| 1. |
- Orwelius, Lotti, 1956-
(author)
-
Health related quality of life in adult former intensive care unit patients
- 2009
-
Doctoral thesis (other academic/artistic)abstract
- Background: Patients treated in an intensive care unit (ICU) are seriously ill, have a high co‐morbidity, morbidity and mortality. ICUs are resource – demanding as they consume significant hospital resources for a minority of patients. The development of new medical procedures for critical care patients has over the years led to survival of larger numbers with more complex illnesses and extensive injuries. Improved survival rates lead to needs for outcome measures other than survival. The present study examines health‐related quality of life (HRQoL) and factors assumed to be important for the long term HRQoL for former ICU patients.Methods: This is a multicenter cohort study of 980 adult patients admitted to one of three mixed medical‐surgical ICUs in Southern Sweden, during 2000 to 2004. The patients were studied at four different occasions after their critical illness: 6, 12, 24, and 36 months after discharge from the ICU and hospital. HRQoL was assessed by the EuroQol 5‐Dimensions (EQ‐5D) and Medical Outcome Short Form (SF‐36), sleep disturbances by the Basic Nordic Sleep questionnaire (BNSQ), and pre‐existing diseases was collected by self‐reported disease diagnosis. Data from a large public health survey (n=6093) of the county population were used as reference group.Results: Compared with the age and sex adjusted general reference group the patients who had been in the ICU had significantly lower scores on EQ‐5D and in SF‐ 36 all eight dimensions. This was seen both for the general ICU patients as well as for the multiple trauma patients. Significant improvement over time was seen only in single and separate dimensions for the general ICU group, and for the multiple trauma group. Long term effects of ICU care on sleep patterns were found minor as 70 % reported an unchanged sleep pattern and only 9% reported worse sleep after the IC period. Pre‐existing diseases were found to be the factor that had the largest influence on HRQoL in both the short‐ and long term perspective for the general ICU patients as well as for the multiple trauma patients. It was also found to have negative impact on sleep. IC ‐related factors showed only a minor influence on HRQoL or sleep patterns after the ICU stay.Conclusions: This multicenter study shows that pre‐existing diseases influence the HRQoL short‐ and long‐term after IC, and it must be accounted for when HRQoL and outcome after IC are studied. Approximately, 50% of the decline in HRQoL for the ICU patients could be explained by pre‐existing diseases. Future research needs to focus on the remaining factors of importance for the total HRQoL impairment for these patients.
|
|
| 2. |
- Bäckman, Carl G
(author)
-
The photo-diary and follow-up appointment on the ICU: Giving back the time to patients and relatives. : A descriptive and interventional study
- 2011
-
Doctoral thesis (other academic/artistic)abstract
- Background: Patients on the ICU often spend a great deal of their time either unconscious or heavily sedated. When they return from the zone between life and death they are often in a state of confusion where dreams and delusions are intertwined with reality and it is not always easy to distinguish them apart. These experiences could lead to psychological problems and post-traumatic stress disorder (PTSD). Recovery may be improved by filling in the significant memory gaps and explaining what really happened during the “chaotic” time on the ICU. The provision of a diary describing the patients’ stay in ICU on a day to day basis and a follow-up meeting (together named the ICU-diary concept), may help the whole family to understand.Aim: The principal aim of this thesis was to see if the ICU-diary concept was of help to patients and relatives in the recovery after critical illness. A further aim was to look for precipitants in the ICU of PTSD.Material and Methods: ICU patients in a handful of European countries and their relatives have been studied. The studies have been single and multi-centred and we have used descriptive observational, randomised controlled and cohort study designs, including matched case-control designs. Quantitative methods have been used with questionnaires and structured interviews using established instruments (i.e Post-traumatic stress syndrome screening-14, Post-traumatic diagnostic scale, ICU memory tool, Short Form-36, Pearlin-Schooler Mastery Scale, Hopelessness scale) as the principal means of data collection.Results: The ICU-diary concept was seen to be a positive and useful aid in helping patients and their relatives understand the events that took place during the time on the ICU. It also decreased the risk for PTSD among patients and relatives. Patients that were supported with the ICU-diary concept perceived a better health-related quality of life even 3 years after the ICU stay. We did not find any definite improvement by the ICU-diary concept in mastery and hope. Variations in how the patients were cared for in the ICU had a significant effect on the development of PTSD. The implementation of an ICU diary, for instance, was associated with a lower frequency of PTSD.Conclusions: The ICU-diary concept was found helpful by patients and their relatives. It was associated with a reduction in new onset PTSD and improved health-related quality of life. The results are encouraging and suggest that an ICU diary may represent an important first step to help patients and relatives come to terms with their experiences during critical illness.ISBN 978-
|
|
