Post-intensive Care Syndrome and Quality of Life in Survivors of Critical Illness

중환자실 퇴원환자의 집중치료 후 증후군과 삶의 질

  • Kim, Soo Gyeong (Surgical Intensive Care Unit, Koshin University Gaspel Hospital) ;
  • Kang, Jiyeon (Department of Nursing, Dong-A University)
  • 김수경 (고신대학교 복음병원 중환자실) ;
  • 강지연 (동아대학교 간호학과)
  • Received : 2016.05.07
  • Accepted : 2016.06.15
  • Published : 2016.06.30

Abstract

Purpose: To investigate the post-intensive care syndrome (PICS) and to analyze the factors affecting the quality of life (QoL) of survivors of critical illness. Methods: Subjects were 114 outpatients who had been discharged from intensive care units of a university hospital in B city, Korea. From July 30 through September 30, 2015, PICS was assessed using the Korean Montreal Cognitive Assessment, Hospital Anxiety-Depression Scale, Korean Instrumental/Activities of Daily Living (K-I/ADL) index, and handwriting transformation, while physical and mental health-related QoL was measured using the SF-12. Results: Of the subjects, 39.5% were screened for mild cognitive disorder and 23.7% experienced handwriting transformation after discharge. Multiple regression analysis revealed that restraint application, current job, time of ${\geq}36$ months after discharge, depression, anxiety, and handwriting transformation accounted for 40.9% of the physical health-related QoL, and depression, anxiety and experience of delirium accounted for 62.4% of the mental health-related QoL. Conclusions: It is necessary to make efforts to reduce restraint application in intensive care units and prevent the occurrence of delirium, with the objective of reducing PICS and improving the QoL of critical illness survivors.

Keywords

References

  1. Abelha, F. J., Luis, C., Veiga, D., Parente, D., Fernandes, V., Santos, P., et al. (2013). Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Critical Care, 17(5), R257. https://doi.org/10.1186/cc13084
  2. Baldwin, F. J., Hinge, D., Dorsett, J., & Boyd, O. F. (2009). Quality of life and persisting symptoms in intensive care unit survivors: Implication for care after discharge. BMC Reserch Notes, 12(2), 160.
  3. Campbell, A. J., Cook, J. A., Adey, G., & Cuthbertson, B. H. (2008). Predicting death and readmission after intensive care discharge. British Journal of Anaesthesia, 100(5), 656-662. https://doi.org/10.1093/bja/aen069
  4. Cornhill, H., & Case-Smith, J. (1996). Factors that relate to good and poor handwriting. American Journal of Occupational Therapy, 50, 732-739. https://doi.org/10.5014/ajot.50.9.732
  5. Cuthbertson, B, H., Rattray, J., Campbell, M. K., Gager, M., Roughton, S., Smith, A., et al. (2009). The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: A pragmatic randomised controlled trial. British Medical Journal,. 339, b3723. https://doi.org/10.1136/bmj.b3723
  6. Ely, E. W., Inouye, S. K., Bernard, G. R., Gordon, S., Francis, J., May, L., et al. (2001). Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). Journal of American Medical Association, 286(21), 2703-2710. https://doi.org/10.1001/jama.286.21.2703
  7. Girard, T, D., Kress, J. P., Fuchs, B. D., Thomason, J. W., Schweickert, W. D., Pun, B. T., et al. (2008). Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): A randomised controlled trial. Lancet, 371(9607), 126-134. https://doi.org/10.1016/S0140-6736(08)60105-1
  8. Hoffman, L. A., & Guttendorf, J. (2015). Post intensive care syndrome: Risk factors and prevention strategies. Critical Care Alert. Retrieved April 10, 2015, from http://www.ahcmedia.com/articles/134820-post-intensive-caresyndrome-risk-factors-and-prevention-strategies
  9. Hopkins, R. O., & Girard, T. D. (2013). Medical and economic implications of cognitive and psychiatric disability of survivorship. Seminars in Respiratory and Critical Care Medicine, 33(4), 348-356. https://doi.org/10.1055/s-0032-1321984
  10. Hopkins, R. O., Suchyta, M. R., Farrer, T. J., & Needham, D. (2012). Improving post-intensive care unit neuropsychiatric outcomes: Understanding cognitive effects of physical activity. American Review of Respiratory Disease, 186(12), 1220-1228. https://doi.org/10.1164/rccm.201206-1022CP
  11. Iwashyna, T. J. (2013). Post-intensive care syndrome: Improving the future of ICU patients. 42nd Critical Care Congress Review. Retrieved January 12, 2005, from http://www.sccm.org/SiteCollectionDocuments/CC-Iwahyna-June-2013.pdf.
  12. Kang, Y. W., Park, J. S., Yu, K. H., & Lee, B. C. (2009). A reliability validity, and normative study of the Korean-Montreal Cognitive Assessment (K-MoCA) as an instrument for screening of Vascular Cognitive Impairment (VCI). Korean Journal of Clinical Psychology, 28(2), 549-562. https://doi.org/10.15842/kjcp.2009.28.2.013
  13. Kim, B. R., Shim, M. J., Jang, S. B., & Lee, J. S. (2012). The influence of instrumental activities of daily living on the quality of life of cancer patients at a general hospital. Journal of Korean Society of Occupational Therapy, 20(3), 81-93.
  14. Maruish, M. E. (2012). User'manual for the SF-12 v2 Health Survey (3rd ed.). Lincoln, RI: QualityMetric Inc.
  15. Mehlhorn, J., Freytag, A., Schmidt, K., Brunkhorst, F. M., Graf, J., Troitzsch, U., et al. (2014). Rehabilitation interventions for post intensive care syndrome: A systematic review. Critical Care Medicine, 42(5), 1263-1271. https://doi.org/10.1097/CCM.0000000000000148
  16. Mikkelsen, M. E., Christie, J. D., Lanken, P. N., Biester, R. C., Thompson, B. T., & Bellamy, S, L. (2012). The adult respiratory distress syndrome cognitive outcomes study: Long-term neuropsychological function in survivors of acute lung injury. American Journal of Respiratory and Critical Care Medicine, 185(12), 1307-1315. https://doi.org/10.1164/rccm.201111-2025OC
  17. Ministry of Health and Welfare. (2013, May 3). 2012 dementia prevalence. Retrieved April 5, 2015, from http://www.mohw.go.kr/front_new/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&page=1&CONT_SEQ=286138&SEARCHKEY=TITLE&SEARCHVALUE=치매 유병률
  18. Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., & Collin, I., (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
  19. Needham, D. M., Dinglas, V. D., Morris, P. E., Jackson, J. C., Hough, C. L., Mendez-Tellez, P. A., et al. (2013). Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. EDEN trial follow-up. American Journal of Respiratory and Critical Care Medicine, 188(5), 567-576. https://doi.org/10.1164/rccm.201304-0651OC
  20. Oh, S. M., Min, K., & Park, D. (1999). A study on the standardization of the hospital anxiety and depression scale for Korean-A comparison of normal, depressed, and anxious groups. Journal of Neuropsychiatric Association, 38(2), 289-296.
  21. Pandharipande, P. P., Girard, T. D., Jackson, J. C., Morandi, A., Thompson, J. L., Pun, B., et al. (2013). Long-term cognitive impairment after critical illness. The New England Journal of Medicine, 369(14), 1306-1316. https://doi.org/10.1056/NEJMoa1301372
  22. Peris, A., Bonizzoli, M., Iozzell,i D., Migliaccio, M. L., Zagli, G., & Bacchereti, A. (2011). Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. Critical Care, 15(1), R41. https://doi.org/10.1186/cc10003
  23. Ryu, J. S., Lee, H. A., Lee, W. K., Kim, M. K., Min, J. W., Hong, Y. S., et al. (2014). The association of self-care behavior and the quality of life among outpatients with diabetes. Korean Journal of Family Practice, 4(2), 122-130.
  24. Soininen, P., Putkonen, H., Joffe, G., Korkeila, J., Puukka, P., Pit-kaen, A., et al. (2013). Does experienced seclusion or restraint affect psychiatric patients' subjective quality of life at discharge? International Journal of Mental Health System, 7(1), 28. https://doi.org/10.1186/1752-4458-7-28
  25. Song, H. S. (2012). Changes in symptom exprience, functional status and health related quality of life of survivors after intensive care units discharge: A 6 month-longitudinal study. Unpublished doctoral dissertation, Soonchunhyang University, Asan.
  26. Vest, M. T., Murphy, T. E., Araujo, K. L., & Pisani, M. A. (2011). Disability in activities of daily living, depression, and quality of life among older medical ICU survivors: A prospective cohort study. Health Quality of Life Outcomes, 9, 9. https://doi.org/10.1186/1477-7525-9-9
  27. Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220-233. https://doi.org/10.1097/00005650-199603000-00003
  28. Won, J. W., Rho, Y. G., Kim, S. Y., Lee, E. J., Yoon, J. L., Cho, K. H., et al. (2002). The development of Korean Activities of Daily Living(K-ADL) and Korean Instrumental Activities of Daily Living(K-IADL) Scale. Journal of the Korean Geriatrics Society, 6(2), 107-120.
  29. Zetterlund, P., Plos, K., Bergbom, I., & Ringdal, M. (2012). Memories from intensive care unit persist for several years-A longitudinal prospective multi-centre study. Intensive Critical Care Nursing, 28(3), 159-167. https://doi.org/10.1016/j.iccn.2011.11.010
  30. Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x