1. 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
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2. 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:
Methods
Results
Conclusions

3. 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

4. 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

5. 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)
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Euro QOL 5d questionnaire
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*Patients were asked after ICU discharge to recall their HRQoL before ICU admission
Intensive Care Med 2001;27:
Results

6. 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

7. 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):

8. 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
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9. 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
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10. 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
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(Boxplots represent median value, 25th-75th percentile and range) 10

11. 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)
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(Boxplots represent median value, 25th-75th percentile and range)

12. 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)
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(Boxplots represent median value, 25th-75th percentile and range)

13. 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)
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14. 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)
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15. 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)

16. 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

17. 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

18. 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
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