Objectives: To examine the longer term functional outcomes of a general critical care population 6 months following critical care discharge. The aim of this study is to identify any possible deficits that these patients may have 6 months post critical care discharge. Patients discharged from critical care can show marked dysfunction both physically and mentally that can be present for a substantial period after their discharge from hospital. To date there is minimal research available on longer term outcomes for a heterogeneous critical care population.
Methods: All general critical care patients in St.James’s hospital Dublin, a large tertiary hospital were screened for participation. Patients were included if they had a critical care stay of greater than 3 days. Of these, 66 were excluded due to delirium, neurological reasons or were bed bound prior to admission. Forty five patients consented to study participation.
Following consent a measure of physical function (CPAx) was completed within 48 hours of critical care discharge on the ward (T1) along with patient’s demographic details such as critical care length of stay, mechanically ventilated, reason for admission, and presence of tracheostomy were recorded. At 6 months (T2) all participants were contacted to attend for follow up, n=11 (24%) attended for full battery of follow up testing ( repeat CPAx, measures of exercise capacity [6MWT], balance [berg balance scale], quality of life [SF-36] and sedentary activity [measure of older adult’s sedentary questionnaire- MOST]). Those who were unable to attend completed measure of older adult sedentary lifestyle questionnaire over the telephone, n= 9(20%).Results were analysed using SPSS and the wilcoxcon signed rank test, P < 0.05 inferred significance.
Results: Twenty nine (54.4%) males and sixteen (35.5%) females were recruited post critical care stay of greater than 3 days. The majority of participants were elective admissions (n= 22, 48.8%) with (n= 6, 13.4%) emergency and (n= 17, 37.8%) medical admissions. A significant increase occurred in CPAx scores at T2 versus T1 (p=0.005) and between actual and age predicted values for 6MWT at T2 (p= 0.003). Significant relationship was also found between the physical health component of the SF-36 (T2) and the CPAx at T1 (p= .032). Participants who passed away within 6 months of critical care discharge scored lower on the CPAx score at T1 which is associated with participants scoring high marks on the CPAx at T1 were discharged home with no rehab needs.
Conclusion: The study population was a general critical care population and was not limited to those who required mechanical ventilation. Using a measure of physical function such as CPAx at the transition stage from critical care may be able to identify future deficits. This study is the first to examine recovery of physical function in a heterogeneous critical care population and may be used as a guide for further research in the longer term outcomes of a general Critical Care population.
References: Corner, E.J., Wood, H., Englebretsen, C., Thomas, A., Grant, R.L., Nikoletou, D. and Soni, N.,( 2013). The Chelsea critical care physical assessment tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy, 99(1), pp.33-41.
Ethical approval was granted by SJH/AMNCH
