Reidar Kvåle

Quality of life 2-7 years after major trauma.

Background: The aim of the present study was to assess potential long‐term reduction in health‐related quality of life (HRQOL) in adult trauma patients 2–7 years after discharge from an intensive care unit (ICU), and to study possible determinants of the HRQOL reduction.

Multiple organ failure after trauma affects even long-term survival and functional status

BackgroundThe aim of this study was to assess the incidence of organ failure in trauma patients treated in an intensive care unit (ICU), and to study the relationship between organ failure and long-term survival and functional status.MethodsThis is a cohort study of all adult ICU trauma patients admitted to a university hospital during 1998 to 2003. Organ failure was quantified by the Sequential Organ Failure Assessment (SOFA) score. A telephone interview was conducted in 2005 (2 to 7 years after trauma) using the Karnofsky Index to measure functional status, and the Glasgow Outcome Score to measure recovery.ResultsOf the 322 patients included, 47% had multiple organ failure (MOF), and 28% had single organ failure. In a Cox regression, MOF increased the overall risk of death 6.0 times. At follow-up, 242 patients (75%) were still alive. Patients with MOF had 3.9 times greater odds for requiring personal assistance in activities of daily living compared to patients without organ failure. Long-term survival and functional status were the same for patients suffering single organ failure and no organ failure. Complete recovery occurred in 52% of survivors, and 87% were able to look after themselves.ConclusionAlmost half of the ICU trauma patients had MOF. While single organ failure had no impact on long-term outcomes, the presence of MOF greatly increased mortality and the risk of impaired functional status. MOF expressed by SOFA score may be used to define trauma patients at particular risk for poor long-term outcomes.

Follow-up after intensive care: a single center study

Objectives To study health problems, quality of life, functional status, and memory after intensive care.Setting Adult patients (n=346) discharged from a university hospital ICU.Design and methods Prospective cohort study. Follow-up patients were found using the ICU database and the Peoples Registry. Quality of life (QOL) was measured with the Short Form 36 (SF-36) 6 months after ICU discharge. Semi-structured interviews, questionnaires, Glasgow Outcome Score (recovery), and Karnofsky Index (functional status) were used at consultations 7–8 months after ICU discharge.Results The SF-36 response rate was 64.5%, with scores significantly lower than population scores. Consultation patients (n=136) did not differ from the rest (n=210) regarding age, SAPS II scores, length of stay (LOS), and reasons for ICU admission. At follow-up 67.6% of consultation patients continued most activities, 75% looked after themselves, and 64.7% were non-workers, compared to 40.4% before the ICU admission. During and after the ICU stay, 40% lost more than 10 kg body weight. Fifty-eight (43%) could not remember anything from their ICU stay. At follow-up only 22 (16%) could remember having received information during their ICU stay. Three patients needed referral to other specialities.Conclusions We should focus more on optimizing symptom management and giving repeated information after ICU discharge. Nutritional status and weight loss is another area of concern. More research is needed to find out how the broad range of psychosocial and physical problems following an ICU stay relates to the stay.

Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia

Background: Evidence‐based treatment protocols including therapeutic hypothermia have increased hospital survival to over 50% in unconscious out‐of‐hospital cardiac arrest survivors. In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest groups level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health‐related quality of life (HRQOL).

Changes in health-related quality of life from 6 months to 2 years after discharge from intensive care.

BackgroundIntensive care patients have, both before and after the ICU stay, a health-related quality of life (HRQOL) that differs from that of the normal population. Studies have described changes in HRQOL in the period from before the ICU stay and up to 12 months after. The aim of this study was to investigate possible longitudinal changes in HRQOL in adult patients (>18 years) from 6 months to 2 years after discharge from a general, mixed intensive care unit (ICU) in a university hospital.MethodsThis is a prospective cohort study. Follow-up patients were found using the ICU database and the Peoples Registry. HRQOL was measured with the Short Form 36 (SF-36) questionnaire. Answers at 6 months and 2 years were compared for all patients, surgical and medical patients, and different admission cohorts.Differences are presented with 95% confidence intervals. The SF-36 data were scored according to designed equations. SPSS 11.0 was used to perform t-tests and Mann-Whitney tests.ResultsA total of 100 patients (26 medical and 74 surgical) answered the SF-36 after 6 months and again after 2 years. There was overall moderate improvement in 6 out of 8 dimensions of the SF-36, and the average increase in score was + 4.0 for all 8 dimensions. The changes for surgical and medical patients were similar. Neurological and respiratory patients reported increased average HRQOL scores, while cardiovascular patients did not. Patients with worsening of scores from 6 months to 2 years were insignificantly older than patients with improved scores (55.3 vs. 49.7 years), and both groups had comparable severity scores (simplified acute physiology score, SAPS II, 37.2 vs. 36.3) and length of ICU stay (2.7 vs. 3.2 days). The statistically significant changes in HRQOL (in the Role Physical and Social Functioning dimensions) were, due to sample size, barely clinically relevant.ConclusionIn a mixed ICU population we found moderate increases in HRQOL both for medical and surgical patients from 6 months to 2 years after ICU discharge, but the sample size is a limitation in this study.

Impact of the post‐World War II generation on intensive care needs in Norway

Background: A high birth rate during the first two decades following World War II has increased the proportion of elderly people in present‐day society and, consequently, the demand for health‐care services. The impact on intensive care services may become dramatic because the age distribution of critically ill patients is skewed towards the elderly. We have used registry data and population statistics to forecast the demand for intensive care services in Norway up until the year 2025.

Cognitive impairments after critical illness

Cognitive impairments are common after critical illness. Aetiology and effects of cognitive impairments in this setting are not fully revealed. The aim of this study was to investigate the effect of critical illness and intensive care unit (ICU) treatment on cerebral function.

Long-term survival and quality of life after intensive care for patients 80 years of age or older

BackgroundComparison of survival and quality of life in a mixed ICU population of patients 80 years of age or older with a matched segment of the general population.MethodsWe retrospectively analyzed survival of ICU patients ≥80 years admitted to the Haukeland University Hospital in 2000–2012. We prospectively used the EuroQol-5D to compare the health-related quality of life (HRQOL) between survivors at follow-up and an age- and gender-matched general population. Follow-up was 1–13.8 years.ResultsThe included 395 patients (mean age 83.8 years, 61.0 % males) showed an overall survival of 75.9 (ICU), 59.5 (hospital), and 42.0 % 1 year after the ICU. High ICU mortality was predicted by age, mechanical ventilator support, SAPS II, maximum SOFA, and multitrauma with head injury. High hospital mortality was predicted by an unplanned surgical admission. One-year mortality was predicted by respiratory failure and isolated head injury. We found no differences in HRQOL at follow-up between survivors (n = 58) and control subjects (n = 179) or between admission categories. Of the ICU non-survivors, 63.2 % died within 2 days after ICU admission (n = 60), and 68.3 % of these had life-sustaining treatment (LST) limitations. LST limitations were applied for 71.3 % (n = 114) of the hospital non-survivors (ICU 70.5 % (n = 67); post-ICU 72.3 % (n = 47)).ConclusionsOverall 1-year survival was 42.0 %. Survival rates beyond that were comparable to those of the general octogenarian population. Among survivors at follow-up, HRQOL was comparable to that of the age- and sex-matched general population. Patients admitted for planned surgery had better short- and long-term survival rates than those admitted for medical reasons or unplanned surgery for 3 years after ICU admittance. The majority of the ICU non-survivors died within 2 days, and most of these had LST limitation decisions.

Do elderly intensive care unit patients receive less intensive care treatment and have higher mortality

The number of elderly (≥ 80 years) will increase markedly in Norway over the next 20 years, increasing the demand for health‐care services, including intensive care. The aims of this study were to see if intensive care unit (ICU) resource use and survival are different for elderly ICU patients than for younger adult ICU patients.

Scandinavian clinical practice guideline on choice of fluid in resuscitation of critically ill patients with acute circulatory failure

The task force on Acute Circulatory Failure of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine produced this guideline with recommendations concerning the use of crystalloid vs. colloid solutions in adult critically ill patients with acute circulatory failure.