title: The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation.
abstract: BACKGROUND
  Disability risk groups and 1-year outcome after greater than or equal to 7 days of mechanical ventilation (MV) in medical/surgical intensive care unit (ICU) patients are unknown and may inform education, prognostication, rehabilitation, and study design.
  
  
  OBJECTIVE
  To stratify patients for post-ICU disability and recovery to 1 year after critical illness.
  
  
  METHODS
  We evaluated a multicenter cohort of 391 medical/surgical ICU patients who received greater than or equal to 1 week of MV at 7 days and 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling.
  
  
  RESULTS
  The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to 1-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay. By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post-ICU healthcare use, and disposition. Patients less than 42 years with ICU length of stay less than 2 weeks had the best function and fewest deaths at 1 year compared with patients greater than 66 years with ICU length of stay greater than 2 weeks who sustained the worst disability and 40% 1-year mortality. Depressive symptoms (17%) and post-traumatic stress disorder (18%) persisted at 1 year.
  
  
  CONCLUSIONS
  ICU survivors of greater than or equal to 1 week of MV may be stratified into four disability groups based on age and ICU length of stay. These groups determine 1-year recovery and healthcare use and are independent of admitting diagnosis and illness severity. Clinical trial registered with www.clinicaltrials.gov (NCT 00896220).
authors.affiliation: 1 Department of Medicine.|2 Medical-Surgical Intensive Care.|4 Institute of Medical Science.|5 Toronto General Research Institute.|3 Interdepartmental Division of Critical Care Medicine.
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authors.affiliation: 3 Interdepartmental Division of Critical Care Medicine.|12 Department of Medicine and Anesthesia, Mount Sinai Hospital, Toronto, Canada.
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authors.affiliation: 13 Centre de Recherche du CHU de Sherbrooke, Sherbrooke, Canada.|14 Ecole de Réadaptation, Institut Universitaire de Gériatrie de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada.
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authors.affiliation: 1 Department of Medicine.|2 Medical-Surgical Intensive Care.|4 Institute of Medical Science.|5 Toronto General Research Institute.|3 Interdepartmental Division of Critical Care Medicine.
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authors.affiliation: 3 Interdepartmental Division of Critical Care Medicine.|9 Department of Medicine.|10 Division of Critical Care Medicine, and.|11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
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keywords: ICU; critical care; patient outcome assessment