Patients' recollections of experiences in the intensive care unit may affect their quality of life.
BACKGROUND
We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL).


METHODS
We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire.


RESULTS
Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30).


CONCLUSIONS
This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL.
Granja
Cristina
C
Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal. cristinagranja@oninet.pt
Lopes
Alice
A
Moreira
Sara
S
Dias
Claudia
C
Costa-Pereira
Altamiro
A
Carneiro
António
A
D000328:Adult; D000368:Aged; D016638:Critical Illness; D003627:Data Interpretation, Statistical; D004325:Dreams / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009484:Neuropsychology; D017063:Outcome Assessment, Health Care; D011174:Portugal; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D018434:Sickness Impact Profile; D012893:Sleep Wake Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors