Patients' recollections of experiences in the intensive care unit may affect their quality of life

Cristina Granja, Alice Lopes, Sara Moreira, Claudia Dias, Altamiro Costa-Pereira, António Carneiro, JMIP Study Group, Cristina Granja, Alice Lopes, Sara Moreira, Claudia Dias, Altamiro Costa-Pereira, António Carneiro, JMIP Study Group

Abstract

Introduction: We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL).

Methods: We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire.

Results: Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30).

Conclusion: This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL.

Figures

Figure 1
Figure 1
Patients included in and excluded from the study. Survival and recollection questionnaire response rates.

References

    1. Sukantarat KT, Brett S. The neuropsychological consequences of intensive care. In: Angus D, Carlet J, editor. Surviving Intensive Care Update in Intensive Care and Emergency Medicine. Vol. 39. Heidelberg: Springer; 2003. pp. 51–61.
    1. Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001;29:573–580. doi: 10.1097/00003246-200103000-00019.
    1. Eddleston JM, White P, Guthrie E. Survival, morbidity and quality of life after discharge from intensive care. Crit Care Med. 2000;28:2293–2299. doi: 10.1097/00003246-200007000-00018.
    1. Jackson JC, Hart RP, Gordon SM, Shintani A, Truman B, May L, Ely EW. Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med. 2003;31:1226–1234. doi: 10.1097/01.CCM.0000059996.30263.94.
    1. Hopkins RO, Weaver LK, Pope D, Orme JF, Jr, Bigler ED, Larson-Lohr V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999;160:50–56.
    1. Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Preub U, et al. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med. 1998;26:651–659. doi: 10.1097/00003246-199804000-00011.
    1. Turner JS, Briggs SJ, Springhorn HE, Potgieter PD. Patient's recollection of intensive care unit experience. Crit Care Med. 1990;18:966–968.
    1. Pennock BE, Crawshaw , Maher T, Price T, Kaplan PD. Distressful events in the ICU as perceived by patients recovering from coronary artery bypass surgery. Heart Lung. 1994;23:323–327.
    1. Rotondi AJ, Chelluri L, Sirio C, Mendelsohn A, Schulz R, Belle S, Im K, Doahoe M, Pinsky MR. Patient's recollection of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002;30:746–752. doi: 10.1097/00003246-200204000-00004.
    1. Fonte Pinto Novaes MA, Knobel E, Bork AM, Nogueira-Martins LA, Bosi Ferraz M. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med. 1999;25:1421–1426. doi: 10.1007/s001340051091.
    1. Granja C, Teixeira-Pinto A, Costa-Pereira A. Quality of life after intensive care – evaluation with EQ-5D. Intensive Care Med. 2002;28:898–907. doi: 10.1007/s00134-002-1345-z.
    1. Granja C, Cabral G, Teixeira-Pinto A, Costa-Pereira A. Quality of life 6 months after cardiac arrest. Resuscitation. 2002;55:37–44. doi: 10.1016/S0300-9572(02)00203-4.
    1. Granja C, Morujão E, Costa-Pereira A. Quality of life in acute respiratory distress syndrome may be no worst than in other ICU survivors. Intensive Care Med. 2003;29:1744–1750. doi: 10.1007/s00134-003-1808-x.
    1. Granja C, Dias C, Costa-Pereira A, Sarmento A. Quality of life of survivors from severe sepsis and septic shock may be similar to that of others who survive critical illness. Crit Care. 2004;8:R91–R98. doi: 10.1186/cc2818. (DOI 10.1186/cc2818).
    1. The EuroQol® Group EuroQol® – a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Brooks R, with the EuroQol Group EuroQol: the current state of play. Health Policy. 1996;37:53–72. doi: 10.1016/0168-8510(96)00822-6.
    1. Rivera Fernandez R, Sanchez Cruz JJ, Vazquez Mata G. Validation of a quality of life questionnaire for critically ill patients. Intensive Care Med. 1996;22:1034–1042. doi: 10.1007/s001340050209.
    1. Jones C. Acute psychological problems. In: Griffiths RD, Jones C, editor. Intensive Care Aftercare. Oxford: Butterworth-Heinemann; 2002. pp. 19–26.
    1. Skirrow P. Delusional memories of ICU. In: Griffiths RD, Jones C, editor. Intensive Care Aftercare. Oxford: Butterworth-Heinemann; 2002. pp. 27–35.
    1. Nunes B, Pais J, Garcia R, Duarte Z, Granja C, Silva MC. Cardiac arrest: long-term cognitive and imaging analysis. Resuscitation. 2003;57:287–297. doi: 10.1016/S0300-9572(03)00033-9.
    1. Kapfhammer HP, Rothenhausler HB, Krauseneck T, Stoll C, Schelling G. Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry. 2004;161:45–52. doi: 10.1176/appi.ajp.161.1.45.
    1. Jones C, Humphries G, Griffiths RD. Preliminary validation of the ICUM tool for assessing memory of the intensive care experience. Clin Intensive Care. 2000;11:251–253.
    1. Capuzzo M, Valpondi V, Cingolani E, De Luca S, Gianstefani G, Grassi L, Alvisi R. Application of the Italian version of the Intensive Care Unit Memory tool in the clinical setting. Crit Care. 2004;8:R48–R55. doi: 10.1186/cc2416.
    1. Van de Leur JP, Van der Schans CP, Loef BG, Deelman BG, Geertzen JHB, Zwaveling JH. Discomfort and factual recollection in intensive care unit patients. Crit Care. 2004;8:R467–R473. doi: 10.1186/cc2976.
    1. Sedation and Analgesia Task Force Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–141.

Source: PubMed

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