A long-term study of survivors of severe critical illness requiring stays in the intensive care unit (ICU) found that even those who were previously healthy, young, and working did not regain the physical or psychological health they had before their illness. The study entitled, “Functional Disability 5 Years after Acute Respiratory Distress Syndrome,” is published in the New England Journal of Medicine. This study is a follow-up to the “One-Year Outcomes in Survivors of Acute Respiratory Distress Syndrome” study published in 2003.

The study followed 64 surviving patients—86% of the patients from the first year follow-up study—throughout the 5 years after their ICU discharge. With an average age of 44, few had pre-existing conditions, and the vast majority were working prior to their critical illness. Patients were interviewed in person, examined, and tested in a follow-up clinic or in their homes as part of a home visit at regular intervals during the 5-year follow-up.

All the patients involved in the study had acute respiratory distress syndrome (ARDS). The researchers found that these patients remained in the ICU for about 26 days, and were ventilated for most of their stay. On average, they also spent an additional 49 days in the hospital. According to the researchers, this was the first time that former ICU patients with ARDS were followed systematically and in-person for such a lengthy time.

The study found that, generally, 5 years after discharge, these patients had not returned to normal physical functioning, notably in their ability to exercise and in the quality of life they had before their illness in the ICU. Their scores on general health and vitality were especially low. Some patients required further operations on their tracheas, while others had ongoing disabilities in their knees and elbows and some had new or recurrent airways disease. Others voiced concerns over scarring from lines, tubes, or tracheostomies inserted during their ICU treatment. Patients also reported hearing loss, stiff joints from immobility during the ICU stay, voice changes, tooth loss; one had parts of both feet amputated.

In terms of mental health, 51% of the patients reported at least one episode of physician-diagnosed depression, anxiety, or both; one patient suffered from post-traumatic stress disorder, and others from severe agitated depression and agoraphobia. One patient was afraid to go outside because of germs and the fear of possibly getting sick again. Substantial mental health challenges were also voiced by the patients’ families. Some 27% spoke about anxiety, depression, and post-traumatic stress disorder. Other problems included job loss and disputes over disability and insurance claims.

The study also found that while 77% of patients had returned to work at the 5-year follow-up, they often required a gradual transition to work, a modified work schedule, or job retraining with supporting justification and documentation from the research team. In addition, the costs reported for the patients with ARDS are higher than those incurred by healthy workers—more than $5,000 in comparison to $1,100 to $3,200 per year, closer to the costs among patients with chronic disease.

The researchers point out that these findings have public health ramifications as many of these patients are relatively young and were previously working, yet were unable to return to normal following one episode of ICU critical illness. The findings point to more difficulty in recovering from a critical illness for the aging baby boomer population with coexisting illness.

Source: University Health Network