The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation Academic Article uri icon

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abstract

  • RATIONALE: Disability risk groups and 1-year outcome after greater than or equal to 7 days of mechanical ventilation (MV) in medical/surgical intensive care unit (ICU) patients are unknown and may inform education, prognostication, rehabilitation, and study design. OBJECTIVES: To stratify patients for post-ICU disability and recovery to 1 year after critical illness. METHODS: We evaluated a multicenter cohort of 391 medical/surgical ICU patients who received greater than or equal to 1 week of MV at 7 days and 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling. MEASUREMENTS AND MAIN RESULTS: The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to 1-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay. By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post-ICU healthcare use, and disposition. Patients less than 42 years with ICU length of stay less than 2 weeks had the best function and fewest deaths at 1 year compared with patients greater than 66 years with ICU length of stay greater than 2 weeks who sustained the worst disability and 40% 1-year mortality. Depressive symptoms (17%) and post-traumatic stress disorder (18%) persisted at 1 year. CONCLUSIONS: ICU survivors of greater than or equal to 1 week of MV may be stratified into four disability groups based on age and ICU length of stay. These groups determine 1-year recovery and healthcare use and are independent of admitting diagnosis and illness severity. Clinical trial registered with www.clinicaltrials.gov (NCT 00896220).

authors

  • Herridge, Margaret S
  • Chu, Leslie M
  • Matte, Andrea
  • Tomlinson, George
  • Chan, Linda
  • Thomas, Claire
  • Friedrich, Jan O
  • Mehta, Sangeeta
  • Lamontagne, Francois
  • Levasseur, Melanie
  • Ferguson, Niall D
  • Adhikari, Neill KJ
  • Rudkowski, Jill
  • Meggison, Hilary
  • Skrobik, Yoanna
  • Flannery, John
  • Bayley, Mark
  • Batt, Jane
  • Santos, Claudia dos
  • Abbey, Susan E
  • Tan, Adrienne
  • Lo, Vincent
  • Mathur, Sunita
  • Parotto, Matteo
  • Morris, Denise
  • Flockhart, Linda
  • Fan, Eddy
  • Lee, Christie M
  • Wilcox, M Elizabeth
  • Ayas, Najib
  • Choong, Karen Li-mei
  • Fowler, Robert
  • Scales, Damon C
  • Sinuff, Tasnim
  • Cuthbertson, Brian H
  • Rose, Louise
  • Robles, Priscila
  • Burns, Stacey
  • Cypel, Marcelo
  • Singer, Lianne
  • Chaparro, Cecelia
  • Chow, Chung-Wai
  • Keshavjee, Shafique
  • Brochard, Laurent
  • Hebert, Paul
  • Slutsky, Arthur S
  • Marshall, John C
  • Cook, Deborah
  • Cameron, Jill I

publication date

  • October 2016