scores in emotional reactions and social isolation domains (baseline before ICU, at ICU discharge, at hosp. discharge) EMOTIONAL REACTIONS SOCIAL ISOLATION P<0.001 P<0.01 NHP Score Baseline (n=30) ICU discharge(n=31) Hospital discharge (n=28) Back (Boxplots represent median value, 25th-75th percentile and range)

MOBILITY % of patients SELF-CARE USUAL ACTIVITIES Figure 4. Percentage of patients reporting moderate to extreme problems in mobility, self-care and usual activities (baseline before ICU, at ICU discharge and at hosp.discharge) MOBILITY % of patients Baseline vs ICU discharge (p<0.001) Baseline vs hosp. discharge (p<0.001) SELF-CARE USUAL ACTIVITIES (n=30) (n=31) (n=28) Back

PAIN / DISCOMFORT ANXIETY/DEPRESSION % of patients PAIN / DISCOMFORT Figure 5. Percentage of patients reporting moderate to extreme pain/ discomfort and anxiety/depression (baseline before ICU, at ICU discharge and at hosp.discharge) Baseline vs ICU discharge (p<0.001) Baseline vs hosp. discharge (NS) ANXIETY/DEPRESSION (n=30) (n=31) (n=28) Back

Figure 6. EURO QoL 5d Self-rated health status (baseline before ICU, at ICU discharge and at hosp.discharge) P<0.001 Baseline ICU discharge Hospital discharge Back (n=30) (n=31) (n=28)

Conclusions 1 Patients significantly considered themselves of lower general health status after ICU discharge than before ICU admission After ICU discharge, the most prevalent complaints were related to physical mobility and energy with difficulties in other aspects of health status (self-care, sleep) These difficulties potentially increase length of stay in the hospital and consequently, the medical care costs

Conclusions 2 Social life and emotional functioning were also affected after ICU The levels of pain/discomfort and anxiety/ depression seem to be increased at ICU discharge, though they tend to improve at discharge from the hospital

Discussion Potential limitations: recall bias (baseline data), small sample size, assessment only until hospital discharge Further studies are needed to evaluate how long the impairment remains after hospital discharge and to assess the effect of specific interventions aimed to improve HRQoL Back to top