Busico M, Intile D, Sívori M, Irastorza N, Alvarez A L, Quintana J, Vazquez L, Plotnikow G, Villarejo F, Desmery P
Unidad de Terapia Intensiva, Clínica Olivos SMG, Buenos Aires, Argentina.
Unidad de Terapia Intensiva, Sanatorio Anchorena, CABA, Argentina.
Med Intensiva. 2016 Oct;40(7):422-30. doi: 10.1016/j.medin.2016.01.002. Epub 2016 Mar 11.
To identify risk factors for worsened quality of life (QoL) and activities of daily living (ADL) at 3 and 12 months after discharge from the Intensive Care Unit (ICU) in patients on mechanical ventilation (MV).
A prospective, multicentric observational study was made.
Three ICUs in Argentina.
The study included a total of 84 out of 129 mainly clinical patients admitted between 2011-2012 and requiring over 24hours of MV.
No interventions were carried out.
Quality of life was assessed with the EQ-5D (version for Argentina), and ADL with the Barthel index.
The EQ-5D and Barthel scores were assessed upon admission to the ICU (baseline) and after three months and one year of follow-up. Comorbidities, delirium, ICU acquired weakness (ICUAW), and medication received were daily assessed during ICU stay. The baseline QoL of the global sample showed a median index of [0.831 (IQR25-75% 0.527-0.931)], versus [0.513 (IQR0.245-0.838)] after three months and [0.850 (IQR0.573-1.00)] after one year. Significant differences were observed compared with QoL in the Argentinean general population [mean 0.880 (CI 0.872-0.888), p<0.001; p<0.001; p0.002]. Individual analysis showed that 67% of the patients had worsened their QoL at three months, while 33% had recovered their QoL. In the multivariate analysis, the variables found to be independent predictors of worsened QoL were a hospital stay ≥21 days [OR 12.57 (2.75-57.47)], age ≥50 years [OR 5.61 (1.27-24.83)], previous poor QoL [OR 0.11 (0.02-0.54)] and persistent ICUAW [OR 8.32 (1.22-56.74)]. Similar results were found for the worsening of ADL.
Quality of life is altered after critical illness, and its recovery is gradual over time. Age, length of hospital stay, previous QoL and persistent ICUAW seem to be risk factors for worsened QoL.
确定机械通气（MV）患者在重症监护病房（ICU）出院后3个月和12个月时生活质量（QoL）恶化及日常生活活动（ADL）受影响的风险因素。
进行一项前瞻性、多中心观察性研究。
阿根廷的三个ICU。
该研究纳入了2011年至2012年间收治的129例主要为临床患者中的84例，这些患者需要接受超过24小时的MV治疗。
未实施干预。
使用EQ-5D（阿根廷版本）评估生活质量，使用Barthel指数评估ADL。
在入住ICU时（基线）以及随访3个月和1年后评估EQ-5D和Barthel评分。在ICU住院期间每天评估合并症、谵妄、ICU获得性肌无力（ICUAW）和所接受的药物治疗。总体样本的基线QoL显示中位数指数为[0.831（IQR25 - 75% 0.527 - 0.931）]，3个月后为[0.513（IQR0.245 - 0.838）]，1年后为[0.850（IQR0.573 - 1.00）]。与阿根廷普通人群的QoL相比观察到显著差异[均值0.880（CI 0.872 - 0.888），p<0.001；p<0.001；p0.002]。个体分析显示,67%的患者在3个月时QoL恶化，而33%的患者QoL恢复。在多变量分析中，被发现是QoL恶化独立预测因素的变量为住院时间≥21天[OR 12.57（2.75 - 57.47）]、年龄≥50岁[OR 5.61（1.27 - 24.83）]、既往QoL差[OR 0.11（0.02 - 0.54）]和持续性ICUAW[OR 8.32（1.22 - 56.74）]。ADL恶化也发现了类似结果。
危重病后生活质量会发生改变，且其恢复是随时间逐渐进行的。年龄、住院时间、既往QoL和持续性ICUAW似乎是QoL恶化的风险因素。
