Li Ronghua, Zhou Ying, Liu Xiaoqing, Huang Jingye, Chen Lihua, Zhang Huijin, Li Yimin
School of Nursing, Guangzhou Medical University, Guangzhou, China.
Department of Critical Care Medicine, Guangzhou Institute of Respiratory Health, The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2021 Mar;13(3):1564-1575. doi: 10.21037/jtd-20-2622.
Critical illness is associated with cognitive, physical, and psychological impairments; however, evidence of the severity and frequency of impairments in Chinese survivors of mechanical ventilation in an intensive care unit (ICU) remains limited. Our aim was to investigate the incidence and severity of impairments in Chinese survivors of mechanical ventilation in ICU and to explore risk factors influencing specific impairments.
Patients discharged alive after mechanical ventilation in a large general ICU for ≥2 days were enrolled in this single-center cross-sectional study. Survivors were evaluated using measures of functional disability (Activity of Daily Living Scale), and post-traumatic stress disorder (PTSD, The Impact of Event Scale-Revised) via telephone interview. Multivariable analysis was conducted.
Data were obtained from 130 consenting survivors. At follow-up (mean: 19.64 months), among those in part-time or full-time employment prior to admission, only 45.1% had returned to work. Further, 29.2% of survivors had clear disabilities affecting daily living. Deficits in activities of daily living (ADL) were mainly characterized by impairment of instrumental ADL. Predictors of ADL in mechanically ventilated survivors included age, ICU admission diagnosis, and Acute Physiology And Chronic Health Evaluation II (APACHE II) score, which accounted for 33.5% of total variance. Furthermore, 17.7% of participants had symptoms consistent with PTSD. ICU length of stay was the only predictor of PTSD, and accounted for 7.5% of total variance.
ICU survivors of mechanical ventilation in China face negative impacts on employment, and commonly have ADL impairment and PTSD. Age, ICU admission diagnosis, and APACHE II score were key factors influencing ADL, while ICU length of stay was the only factor affecting PTSD. These findings suggest that some survivors who have had certain exposures may warrant closer follow-up, and systematic interventions for these high-risk survivors should be developed in China.
危重病与认知、身体和心理障碍有关；然而，在中国重症监护病房（ICU）接受机械通气的幸存者中，关于障碍的严重程度和频率的证据仍然有限。我们的目的是调查中国ICU机械通气幸存者中障碍的发生率和严重程度，并探索影响特定障碍的危险因素。
在一家大型综合ICU接受机械通气≥2天且存活出院的患者纳入了这项单中心横断面研究。通过电话访谈，使用功能残疾测量方法（日常生活活动量表）和创伤后应激障碍（PTSD，事件影响量表修订版）对幸存者进行评估。进行了多变量分析。
从130名同意参与的幸存者中获得了数据。在随访时（平均：19.64个月），入院前有兼职或全职工作的幸存者中，只有45.1%恢复了工作。此外，29.2%的幸存者有明显影响日常生活的残疾。日常生活活动（ADL）缺陷主要表现为工具性ADL受损。机械通气幸存者ADL的预测因素包括年龄、ICU入院诊断和急性生理与慢性健康评估II（APACHE II）评分，这三者占总方差的33.5%。此外，17.7%的参与者有与PTSD一致的症状。ICU住院时间是PTSD的唯一预测因素，占总方差的7.5%。
中国ICU机械通气幸存者面临就业方面的负面影响，且普遍存在ADL受损和PTSD。年龄、ICU入院诊断和APACHE II评分是影响ADL的关键因素，而ICU住院时间是影响PTSD的唯一因素。这些发现表明，一些有特定暴露经历的幸存者可能需要更密切的随访，并且在中国应为这些高危幸存者制定系统的干预措施。
