Venni Angelica, Ioia Francesca, Laviola Silvia, Frigieri Francesca, Pieri Alessandra, Marilli Simona, Balzi Daniela, Ballo Piercarlo, Gori Stefano, Guarducci Diletta
Department of Intensive Care, S. Maria Annunziata Hospital, Florence, Italy.
Department of Epidemiology, Local Health Authority, Florence, Italy.
Crit Care Res Pract. 2018 May 8;2018:3838962. doi: 10.1155/2018/3838962. eCollection 2018.
Postdischarge deterioration in health-related quality of life (HRQoL) is a major clinical issue for patients after an intensive care unit (ICU) hospitalization. A significant proportion of these patients is known to develop a progressive worsening of mental and physical performance-the so-called post-intensive care syndrome (PICS).
We aimed at exploring the effects of a structured program for the management of ICU patients, aimed at improving postdischarge HRQoL and reducing the risk of PICS.
A total of 159 patients hospitalized in our ICU with a length of stay >72 hours were enrolled in an institutional management protocol including specific recommendations: adequate sedation and analgesia protocols, to ensure a valid delirium prevention strategy, and to provide a planned midterm after discharge. The main endpoint was the occurrence of PICS at the 6-month follow-up visitation, defined as an abnormal physical or mental score in the SF-12 questionnaire in the presence of clinical evidence of new or worsening impairment in physical, cognitive, or mental health status. An additional questionnaire was administered, to assess the effects of ICU-related memories.
Most patients positively rated their health at the 6-month follow-up and had no significant impairment in physical or mental health status. The mean normalized values of the physical and mental component of the SF-12 score were 46 ± 11 and 48 ± 14, suggesting a normal physical and mental health status in most patients. Twenty-nine patients (18.2%) showed evidence of PICS. Similar good results were found by the questionnaire of memories. In multivariable analysis, no variable was found to predict the risk of PICS in our population.
In this real-world analysis that lacks a control group, patients who used a program aimed at minimizing the risk of HRQoL deterioration and PICS reported a good perception of their state of health with a relatively low prevalence of PICS.
重症监护病房（ICU）住院患者出院后健康相关生活质量（HRQoL）下降是一个主要的临床问题。已知这些患者中有很大一部分会出现精神和身体机能的逐渐恶化，即所谓的重症监护后综合征（PICS）。
我们旨在探讨一项针对ICU患者的结构化管理方案的效果，该方案旨在改善出院后的HRQoL并降低PICS风险。
共有159名在我们ICU住院时间超过72小时的患者纳入一项机构管理方案，该方案包括特定建议：适当的镇静和镇痛方案，以确保有效的谵妄预防策略，并在出院后提供有计划的中期随访。主要终点是在6个月随访时PICS的发生情况，定义为在存在身体、认知或心理健康状况新的或恶化损害的临床证据时，SF-12问卷中的身体或精神评分异常。还发放了一份额外的问卷，以评估与ICU相关记忆的影响。
大多数患者在6个月随访时对自己的健康状况给予积极评价，身体或心理健康状况无明显损害。SF-12评分的身体和精神成分的平均标准化值分别为46±11和48±14，表明大多数患者身体和心理健康状况正常。29名患者（18.2%）有PICS的证据。记忆问卷也得出了类似的良好结果。在多变量分析中，未发现任何变量可预测我们研究人群中PICS的风险。
在这项缺乏对照组的真实世界分析中，使用旨在将HRQoL恶化和PICS风险降至最低的方案的患者报告对自己的健康状况感觉良好，PICS患病率相对较低。
