Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
School of Nursing, Yale University, New Haven, Connecticut; and.
Am J Respir Crit Care Med. 2023 Dec 1;208(11):1206-1215. doi: 10.1164/rccm.202304-0693OC.
Survivors of critical illness have multiple symptoms, but how restricting symptoms change after critical illness and whether these changes differ among vulnerable subgroups is unknown. To evaluate changes in restricting symptoms over the six months after critical illness among older adults and to determine whether these changes differ by sex, multimorbidity, and individual- and neighborhood-level socioeconomic disadvantage. From a prospective longitudinal study of 754 community-living adults ⩾70 years old interviewed monthly (1998-2018), we identified 233 admissions from 193 participants to the ICU. The occurrence of 15 restricting symptoms, defined as those leading to restricted activity, were ascertained during interviews in the month before ICU admission (baseline) and each of the six months after hospital discharge. The occurrence and number of restricting symptoms increased more than threefold in the six months after a critical illness hospitalization (adjusted rate ratio [95% confidence interval], 3.1 [2.1-4.6] and 3.3 [2.1-5.3], respectively), relative to baseline. These increases were largest in the first month after hospitalization (adjusted rate ratio [95% confidence interval], 5.3 [3.8-7.3] and 5.4 [3.9-7.5], respectively] before declining and becoming nonsignificant in the third month. Increases in restricting symptoms did not differ significantly by sex, multimorbidity, or individual- or neighborhood-level socioeconomic disadvantage. Restricting symptoms increase substantially after a critical illness before returning to baseline three months after hospital discharge. Our findings highlight the need to incorporate symptom management into post-ICU care and for further investigation into whether addressing restricting symptoms can improve quality of life and functional recovery among older ICU survivors.
危重病幸存者有多种症状，但危重病后限制症状如何变化以及这些变化是否在脆弱亚组之间存在差异尚不清楚。本研究旨在评估 754 名 ⩾70 岁的社区居住成年人在危重病后 6 个月内限制症状的变化，并确定这些变化是否因性别、多病共存和个体及邻里社会经济劣势而有所不同。本研究为前瞻性纵向研究，纳入了 193 名参与者，他们入住 ICU 前每月接受一次访谈（1998-2018 年）。我们共确定了 233 名参与者从普通病房转入 ICU。在 ICU 入院前（基线）和出院后每一个月，通过访谈确定了 15 种限制症状的发生情况，这些症状限制了活动。与基线相比，危重病住院后 6 个月内限制症状的发生和数量增加了两倍以上（调整后的发病比[95%置信区间]，3.1[2.1-4.6]和 3.3[2.1-5.3]）。住院后第一个月增加幅度最大（调整后的发病比[95%置信区间]，5.3[3.8-7.3]和 5.4[3.9-7.5]），然后逐渐下降，在第三个月时无统计学意义。限制症状的增加在性别、多病共存或个体及邻里社会经济劣势方面没有显著差异。危重病后限制症状显著增加，在出院后三个月恢复到基线。我们的研究结果强调了在 ICU 后护理中纳入症状管理的必要性，以及进一步研究解决限制症状是否可以改善 ICU 幸存者的生活质量和功能恢复。
