Characteristics and outcomes of palliative care patients in intensive care unit.

145 Background: Despite the growing palliative care movement, most admissions still occur in Intensive Care Units. The aim of this study was to determine the frequency of palliative care patients admitted in an ICU and assessed their outcomes. Methods: This prospective study was conducted in a tertiary private hospital, in an adult medical-surgical ICU with 22-bed in São Paulo, Brazil. Patients or their family member with ICU stay ≥ 48 hours were invited to participate. They were excluded if they had no conditions to answer the questionnaire or if they refuse to participate. During ICU stay we analyzed through the medical records and questionnaire their clinical condition and their oncologic status. We called them by telephonic assessment to assess their survival. Results: From March 2011 to March 2013 a total of 576 ICU patients were analyzed; of these, 280 were oncologic patients and 95 were palliative care. Of total, the majority was male gender (57.8%), median age was 67[54-79] years, SAPS III score was 54±18.4 points, SOFA was 3.1±3.0 and ICU Length of stay (LOS) was 9.0±11.3 days. ICU mortality was 16.5%, 1-month mortality was 22% and 3-months cumulative mortality was 28.6%. We could observe that palliative care patients were in majority cancer patients (75%vs 43.4%,p<0.001), with metastatic disease(81.7 vs 36.3, p<0.001), had greater mean time of initial diagnosis(3.21±3.7 vs 2.17±2.5, p=0.009), had greater ICU LOS (14.2±16.2 days vs 7.96±9.8, p<0.001) greater mean SAPS III (68.5±16.0 vs p<0.001) and SOFA (4.81±3.2 vs 2.81±2.8, p<0.001) when compared with non palliative patients care. They also needed more mechanical ventilation (50.0%vs32.6%, p=0.001), tracheotomy (11.6%vs 5.0%,p=0.014) and vasopressors (54.7% vs 36.8,p=0.001). The ICU mortality was greater (32.6% vs 6.8%, p<0.001), 1-month (60.0% vs 14.0%, p<0.001) and 3-months (73.5% vs 19.1%). Conclusions: Palliative care suffers most in Intensive Care Unit and we observed a high mortality at 3-months after ICU discharge. We recommend more discussions before palliative care patient’s admissions in ICU to better provide them quality of life.

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Early mobilization is associated with decreased mechanical ventilation and ICU length of stay following cardiac surgery

Health & Research Journal ◽

10.12681/healthresj.28161 ◽

2021 ◽

Vol 7 (4) ◽

pp. 184

Author(s):

Vasiliki Raidou ◽

Stavros Dimopoulos ◽

Foteini Chatzivasiloglou ◽

Christos Kourek ◽

Vasiliki Tsagari ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Length Of Stay ◽

Medical Records ◽

Early Mobilization ◽

Icu Stay ◽

Icu Length Of Stay ◽

Icu Discharge

Background: Early mobilization of the Intensive Care Unit (ICU) patients improves muscle strength and functional capacity. It has been demonstrated that prevents Intensive Care Unit Acquired Weakness (ICUAW) and accelerates ICU discharge. However, data on mobilization early after cardiac surgery are inadequate. This study aimed to record early mobilization and investigates the association with ICU findings in cardiac surgery patients.Material and Methods: In this observational study, 165 patients after cardiac surgery were enrolled. Of these, 159 were assessed for early mobilization and mobilization status during ICU stay. Mobilization practices were recorded from 1st post ICU admission and every 48 h until 7th day. The duration of mechanical ventilation (MV) support, ICU length of stay and clinical outcome were recorded from medical records registration. Results: Early mobilization consisted of active and passive limb mobilization, sitting in bed and transferring from bed to chair. The proportion of patients mobilized, was 18% (n = 29/159) on day 1, 53% (n = 46/87) on day 3, 54% (n = 22/41) on day 5 and 62% (n = 15/24) on day 7. ICU length of stay was reduced for mobilized patients (n = 29) on day 1 compared to non-mobilized ones (24 ± 10 vs 47 ± 73 h respectively, P = 0.001). The duration of MV was shorter in mobilized patients on day 3 (n =46) compared to bedridden, (18 ± 9 vs 23 ± 30 h respectively, P = 0.01).Conclusions: Early mobilization after cardiac surgery was found to be low with a significant trend to increase over ICU stay. It is also associated with a reduced duration of MV and ICU length of stay.

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Families' perception, knowledge, and psychological stressors associated with transition of care from the intensive care unit

Journal of Precision Respiratory Medicine ◽

10.2500/jprm.2019.190004 ◽

2019 ◽

Vol 2 (1) ◽

pp. 53-56

Author(s):

Gustavo Ferrer ◽

Chi Chan Lee ◽

Monica Egozcue ◽

Hector Vazquez ◽

Melissa Elizee ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Care Providers ◽

Family Members ◽

Expected Improvement ◽

Transition Of Care ◽

Care Providers ◽

Icu Discharge ◽

Family Perceptions

Background: During the process of transition of care from the intensive care setting, clarity, and understanding are vital to a patient's outcome. A successful transition of care requires collaboration between health-care providers and the patient's family. The objective of this project was to assess the quality of continuity of care with regard to family perceptions, education provided, and psychological stress during the process. Methods: A prospective study conducted in a long-term acute care (LTAC) facility. On admission, family members of individuals admitted to the LTAC were asked to fill out a 15-item questionnaire with regard to their experiences from preceding intensive care unit (ICU) hospitalization. The setting was an LTAC facility. Patients were admitted to an LTAC after ICU admission. Results: Seventy-six participants completed the questionnaire: 38% expected a complete recovery, 61% expected improvement with disabilities, and 1.3% expected no recovery. With regard to the length of stay in the LTAC, 11% expected < 1 week, 26% expected 1 to 2 weeks, 21% expected 3 to 4 weeks, and 42% were not sure. Before ICU discharge, 33% of the participants expected the transfer to the LTAC. Also, 72% did not report a satisfactory level of knowledge regarding their family's clinical condition or medical services required; 21% did not receive help from family members; and 50% reported anxiety, 20% reported depression, and 29% reported insomnia. Conclusion: Families' perception of patients' prognosis and disposition can be different from what was communicated by the physician. Families' anxiety and emotional stress may precipitate this discrepancy. The establishment of optimal projects to eliminate communication barriers and educate family members will undoubtedly improve the quality of transition of care from the ICU.

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Quality of palliative care in intensive care unit “X” Hospital Indonesia

Enfermería Clínica ◽

10.1016/j.enfcli.2020.07.003 ◽

2020 ◽

Vol 30 ◽

pp. 16-19

Author(s):

Ifa Hafifah ◽

Syamsul Arifin ◽

Dhemes Alin ◽

Isnawati

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care

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Comparing Clinician Ratings Of The Quality Of Palliative Care In The Intensive Care Unit

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a6859 ◽

2010 ◽

Author(s):

Lawrence Ho ◽

Ruth A. Engelberg ◽

J R. Curtis ◽

Judith Nelson ◽

John Luce ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care

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Health-related quality of life of patients 12 months following surgical intensive care discharge

South African Journal of Physiotherapy ◽

10.4102/sajp.v67i1.36 ◽

2011 ◽

Vol 67 (1) ◽

Cited By ~ 3

Author(s):

F. Karachi ◽

S. Hanekom ◽

M. Faure

Keyword(s):

Intensive Care ◽

Physical Functioning ◽

Health Related Quality ◽

Surgical Intensive Care ◽

Icu Discharge ◽

Related Quality ◽

Health Related ◽

Surgical Icu ◽

Hrqol Domain

Health related quality of life (HRQoL) and the effect of selected socio-demographic and clinical intensive care variables on HRQoL of patients 12 months following adult surgical intensive care unit discharge in the Western Cape was evaluated. A prospective observational study was conducted. The sample comprised 46 patients who had survived 12 months following discharge. Structured telephonic interviews were conducted using a self-developed and SF-36v2 HRQoL questionnaire. Data was analyzed using Stastica 7 and values were accepted as significant at the 5% level. Low mean HRQoL domain scores (43% - 53%) were found implying a poor HRQoL outcome. Physical functioning [43.5%], Role Play [44.5%] and Role Emotion [43.1%] scores were specifically lower than the other HRQoL domain scores. Age and severity of illness scores (APACHE II) were significantly associated with the social functioning (p=0.01) and physical functioning (p=0.02) scores respectively. APACHE II may be a useful contributor in predicting long-term physical functioning outcomes in patients following surgical ICU discharge. The HRQoL outcomes are slightly lower than that found for inter-national ICU populations however responses in the domains affected are comparable. Low physical functioning, role play and role emotion scores indicate a need for further physical and emotional rehabilitation following surgical ICU discharge.

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Quality of life aspects in oncologic patients who survived an intensive care unit admission

Critical Care ◽

10.1186/cc5655 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P495

Author(s):

D Forte ◽

O Ranzani ◽

N Stape ◽

F Gianinni ◽

R Cordioli ◽

...

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Admission ◽

Oncologic Patients

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Impact on Mental, Physical and Cognitive functioning of a Critical care sTay during the COVID-19 pandemic (IMPACCT COVID-19): protocol for a prospective, multicentre, mixed-methods cohort study

BMJ Open ◽

10.1136/bmjopen-2021-053610 ◽

2021 ◽

Vol 11 (9) ◽

pp. e053610

Author(s):

Ana Cristina Castro-Ávila ◽

Catalina Merino-Osorio ◽

Felipe González-Seguel ◽

Agustín Camus-Molina ◽

Jaime Leppe

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Cognitive Functioning ◽

Healthcare Professionals ◽

Cognitive Impairments ◽

Anxiety And Depression ◽

Icu Discharge

IntroductionThe ongoing pandemic could affect the duration, variety and severity of the mental, physical, and cognitive impairments intensive care unit (ICU) survivors and their families frequently present. We aim to determine the impact of the COVID-19 pandemic on the mental, physical, and cognitive health of survivors, the experience of their families and their treating healthcare professionals.Methods and analysisProspective, multicentre, mixed-methods cohort study in seven Chilean ICUs. Sample: 450 adults, able to walk independently prior to admission, in ICU and mechanical ventilation >48 hours with and without COVID-19. Clinical Frailty Scale, Charlson comorbidity index, mobility (Functional Status Score for the Status Score for the Intensive Care Unit) and muscle strength (Medical Research Council Sum Score) will be assessed at ICU discharge. Cognitive functioning (Montreal Cognitive Assessment–blind), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Impact of Event Scale-Revised) symptoms, disability (WHO Disability Assessment Schedule 2.0), quality of life (European Quality of Life Health Questionnaire), employment and survival will be assessed at ICU discharge, 3 months and 6 months. A sample will be assessed using actigraphy and the Global Physical Activity Questionnaire at 6 months after ICU discharge. Trajectories of mental, physical, and cognitive impairments will be estimated using multilevel longitudinal modelling. A sensitivity analysis using multiple imputations will be performed to account for missing data and loss-to-follow-up. Survival will be analysed using Kaplan-Meier curves. The perceptions of family members regarding the ICU stay and the later recovery will be explored 3 months after discharge. Healthcare professionals will be invited to discuss the challenges faced during the pandemic using semistructured interviews. Interviews will be thematically analysed by two independent coders to identify the main themes of the experience of family members and healthcare professionals.Ethics and disseminationThe study was approved by the Clinica Alemana Universidad del Desarrollo Ethics Committee (2020–78) and each participating site. Study findings will be published in peer-reviewed journals and disseminated through social media and conference meetings.Trial registration numberNCT04979897.

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P3506A novel urinary biomarker predicts 1 year mortality after discharge from Intensive Care

European Heart Journal ◽

10.1093/eurheartj/ehz745.0370 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Z Y Zhang ◽

E Nkuipou-Kenfack ◽

W Y Yang ◽

B Mujaj ◽

L Thijs ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Model Performance ◽

Biologically Active ◽

Support Vector ◽

Charlson Score ◽

Icu Mortality ◽

Discovery Sample ◽

Net Reclassification Improvement ◽

Icu Discharge

Abstract Rationale Tools reflecting molecular processes predicting death after discharge from intensive care unit (ICU) are currently unavailable. Objectives To construct a urinary proteomic biomarker predicting 1-year post-ICU mortality. Methods In 1081 patients, enrolled in the French and European Outcome Registry in Intensive Care Unit (NCT01367093), the urinary proteome was measured at ICU discharge using capillary electrophoresis couple with mass spectrometry along with clinical variables; circulating biomarkers (NT-proBNP, hsTnT, biologically active adrenomedullin, soluble ST2, and NGAL) and urinary albumin were available in 886 patients. Measurements and main results In the discovery sample (60/256 deaths/survivors), support vector machine modelling identified ACM150, mainly consisting of collagen fragments, yielding an AUC of 0.676 (95% CI, 0.615–0.737). In the replication sample (151/608 deaths/survivors), AUC was 0.704 (0.659–0.750). While accounting for center and clinical risk factors, the hazard ratios in all available patients were 1.27 (1.18–1.37) for ACM150 (+1 SD), 1.20 (1.16–1.33) for the Charlson score (+1 point), and ≥1.30 (P≤0.0071) for the other biomarkers (+ 1 SD). Model performance assessed by adding ACM150 to a basic model including the aforementioned covariables, the Charlson score or any other biomarker confirmed the prognostic accuracy of ACM15 with significant increases (P≤0.0038) in integrated discrimination (≥ +0.50) and net reclassification improvement (≥ +53.7) and AUC (≥ +0.037). Interactome mapping (STRING) based on 72 sequenced peptides and 25 parental proteins gravitated around collagen nodes. Conclusions ACM150 is a urinary proteomic classifier predicting 1-year post-ICU mortality over and beyond other biomarkers and reflects dysregulation of collagen turnover as underlying pathophysiological process.

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The Impact of Medical Conditions on the Quality of Life of Survivors at Discharge From Intensive Care Unit

Medicina ◽

10.3390/medicina47050038 ◽

2011 ◽

Vol 47 (5) ◽

pp. 38 ◽

Cited By ~ 1

Author(s):

Andrius Klimašauskas ◽

Ieva Sereikė ◽

Aušra Klimašauskienė ◽

Gintautas Kėkštas ◽

Juozas Ivaškevičius

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Intensive Care ◽

Organ System ◽

Therapeutic Interventions ◽

Prolonged Stay ◽

Role Physical ◽

Icu Discharge ◽

The Impact

Background and Objective. Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors’ HRQOL 6 months after intensive care. Material and Methods. A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge. Results. In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038). Conclusions. HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU.

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Family satisfaction in the intensive care unit, a cross-sectional study from Norway

BMC Emergency Medicine ◽

10.1186/s12873-021-00412-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Randi Olsson Haave ◽

Hilde Hammerud Bakke ◽

Agneta Schröder

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Family Satisfaction ◽

Cross Sectional Study ◽

Care Patient ◽

Demographic Variables ◽

Cross Sectional ◽

Icu Stay ◽

The Family

Abstract Background Becoming critically ill represents not just a great upheaval for the patient in question, but also for the patient’s closest family. In recent years, there has been a change in how the quality of the public health service is measured. There is currently a focus on how patients and their families perceive the quality of treatment and care. It can be challenging for patients to evaluate their stay in an intensive care unit (ICU) due to illness and treatment. Earlier studies show that the perceptions of the family and the patient may concur. It is important, therefore, to ascertain the family’s level of satisfaction with the ICU stay. The aim of the study was to describe how the family evaluate their satisfaction with the ICU stay. A further aim was to identify which demographic variables were associated with differences in family satisfaction. Method The study had a cross-sectional design. A sample of 57 family members in two ICUs in Norway completed the questionnaire: Family satisfaction in the intensive care unit 24 (FS-ICU 24). Statistical analysis was conducted using the Mann-Whitney U test (U), Kruskal Wallis, Spearman rho and a performance-importance plot. Results The results showed that families were very satisfied with a considerable portion of the ICU stay. Families were less satisfied with the information they received and the decision-making processes than with the nursing and care performed during the ICU stay. The results revealed that two demographic variables – relation to the patient and patient survival – significantly affected family satisfaction. Conclusion Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The results showed that some of the family demographic variables were significant for family satisfaction. The findings are clinically relevant since the results can strengthen intensive care nurses’ knowledge when meeting the family of the intensive care patient.

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