Survival and Quality of Life after a Long-Term
Intensive Care Stay

Abstract

Objective: The growing number of high-risk patients in cardiac surgery unavoidably leads to more complications, and therefore to a prolonged stay in an intensive care unit (ICU). The aim of our investigation was to elaborate on the fate of patents after long-term ICU treatment. Methods: Out of 5055 patients, 232 had to be treated for longer than 5 days in ICU. These 232 patients were analyzed for in-hospital mortality and followed up for quality of life. The Barthel mobility index and geriatric depression scale by Sheikh and Yesavage were used to evaluate physical ability and mood disturbances. Follow-up time was 82 months, and could be completed for 99 % of the patents. Results: In-hospital mortality was 34.6 %, with the majority of cases being coronary artery bypass grafting procedures (59.9 %). Average stay in ICU was 12.0 days for the survivors and 17 days for non-survivors. During follow-up time (6 - 82 months), another 56 patients (23 %) died. Survivors (n = 98) were predominantly in NYHA classes l-ll (83 %) with a Barthel index of more than 80, representing adequate mobilization during daily life in 78 % of the patients. Results according to the geriatric depression scale were normal in the vast majority of patients (91 %) with severe or life threatening depressions in only 6 patients (8 %). Conclusion: Long-term treatment of critically ill patients is admittedly burdened with high in-hospital and follow-up mortality. However, the excellent physical and psychological recovery of survivors unequivocally supports the employment of all technical and personnel resources within modern intensive care medicine.

ICU stay - Cardiac surgery - Survival - Mortality - Barthel index - Quality of life

References

• 1 Bashour C A, Yared J-P, Ryan T A. Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care.  Crit Care Med. 2000;  12 ISO-IBS
• 2 Trouillet J.-L, Scheimberg A, Vuagnat A, Fagon J Y, Chastre J, Gibert C. Long-term outcome and quality of life patients requiring multodisciplinary intensive care unit asmission after cardiac operations.  J Thorac Cardiovasc Surg. 1994;  112 1132-1135
• 3 Lipsett P A, Swoboda S M, Dickerson J, Ylitalo M, Gordon T, Breslow M, Campbell K, Dorman T, Pronovost P, Rosenfeld B. Survival and Functional Outcome After Prolonged Intensive Care Unit Stay. Annals of Surgery Vol. 231, No. 2. Lippincott; Williams & Wilkins 2000: 262-268
• 4 Mahoney F I, Barthel D W. Functional evaluation: The Barthel Index.  Med J. 1965;  14 61-65
• 5 Yesavage J A, Brink T L, Rose T L, et al. Development and Validation of a geriatric depression screening scale a prelminiary report.  J Psychiatr Res. 1983;  17 37-49
• 6 Hammermeister K E, Sethi G K, Henderson W G, Oprian C, Kim T, Rahimtoola S A. Comparison of outcomes in men 11 years after heart-valve replacement with a mechanical valve or bioprosthesis. Veterans' Affairs Cooperative Study on Valvular Heart Disease.  N Engl J Med. 1993;  328 1289-1296
• 7 Yusuf S, Zucker D, Peduzzi P, Fisher L D, Takaro T, Kennedy J W, et al. Effect of coronary artery bypass graft surgery on survival overview of 10-year results from randomized trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration.  Lancet. 1994;  344 563-570
• 8 Parsonnet V, Dean D, Bernstein A D. A method of uniform stratification of risk for evaluating the results of surgery in acquired adult heart disease.  Circulation. 1989;  79 (6 Pt 2) 13-12
• 9 Weintraub W S, Jones E L, Graver J, Guyton R, Cohen C. Determinants of prolonged hospital stay after coronary bypass surgery.  Circulation. 1989;  80 276-284
• 10 Hannan E L, Kilburn H , O'Donnel J K, Lukaak G, Shields E P. Adult open heart surgery in New York state an analysis of risk factors and hospital mortality rates.  J Am Med Ass. 1990;  264 2768-2774
• 11 O'Connor G T, Plume S K, Olmstead E M, Coffin L H, Morton J R, Maloney C T, et al. Multivariate prediction of in-hospital mortality associated with coronary artery bypass graft surgery. Northern New England Cardiovascular Disease Study Group.  Circulation. 1992;  85 2110-2118
• 12 Hammermeister K E, Burchfiel C, Johnson R, Graver F L. Identification of patients at greatest risk for developing major complications at cardiac surgery.  Circulation. 1990;  82 (5 IV) 380-389
• 13 Higgins T L, Estrafanous F G, Loop F D, Beck G J, Blum J M, Parandi L. Stratification of morbidity and mortality outcome by preoperative risk factors in coronary artery bypass patients a clinical seventy score.  J Am Med Ass. 1992;  267 2344-2348
• 14 Tu J V, Jaglal S B, Naylor D, et al. Multicenter validation of risk index mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery.  Circulation. 1995;  91 677-684
• 15 Spicker J E, White D P. Outcome and function following prolonged mechanical ventilation.  Arch Intern Med. 1987;  147 421-425
• 16 Fakhry S M, Kercher K W, Rutledge R. Survival, quality of life and charges in critically ill surgical patients requiring prolonged ICU stays.  J Trauma. 1997;  41 999-1007
• 17 Higgins T L, Estafanous F G, Loop F D, et al. ICU admission score for predicting morbidity and mortality risk after coronary artery bypass grafting.  Ann Thorac Surg. 1997;  64 1050-1058
• 18 Knaus W A, Wagner D P, Draper E A, et al. The Apache III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.  Chest. 1991;  100 1619-1636
• 19 Chelluri L, Pinsky M R, Donahoe M P, Grenvik A. Long-term outcome of critically ill elderly patients requiring intensive care.  J Am Med Ass. 1993;  269 3119-3123
• 20 Stauffer J L, Fayter N A, Graves B, Cromb M, Lynch J C, Goebel P. Survival following mechanical ventilation for acute respiratory failure in adult men.  Chest. 1993;  104 1222-1229
• 21 Heyland D K, Konopad E, Noseworthly T W, Johnson R, Gafni A. Is it “Worthwhile” To Continue Treating Patients with a Prolonged Stay (> 14 Days) in the ICU?.  Chest. 1998;  1 114