Ferrante Lauren E, Pisani Margaret A, Murphy Terrence E, Gahbauer Evelyne A, Leo-Summers Linda S, Gill Thomas M
1 Section of Pulmonary, Critical Care, and Sleep Medicine and.
2 Section of Geriatrics, Department of Medicine, Yale School of Medicine, New Haven, Connecticut.
Am J Respir Crit Care Med. 2016 Aug 1;194(3):299-307. doi: 10.1164/rccm.201506-1256OC.
Most of the 1.4 million older adults who survive the intensive care unit (ICU) annually in the United States face increased disability, but little is known about those who achieve functional recovery.
Our objectives were twofold: to evaluate the incidence and time to recovery of premorbid function within 6 months of a critical illness and to identify independent predictors of functional recovery among older ICU survivors.
Potential participants included 754 persons aged 70 years or older who were evaluated monthly in 13 functional activities (1998-2012). The analytic sample included 218 ICU admissions from 186 ICU survivors. Functional recovery was defined as returning to a disability count less than or equal to the pre-ICU disability count within 6 months. Twenty-one potential predictors were evaluated for their associations with recovery.
Functional recovery was observed for 114 (52.3%) of the 218 admissions. In multivariable analysis, higher body mass index (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12) and greater functional self-efficacy (HR, 1.05; 95% CI, 1.02-1.08), a measure of confidence in performing various activities, were associated with recovery, whereas pre-ICU impairment in hearing (HR, 0.38; 95% CI, 0.22-0.66) and vision (HR, 0.59; 95% CI, 0.37-0.95) were associated with a lack of recovery.
Among older adults who survived an ICU admission with increased disability, pre-ICU hearing and vision impairment were strongly associated with poor functional recovery within 6 months, whereas higher body mass index and functional self-efficacy were associated with recovery. Future research is needed to evaluate whether interventions targeting these factors improve functional outcomes among older ICU survivors.
在美国，每年有140万在重症监护病房（ICU）存活下来的老年人面临残疾增加的问题，但对于那些实现功能恢复的人了解甚少。
我们的目标有两个：评估危重病6个月内病前功能恢复的发生率和时间，并确定老年ICU幸存者中功能恢复的独立预测因素。
潜在参与者包括754名70岁及以上的人，他们在13项功能活动中每月接受评估（1998 - 2012年）。分析样本包括来自186名ICU幸存者的218次ICU入院。功能恢复定义为在6个月内残疾计数恢复到小于或等于ICU入院前的残疾计数。评估了21个潜在预测因素与恢复的关联。
218次入院中有114次（52.3%）观察到功能恢复。在多变量分析中，较高的体重指数（风险比[HR]，1.07；95%置信区间[CI]，1.03 - 1.12）和更高的功能自我效能感（HR，1.05；95% CI，1.02 - 1.08），一种对进行各种活动的信心的衡量指标，与恢复相关，而ICU入院前听力受损（HR，0.38；95% CI，0.22 - 0.66）和视力受损（HR，0.59；95% CI，0.37 - 0.95）与未恢复相关。
在残疾增加的ICU入院存活的老年人中，ICU入院前的听力和视力受损与6个月内功能恢复不良密切相关，而较高的体重指数和功能自我效能感与恢复相关。需要未来的研究来评估针对这些因素的干预措施是否能改善老年ICU幸存者的功能结局。
