title: A feasibility study of functional status and follow-up clinic preferences of patients at high risk of post intensive care syndrome.
abstract: After prolonged mechanical ventilation patients may experience the 'post intensive care syndrome' (PICS) and may be candidates for post-discharge follow-up clinics. We aimed to ascertain the incidence and severity of PICS symptoms in patients surviving prolonged mechanical ventilation and to describe their views regarding follow-up clinics. In a teaching hospital, we conducted a cohort study of all adult patients discharged alive after ventilation in ICU for ≥7 days during 2013. We administered the EuroQol-5D (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) via telephone interview and asked patients their views about the possible utility of a follow-up clinic. We studied 48 patients. At follow-up (average 19.5 months), seven (15%) patients had died and 14 (29%) did not participate (eight declined; two were non-English speakers; four were non-contactable). Among the 27 responders, 16 (59%) reported at least moderate problems in ≥1 EQ-5D dimension; 10 (37%) in ≥2 dimensions, and 8 (30%) in ≥3 dimensions. Moreover, 10 (37%) patients reported marked psychological symptoms; six (22%) scored borderline or abnormal on the HADS for both anxiety and depression; and four (15%) scored borderline or abnormal for one component. Finally, 21/26 (81%) patients stated that an ICU follow-up clinic would have been beneficial. At long-term follow-up, the majority of survivors of prolonged mechanical ventilation reported impaired quality of life and significant psychological symptoms. Most believed that a follow-up clinic would have been beneficial.
authors.affiliation: Intensive Care Specialist, Western Health, Melbourne, Victoria.
authors.forename: K J
authors.initials: KJ
authors.lastname: Farley
authors.affiliation: Adjunct Senior Research Fellow, Faculty of MN&HS, Monash University, Research Manager, Department of Intensive Care, Austin Hospital, Victoria, Melbourne, Victoria.
authors.forename: G M
authors.initials: GM
authors.lastname: Eastwood
authors.affiliation: Director of Intensive Care Research & Intensive Care Specialist, Austin Hospital, Melbourne, Victoria.
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000523:psychology; D001007:Anxiety / Q000453:epidemiology; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003422:Critical Care / Q000523:psychology*; D003625:Data Collection; D003863:Depression / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012121:Respiration, Artificial / Q000523:psychology*; D013577:Syndrome
keywords: ICU follow-up clinic; critical illness; intensive care; post intensive care syndrome; prolonged ICU stay; rehabilitation