PURPOSE: To better describe the effect of ICU care on trajectories of functional, emotional, social, and physical well-being in patients with three common advanced illnesses.
METHODS: Patients with an ICU admission were identified from a cohort study of 210 patients with stage IV breast, prostate, or colon cancer; Stage IIIb or IV lung cancer; New York Heart Association Class III or IV CHF with a left ventricular ejection fraction of <40%; or COPD with hypercapnea (pC02>46). Functional Assessment of Chronic Illness Therapy-General survey subscales were measured monthly for six months before and after ICU admission and were analyzed using the ICU admission date as a point of discontinuous change in order to illustrate trajectories with means and slopes before and after the ICU visit.
RESULTS: Of the 42 patients included, only two died within six months after ICU discharge. In survivors, trajectories of all four well-being subscales sharply declined after ICU discharge. During the six months subsequent to ICU discharge, functional, physical, and emotional well-being scores trended back up to baseline while social well-being scores continued to decline. Individual trajectories of well-being after an ICU stay fall into three patterns of sharp decline with recovery, sharp decline with a new lower baseline, and continuous decline. These are illustrated through patient stories selected from the cohort.
CONCLUSIONS: Mortality is low after ICU admission in this population; however, well-being trajectories sharply decline after the ICU stay with overall recovery in the subsequent six months. Individual trajectories fall into three distinct, generalizable patterns.
CLINICAL IMPLICATIONS: These results help to better describe the impact of ICU care on patients with advanced chronic illness. Future research should focus on identifying risk factors for poor outcomes and variables that influence recovery trajectories in order to improve patient and surrogate counseling on potential long term sequelae of ICU care.
DISCLOSURE: The following authors have nothing to disclose: Jared Chiarchiaro, Maren Olsen, Karen Steinhauser, James Tulsky
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