SURVIVAL AND OUTCOME OF NEUROSURGICAL PATIENTS REQUIRING VENTILATORY SUPPORT AFTER INTENSIVE CARE UNIT STAY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 530-538 ◽  
Author(s):  
Kirsi Malmivaara ◽  
Juha Hernesniemi ◽  
Ritva Salmenperä ◽  
Juha Öhman ◽  
Risto P. Roine ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neurosurgical Patients ◽  
Neurosurgical Treatment ◽  
Index Value ◽  
Artificial Life Support ◽  
Lost To Follow Up

Abstract OBJECTIVE The aim of this study was to analyze the clinical outcome of severely ill neurosurgical patients whose need for artificial life support was extended. We sought to determine whether these patients benefit from extended treatment both in life expectancy and quality of life. Furthermore, we evaluated the direct cost of the neurosurgical treatment. METHODS The study group comprised a consecutive series of 346 neurosurgical patients in poor condition who were discharged from the intensive care unit but still in need of artificial respiratory support. The patients had various neurosurgical diagnoses and were treated between 2000 and 2003 at the Department of Neurosurgery, Helsinki University Central Hospital. We followed the outcome of these patients by specially formatted questionnaires 6 months and 1, 2, and 5 years after treatment. Their health-related quality of life was evaluated with EuroQol EQ-5D; quality-adjusted life years (QALY) gained with the treatment and the costs of a QALY were calculated. RESULTS The median follow-up time was 5 years. The mortality rate was 27% at 30 days, 45% at 1 year, and 59% at 5 years after treatment. Of the patients, 20% had a good recovery (Glasgow Outcome Scale [GOS] scores 4 and 5), 18% had severe disability (GOS score 3), none was in a vegetative state (GOS score 2), 59% were dead (GOS score 1), and 3% were lost to follow-up. Of the survivors, 69% lived at home, 22% in a nursing home, 2% were in a hospital, and 7% were lost to follow-up. The median EQ-5D index value was lower than the median index value for the general population: 0.71 (25th percentile [Q1] 0.38 and 75th percentile [Q3] 0.85) versus 0.85 (Q1 0.73 and Q3 1.00). The median cost of the direct neurosurgical treatment per patient was 15 000 € (25th percentile, 10 000 € 75th percentile, 22 000 €). Surviving patients gained a mean of 17 ± 13 QALYs. The cost of 1 QALY was 2521 €. CONCLUSION Prolonged intensive care unit and step-down unit treatment of critically ill neurosurgical patients seems to be clinically justified. Moreover, direct costs of neurosurgical treatment were reasonably low.

scholarly journals Feasibility of Nurse-Led Multidimensional Outcome Assessments in the Neuroscience Intensive Care Unit

2020 ◽  
Vol 40 (3) ◽  
pp. e1-e8
Author(s):  
Erika Schlichter ◽  
Omar Lopez ◽  
Raymond Scott ◽  
Laura Ngwenya ◽  
Natalie Kreitzer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Neurocritical Care ◽  
Loss To Follow Up ◽  
Outcome Assessments ◽  
Neuroscience Intensive Care Unit

Background The outcome focus for survivors of critical care has shifted from mortality to patient-centered outcomes. Multidimensional outcome assessments performed in critically ill patients typically exclude those with primary neurological injuries. Objective To determine the feasibility of measurements of physical function, cognition, and quality of life in patients requiring neurocritical care. Methods This evaluation of a quality improvement initiative involved all patients admitted to the neuroscience intensive care unit at the University of Cincinnati Medical Center. Interventions Telephone assessments of physical function (Glasgow Outcome Scale-Extended and modified Rankin Scale scores), cognition (modified Telephone Interview for Cognitive Status), and quality of life (5-level EQ-5D) were conducted between 3 and 6 months after admission. Results During the 2-week pilot phase, the authors contacted and completed data entry for all patients admitted to the neuroscience intensive care unit over a 2-week period in approximately 11 hours. During the 18-month implementation phase, the authors followed 1324 patients at a mean (SD) time of 4.4 (0.8) months after admission. Mortality at follow-up was 38.9%; 74.8% of these patients underwent withdrawal of care. The overall loss to follow-up rate was 23.6%. Among all patients contacted, 94% were available by the second attempt to interview them by telephone. Conclusions Obtaining multidimensional outcome assessments by telephone across a diverse population of neurocritically ill patients was feasible and efficient. The sample was similar to those in other cohort studies in the neurocritical care population, and the loss to follow-up rate was comparable with that of the general critical care population.

scholarly journals Longitudinal Smartphone-Based Post-hospitalisation Symptom Monitoring in SARS-CoV-2 Associated Respiratory Failure: A Multi-Centre Observational Study

2021 ◽  
Vol 2 ◽  
Author(s):  
Dario Kohlbrenner ◽  
Manuel Kuhn ◽  
Melina Stüssi-Helbling ◽  
Yves Nordmann ◽  
Marc Spielmanns ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Status ◽  
Respiratory Failure ◽  
Hospital Discharge ◽  
Symptom Burden ◽  
General Health Status

Background: We aimed to longitudinally monitor the recovery in breathlessness, symptom burden, health-related quality-of-life, and mental health status in individuals hospitalised due to SARS-CoV-2 associated respiratory failure.Methods: Individuals hospitalised due to SARS-CoV-2 associated respiratory failure were recruited at hospital discharge in three participating centres. During the 90 day follow-up, European Quality of Life−5 Dimensions−5 Levels Instrument (EQ-5D-5L), modified Medical Research Council (mMRC) Dyspnoea Scale, COPD Assessment Test (CAT), and weekly Hospital Anxiety and Depression Scale (HADS) questionnaires were assessed using a smartphone application. The results were presented using descriptive statistics and graphics. Linear mixed models with random intercept were fitted to analyse differences of intensive-care unit status on the recovery course in each outcome.Results: We included 58 participants, 40 completed the study. From hospital discharge until 90 days post-discharge, EQ-5D-5L index changed from 0.83 (0.66, 0.92) to 0.96 (0.82, 1.0), VAS rating on general health status changed from 62 (50, 75) % to 80 (74, 94) %, CAT changed from 13 (10, 21) to 7 (3, 11) points, mMRC changed from 1 (0, 2) to 0 (0, 1) points, HADS depression subscale changed from 6 (4, 9) to 5 (1, 6) points, HADS anxiety subscale changed from 7 (3, 9) to 2 (1, 8) points. Differences in the recovery courses were observed between intensive-care and ward participants. Participants that were admitted to an intensive-care unit during their hospitalisation (n = 16) showed increases in CAT, mMRC, HADS scores, and decreases in EQ-5D-5L 30 days after hospital discharge.Conclusion: Being admitted to an ICU led to statistically significant reductions in recovery in the EQ-5D-5L and the CAT. Furthermore, the flare-up in symptom burden and depression scores, accompanied by an attenuated recovery in HrQoL and general health status in the ICU-group suggests that a clinical follow-up 1 month after hospital discharge can be recommended, evaluating further treatments.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04365595].

ASSESSMENT OF QUALITY OF LIFE AFTER DISCHARGE FROM MULTIDISCIPLINARY INTENSIVE CARE UNIT (ICU) BY SYSTEMATIC FOLLOW UP

1979 ◽  
Vol 7 (3) ◽  
pp. 132
Author(s):  
Le Gall ◽  
L. Mouellic ◽  
Y. Saillard ◽  
J. Carlet ◽  
P. Trumet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care
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