Muscedere John, Bagshaw Sean M, Boyd Gordon, Sibley Stephanie, Norman Patrick, Day Andrew, Hunt Miranda, Rolfson Darryl
Department of Critical Care Medicine, Queens University, Kingston Health Sciences Center, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
Department of Critical Care Medicine, University of Alberta, Edmonton, Canada.
Intensive Care Med Exp. 2022 Jun 10;10(1):23. doi: 10.1186/s40635-022-00446-7.
Frailty is common in critically ill patients and is associated with increased morbidity and mortality. There remains uncertainty as to the optimal method/timing of frailty assessment and the impact of care processes and adverse events on outcomes is unknown. We conducted a pilot study to inform on the conduct, design and feasibility of a multicenter study measuring frailty longitudinally during critical illness, care processes, occurrence of adverse events, and resultant outcomes.
Single-center pilot study enrolling patients over the age of 55 admitted to an Intensive Care Unit (ICU) for life-support interventions including mechanical ventilation, vasopressor therapy and/or renal replacement therapy. Frailty was measured on ICU admission and hospital discharge with the Clinical Frailty Scale (CFS), the Frailty Index (FI) and CFS at 6-month follow-up. Frailty was defined as CFS ≥ 5 and a FI ≥ 0.20. Processes of care and adverse events were measured during their ICU and hospital stay including nutritional support, mobility, nosocomial infections and delirium. ICU, hospital and 6 months were determined.
In 49 patients enrolled, the mean (SD) age was 68.7 ± 7.9 with a 6-month mortality of 29%. Enrollment was 1 patient/per week. Frailty was successfully measured at different time points during the patients stay/follow-up and varied by method/timing of assessment; by CFS and FI, respectively, in 17/49 (36%), 23/49 (47%) on admission, 22/33 (67%), 21/33 (63%) on hospital discharge and 11/30 (37%) had a CFS ≥ 5 at 6 months. Processes of care and adverse events were readily captured during the ICU and ward stay with the exception of ward nutritional data. ICU, hospital outcomes and follow-up outcomes were worse in those who were frail irrespective of ascertainment method. Pre-existing frailty remained static in survivors, but progressed in non-frail survivors.
In this pilot study, we demonstrate that frailty measurement in critically ill patients over the course and recovery of their illness is feasible, that processes of care and adverse events are readily captured, have developed the tools and obtained data necessary for the planning and conduct of a large multicenter trial studying the interaction between frailty and critical illness.
衰弱在危重症患者中很常见，且与发病率和死亡率增加相关。关于衰弱评估的最佳方法/时机仍存在不确定性，护理过程和不良事件对结局的影响尚不清楚。我们进行了一项试点研究，以了解一项多中心研究的实施、设计和可行性，该研究纵向测量危重症期间的衰弱、护理过程、不良事件的发生情况以及最终结局。
单中心试点研究，纳入年龄在55岁以上因生命支持干预措施（包括机械通气、血管活性药物治疗和/或肾脏替代治疗）入住重症监护病房（ICU）的患者。在ICU入院时、出院时以及6个月随访时使用临床衰弱量表（CFS）、衰弱指数（FI）测量衰弱情况。衰弱定义为CFS≥5且FI≥0.20。在患者的ICU和住院期间测量护理过程和不良事件，包括营养支持、活动能力、医院感染和谵妄。确定了ICU、住院和6个月时的情况。
在纳入的49例患者中，平均（标准差）年龄为68.7±7.9岁，6个月死亡率为29%。入组率为每周1例患者。在患者住院/随访期间的不同时间点成功测量了衰弱情况，且因评估方法/时间不同而有所差异；分别通过CFS和FI测量，入院时为17/49（36%）、23/49（47%），出院时为22/33（67%）、21/33（63%），6个月时11/30（37%）的CFS≥5。除病房营养数据外，在ICU和病房住院期间很容易获取护理过程和不良事件。无论确定方法如何，衰弱患者的ICU、住院结局和随访结局都更差。幸存者中既往存在的衰弱情况保持稳定，但非衰弱幸存者的衰弱情况有所进展。
在这项试点研究中，我们证明了在危重症患者疾病过程和康复过程中测量衰弱是可行的，护理过程和不良事件很容易获取，已经开发了工具并获得了规划和开展一项大型多中心试验所需的数据，该试验研究衰弱与危重症之间的相互作用。
