Quality of Life Six Years After Intensive Care

Modern technology makes it possible to keep more sick, extremely small, and vulnerable neonates alive. Many neonatologists in the Netherlands believe they should be concerned not only about the rate of survival of their patients, but also about the way the graduates of their care do, in fact, survive beyond the neonatal period. In most cases, we use all available methods to keep newborns alive. However, in some instances there is great concern about the quality of life, if the newborn should survive; here questions do arise about continuing or withholding treatment. In this commentary, I present my impression of the opinions held by a majority of practicing neonatologists in the Netherlands, as well as some personal thoughts and ideas. Recently, a committee convened by the Ministers of Justice and Health in the Netherlands issued an official report regarding the practice of euthanasia and the rules of medical practice when treatment is withheld.1 In this report of more than 250 pages, only 2 pages focus on the newborn. The following conclusions were made in this small section of the report. In almost one half of the instances of a fatal outcome in a neonatal intensive care unit in the Netherlands, discussions about sustaining or withholding treatment did take place at some stage of the hospital stay. A consideration of the future quality of life was always included in the discussion. The committee agreed with doctors interviewed for the report that there are circumstances in which continuation of intensive care treatment is not necessarily in the best interest of a neonate.

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Post–Intensive Care Syndrome in Family Decision Makers of Long-term Acute Care Hospital Patients

American Journal of Critical Care ◽

10.4037/ajcc2017414 ◽

2017 ◽

Vol 26 (5) ◽

pp. 416-422 ◽

Cited By ~ 3

Author(s):

Amy Petrinec

Keyword(s):

Quality Of Life ◽

Intensive Care ◽

Acute Care ◽

Acute Care Hospitals ◽

Summary Score ◽

Decision Makers ◽

Family Decision ◽

Post Intensive Care Syndrome

Background Family members of critically ill patients experience indications of post–intensive care syndrome, including anxiety, depression, and posttraumatic stress disorder. Despite increased use of long-term acute care hospitals for critically ill patients, little is known about the impact of long-term hospitalization on patients’ family members. Objectives To examine indications of post–intensive care syndrome, coping strategies, and health-related quality of life among family decision makers during and after patients’ long-term hospitalization. Methods A single-center, prospective, longitudinal descriptive study was undertaken of family decision makers of adult patients admitted to long-term acute care hospitals. Indications of post–intensive care syndrome and coping strategies were measured on the day of hospital admission and 30 and 60 days later. Health-related quality of life was measured by using the Short Form-36, version 2, at admission and 60 days later. Results The sample consisted of 30 family decision makers. On admission, 27% reported moderate to severe anxiety, and 20% reported moderate to severe depression. Among the decision makers, 10% met criteria for a provisional diagnosis of posttraumatic stress disorder. At admission, the mean physical summary score for quality of life was 47.8 (SD, 9.91) and the mean mental summary score was 48.00 (SD, 10.28). No significant changes occurred during the study period. Problem-focused coping was the most frequently used coping strategy at all time points. Conclusion Family decision makers of patients in long-term acute care hospitals have a significant prevalence of indications of post–intensive care syndrome.

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