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Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness*

Marra, Annachiara, MD, PhD1,2; Pandharipande, Pratik P., MD, MSCI3; Girard, Timothy D., MD, MSCI4; Patel, Mayur B., MD, MPH5; Hughes, Christopher G., MD3; Jackson, James C., PsyD1,6,7,8; Thompson, Jennifer L., MPH9; Chandrasekhar, Rameela, MA, PhD9; Ely, Eugene Wesley, MD, MPH1,6,10,11; Brummel, Nathan E., MD, MSCI1,6,11

doi: 10.1097/CCM.0000000000003218
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Objectives: To describe the frequency of co-occurring newly acquired cognitive impairment, disability in activities of daily livings, and depression among survivors of a critical illness and to evaluate predictors of being free of post-intensive care syndrome problems.

Design: Prospective cohort study.

Setting: Medical and surgical ICUs from five U.S. centers.

Patients: Patients with respiratory failure or shock, excluding those with preexisting cognitive impairment or disability in activities of daily livings.

Interventions: None.

Measurements and Main Results: At 3 and 12 months after hospital discharge, we assessed patients for cognitive impairment, disability, and depression. We categorized patients into eight groups reflecting combinations of cognitive, disability, and mental health problems. Using multivariable logistic regression, we modeled the association between age, education, frailty, durations of mechanical ventilation, delirium, and severe sepsis with the odds of being post-intensive care syndrome free. We analyzed 406 patients with a median age of 61 years and an Acute Physiology and Chronic Health Evaluation II of 23. At 3 and 12 months, one or more post-intensive care syndrome problems were present in 64% and 56%, respectively. Nevertheless, co-occurring post-intensive care syndrome problems (i.e., in two or more domains) were present in 25% at 3 months and 21% at 12 months. Post-intensive care syndrome problems in all three domains were present in only 6% at 3 months and 4% at 12 months. More years of education was associated with greater odds of being post-intensive care syndrome free (p < 0.001 at 3 and 12 mo). More severe frailty was associated with lower odds of being post-intensive care syndrome free (p = 0.005 at 3 mo and p = 0.048 at 12 mo).

Conclusions: In this multicenter cohort study, one or more post-intensive care syndrome problems were present in the majority of survivors, but co-occurring problems were present in only one out of four. Education was protective from post-intensive care syndrome problems and frailty predictive of the development of post-intensive care syndrome problems. Future studies are needed to understand better the heterogeneous subtypes of post-intensive care syndrome and to identify modifiable risk factors.

1Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

2Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples, Federico II, Naples, Italy.

3Division of Anesthesia Critical Care Medicine, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN.

4Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

5Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Departments of Surgery, Neurosurgery, and Hearing & Speech Sciences, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.

6Center for Health Services Research, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

7Department of Psychiatry, Vanderbilt Medical Center, Nashville, TN.

8Research Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

9Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.

10Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.

11Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.

*See also p. 1551.

This work was performed at the Vanderbilt University Medical Center, Nashville, TN; Saint Thomas Hospital, Nashville, TN; Department of Veterans Affairs Medical Center, Tennessee Valley Healthsystem, Nashville, TN; Veterans Affairs Puget Sound Health Care System, Seattle, WA; and George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT.

The contents of this article are solely the responsibility of the authors and do not necessarily represent those of the Department of Veterans Affairs, the National Institutes of Health, or Vanderbilt University Medical Center.

Drs. Marra and Brummel had full access to all study data, take responsibility for the integrity of the data and the accuracy of the data analysis. Drs. Marra, Pandharipande, Girard, Ely, and Brummel designed and conducted the study. Drs. Thompson and Chandrasekhar contributed to statistical analysis. Drs. Marra and Brummel drafted the article. Drs. Pandharipande, Girard, Ely, and Brummel obtained funding. All authors contributed to data acquisition, analysis, and interpretation of the data; critical revision of the article for important intellectual content; and final approval of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Department of Veterans Affairs Tennessee Valley Health Care System Geriatric Research, Education, and Clinical Center and VA-MERIT, the National Institutes of Health under awards (K76AG054864, R01AG027472, KL2TR000446, R03AG040549, R01AG035117, R01HL111111, R01GM120484) and the Doris Duke Foundation.

Drs. Pandharipande, Girard, Patel, Hughes, Jackson, Ely, and Brummel received support for article research from the National Institutes of Health (NIH). Dr. Pandharipande received other support from a research grant from Hospira in collaboration with the NIH. Dr. Girard’s institution received funding from NIH AG034257 and NIH HL135144. Dr. Ely received honoraria from NIH and VA funding, and he received funding from Orion Pharma, Pfizer, and Abbott Laboratories for continuing medical education activities. Dr. Brummel received an honorarium from ArjoHuntleigh for advisory board activities. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: nathan.brummel@vanderbilt.edu

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