Egger Marion, Finsterhölzl Melanie, Farabegoli Daria, Wippenbeck Franziska, Schlutt Maria, Müller Friedemann, Huge Volker, Jahn Klaus, Bergmann Jeannine
Department of Neurology, Schoen Clinic Bad Aibling, Research Group, Kolbermoorer Strasse 72, 83043, Bad Aibling, Germany.
Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany.
Ann Intensive Care. 2024 Nov 26;14(1):175. doi: 10.1186/s13613-024-01396-x.
Critical illness survivors frequently suffer from long-term impairments, often described as post-intensive care syndrome (PICS). PICS encompasses physical, cognitive, and mental impairments. Additionally, the term intensive care unit (ICU)-acquired weakness (ICUAW) was coined for muscle weakness after critical illness. Research on the progression and outcome of individuals affected by PICS and ICUAW is scant. Thus we aimed to assess the health status and its progression during neurorehabilitation in critically ill patients using comprehensive outcome measures, describe the prevalence of PICS, and evaluate factors associated with rehabilitation outcomes.
Patients with mixed reasons for critical illness who received ≥ 5 days of mechanical ventilation on the ICU and who were admitted to neurorehabilitation, were eligible to be included in this prospective cohort study. A number of outcomes (patient-reported, clinician-reported, and performance) were assessed after discharge from the ICU (V1) and shortly before discharge from inpatient neurorehabilitation (V2). The prevalence of PICS, defined as having at least one impairment in any PICS dimension), was calculated at V1 and V2. Multiple logistic regressions were conducted to identify factors associated with rehabilitation outcome (poor outcome = modified Rankin Scale > 2) and ICUAW at V2 (MRC sum score < 48).
In total, 250 critical illness survivors (62 ± 14 years, 34% female, median stay on ICU 55 days, median inpatient rehabilitation 65 days) were included. 11 participants (4.4%) died before V2. All outcomes improved significantly during rehabilitation except sensory impairment and pain. PICS was present in 96% at V1 and in 85% at V2, whereby mainly the physical domain (V1: 87%, V2: 66%; ICUAW with MRC sum score < 48) and the cognitive domain (V1:65%, V2:55%; Montreal Cognitive Assessment < 26) were affected. Mental impairment was lower (V1:48%, V2:29%; Hospital Anxiety and Depression Scale > 7), but still affected a considerable number of participants. Accordingly, health-related quality of life was rather low at discharge (0.64 ± 0.28, index value of EQ-5D-5L). MRC sum score at V1, duration of mechanical ventilation, and female gender were significantly associated with a poor rehabilitation outcome. Grip strength in % of reference at V1, age, female gender, and comorbidities were significantly associated with persistent ICUAW at discharge.
Despite significant improvements during rehabilitation, survivors after critical illness experience a substantial burden of PICS and ICUAW at discharge from rehabilitation care. Survivors of critical illness require long-term follow-up, supportive structures, and tailored long-term multi-disciplinary therapies even after intensive rehabilitation.
German Clinical Trials Register, DRKS00021753. Registered 03 September, 2020. https://drks.de/search/en/trial/DRKS00021753 .
危重症幸存者常常遭受长期功能障碍，通常被描述为重症监护后综合征（PICS）。PICS包括身体、认知和精神方面的功能障碍。此外，“重症监护病房（ICU）获得性肌无力（ICUAW）”这一术语用于描述危重症后的肌肉无力。关于受PICS和ICUAW影响个体的病情进展和结局的研究很少。因此，我们旨在使用综合结局指标评估危重症患者神经康复期间的健康状况及其进展，描述PICS的患病率，并评估与康复结局相关的因素。
因各种原因导致危重症且在ICU接受≥5天机械通气并入住神经康复科的患者有资格纳入这项前瞻性队列研究。在从ICU出院时（V1）和住院神经康复即将出院前（V2）评估了多项结局指标（患者报告、临床医生报告和功能表现）。计算V1和V2时PICS的患病率，PICS定义为在任何PICS维度中至少有一种功能障碍。进行多因素逻辑回归以确定与康复结局（不良结局=改良Rankin量表>2）和V2时的ICUAW（医学研究委员会（MRC）总分<48）相关的因素。
共纳入250名危重症幸存者（62±14岁，34%为女性，在ICU的中位住院时间为55天，住院康复的中位时间为65天）。11名参与者（4.4%）在V2前死亡。除感觉障碍和疼痛外，所有结局指标在康复期间均有显著改善。V1时96%的患者存在PICS，V2时为85%，主要是身体领域（V1：87%，V2：66%；MRC总分<48的ICUAW）和认知领域（V1：65%，V2：55%；蒙特利尔认知评估<26）受到影响。精神障碍的比例较低（V1：48%，V2：29%；医院焦虑抑郁量表>7），但仍影响了相当数量的参与者。因此，出院时与健康相关的生活质量相当低（0.64±0.28，EQ-5D-5L指数值）。V1时的MRC总分、机械通气时间和女性性别与不良康复结局显著相关。V1时相对于参考值的握力、年龄、女性性别和合并症与出院时持续存在的ICUAW显著相关。
尽管在康复期间有显著改善，但危重症幸存者在康复护理出院时仍承受着PICS和ICUAW的沉重负担。危重症幸存者即使在强化康复后仍需要长期随访、支持性结构和量身定制的长期多学科治疗。
德国临床试验注册中心，DRKS00021753。2020年9月3日注册。https://drks.de/search/en/trial/DRKS00021753 。
