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Study of outcomes of intensive care

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Marsden, KM (2014) Study of outcomes of intensive care. PhD thesis, University of Tasmania.

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Abstract

Many studies show long-term outcome following critical illness involves reduced physical
function, increased psychological symptoms, neuropsychological impairment and reduced
quality of life compared with population norms. It is assumed these are a direct
consequence of critical illness and critical care therapies.
The STudy of Outcomes of Intensive Care (STOIC) was designed to compare the long-term
functional, neuropsychological and psychosocial recovery of intensive care unit {ICU)
survivors (ICU patients) with non-intensive care, acute-care hospitalised controls. Secondary
aims include identifying variables which predict outcome (for ICU patients only) at two years
after ICU discharge.
Seventy-one survivors from two mixed medical-surgicaiiCU populations and seventy-two
age- sex- matched non-ICU acute-care hospitalised controls, (selected from same hospital
populations) were consecutively recruited at unit discharge. A broad test-battery
incorporating standardised objective and subjective tests to measure functional,
psychosocial, neuropsychological impairment together with patient self-report was used at
six timepoints, across a two year period. Face-to-face, semi-structured interviews were
conducted.
Data was analysed using mixed model regression. Thematic analysis drew subject themes
from patient narratives. Pearson correlations were calculated to inform selection of variables
for outcome prediction.
Preadmission scores reflect a state of chronic disability for both ICU patients and controls.
Neither group reach complete functional independence during the study period. High levels
of functional impairment are seen among controls, ranging between 56 - 85%. At two years
following discharge mean functional test scores for both groups remain below preadmission
levels.
Comparatively, ICU patients display lower levels of community integration throughout the
study period.
There were no cases of Post-Traumatic Stress Disorder identified with both groups displaying
low levels of anxiety and depression. Neuropsychologically, neither group achieved scores in
the normative average range. A higher proportion of the ICU group were cognitively
impaired at each time point. At two years following discharge, 21% of ICU patients and 16%
of controls remain impaired in verbat working memory. Several baseline variables were
strongly correlated with impairment and mortality two years after unit discharge. Significant
predictors include years of education, Mini Mental State Examination, Community
Integration Questionnaire, Functional Independence Measure, and Charlson Age
Comorbidity Index.
This study unexpectedly uncovers high levels of impairment for a non-ICU acute-care
hospital population which have not previously been acknowledged whilst also demonstrating
a correlation of high impairment among ICU patients. Baseline variables are capable of
predicting clinically relevant outcomes two years after discharge. Clinicians, patients and
carers are benefited with the research of this paper, to be further informed of the possible
after-effects associated with treatment for critical illness.

Item Type: Thesis (PhD)
Keywords: critical illness, outcomes, quality of life, psychological morbidity
Copyright Information:

Copyright 2014 the Author

Date Deposited: 20 Apr 2015 05:48
Last Modified: 11 Nov 2016 16:00
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