Self-reported physical symptoms in intensive care unit (ICU) survivors: pilot exploration over four months post-ICU discharge

Abstract

Context: Survivors of critical illness must overcome persistent physical and psychological challenges. Few studies have longitudinally examined self-reported physical symptoms in intensive care unit (ICU) survivors.

Objectives: To describe prevalence and severity of self-reported symptoms in 28 adult medical ICU survivors during the first four months post-ICU discharge and their associations with family caregiver responses.

Methods: Patients completed the Modified Given Symptom Assessment Scale. Caregivers completed the Shortened 10-item Center for Epidemiologic Studies Depression Scale, Brief Zarit Burden Score, Pittsburgh Sleep Quality Index, and the Caregiver Health Behavior form. Data at ICU discharge (two weeks or less), and two and four months post-ICU discharge were analyzed.

Results: Across the time points, most patients reported one or more symptoms (88.5-97%), with sleep disturbance, fatigue, weakness, and pain the most prevalent. For these four symptoms with the highest prevalence, there were: 1) moderate correlations among symptom severity at two and four months post-ICU discharge; and 2) no difference in prevalence or severity by patients' disposition (home vs. institution), except worse fatigue in patients at home at two weeks or less post-ICU discharge. Patients' overall symptom burden showed significant correlation with caregivers' depressive symptoms two weeks or less post-ICU discharge. There were trends of moderate correlations between patients' overall symptom burden and caregivers' health risk behaviors and sleep quality at two and four months post-ICU discharge.

Conclusion: In our sample, sleep disturbance, fatigue, weakness, and pain were the four key symptoms during first four months post-ICU discharge. Future studies focusing on these four symptoms are necessary to promote quality in post-ICU symptom management.

Keywords: ICU; Intensive care unit; caregivers; critical illness; fatigue; pain; sleep; weakness.

Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Participants Enrollment and Follow-Up Participant enrollment occurred between November 2008 and July 2010 (over 21 months). In 19 dyads who refused, reasons for refusal include: “too busy” (n=10, 53%), “feel stressed” (n=4, 21%), “other family members disagree” (n=2, 10.5%), “not interested” (n=2, 10.5%), and “not feel comfortable” (n=1, 5%).

Figure 2

Proportion of the patients by the number of symptoms present at each time point following ICU discharge.

Figure 3

Severity Scores of Four Symptoms for Four Months Post-ICU Discharge