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A prospective longitudinal multicentre study of health related quality of life in ICU survivors with COPD
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Department of Anaesthesia and Intensive Care, Västervik County Hospital, Västervik, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Norrköping.
Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Intensive Care in Linköping. Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Department of Anaesthesia and Intensive Care, Ryhov Hospital, Jönköping,.
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2013 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 17, no 5, R211- p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Mortality amongst COPD patients treated on the ICU is high. Health-related quality of life (HRQL) after intensive care is a relevant concern for COPD patients, their families and providers of health care. Still, there are few HRQL studies after intensive care of this patient group. Our hypothesis was that HRQL of COPD patients treated on the ICU declines rapidly with time.

METHODS: Fifty-one COPD patients (COPD-ICU group) with an ICU stay longer than 24 hours received a questionnaire at 6, 12 and 24 months after discharge from ICU. HRQL was measured using two generic instruments: the EuroQoL instrument (EQ-5D and EQ-VAS) and the Short Form 36 Health Survey (SF-36). The results were compared to HRQL of two reference groups from the general population; an age- and sex-adjusted reference population (Non-COPD reference) and a reference group with COPD (COPD reference).

RESULTS: HRQL of the COPD-ICU group at 6 months after discharge from ICU was lower compared to the COPD reference group: Median EQ-5D was 0.66 vs. 0.73, P=0.08 and median EQ-VAS was 50 vs.55, P<0.05. There were no significant differences in the SF-36 dimensions between the COPD-ICU and COPD-reference groups, although the difference in physical functioning (PF) approached statistical significance (P=0.059). Patients in the COPD-ICU group who were lost to follow-up after 6 months had low HRQL scores at 6 months. Scores for patients who died were generally lower compared to patients who failed to respond to the questionnaire. The PF and social functioning (SF) scores in those who died were significantly lower compared to patients with a complete follow up. HRQL of patients in the COPD-ICU group that survived a complete 24 months follow up was low but stable with no statistically significant decline from 6 to 24 months after ICU discharge. Their HRQL at 24 months was not significantly different from HRQL in the COPD reference group.

CONCLUSIONS: HRQL in COPD survivors after intensive care was low but did not decline from 6 to 24 months after discharge from ICU. Furthermore, HRQL at 24 months was similar to patients with COPD who had not received ICU treatment.

Place, publisher, year, edition, pages
BioMed Central, 2013. Vol. 17, no 5, R211- p.
National Category
Clinical Medicine Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-100737DOI: 10.1186/cc13019ISI: 000331540900132PubMedID: 24063309OAI: oai:DiVA.org:liu-100737DiVA: diva2:663350
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Intensive care in chronic obstructive pulmonary disease: treatment with non-invasive ventilation and long-term outcome
Open this publication in new window or tab >>Intensive care in chronic obstructive pulmonary disease: treatment with non-invasive ventilation and long-term outcome
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. When we began this project our knowledge about the outcome of COPD patients admitted to the ICU in Sweden was scarce.

Aims: To investigate the characteristics, survival and health-related quality of life (HRQL) of COPD patients admitted to Swedish ICUs. To investigate how ICU personnel decide whether to use invasive or non-invasive ventilatory treatment (NIV) of the newly admitted COPD patient in need of ventilatory support. To investigate outcome according to mode of ventilation.

Material and methods: Detailed data, including HRQL during recovery, from COPD patients admitted to ICUs that participated in the Swedish intensive care registry were analysed. A questionnaire was distributed to personnel in 6 of the participating ICUs in order to define factors deemed important in making the choice between invasive and non-invasive ventilation immediately after admission. The answers were analysed.

Results: The proportion of COPD patients admitted to Swedish ICUs in need of ventilatory support is 1.3-1.6 % of all admissions. The patients are around 70 years-old and are severely ill on admission, with high respiratory rates and most have life-threatening disturbances in their acid-base balance and blood gases. There are more women than men. The short- and long-term mortality is high despite intensive care treatment. The majority of patients are treated with NIV. The length of stay on the ICU is shorter when NIV is used. The choice between NIV and invasive ventilation in these patients may be irrational. It is guided by current guidelines, but other non-patient-related factors seem to influence this decision. NIV seems to be preferable to invasive ventilation at admission, not only according to short-term benefits but also to long-term survival. Failure of NIV followed by invasive ventilation does not have a poorer prognosis than directly employing invasive ventilation. The health-related quality of life of COPD patients after treatment on Swedish ICUs is lower than in the general population. However it does not decline between 6 and 24 months after ICU discharge. After 24 months the HRQL is quite similar to that of COPD patients not treated on the ICU.

Conclusions: COPD patients in need of ventilatory support admitted to Swedish ICUs are severely ill on admission, and their short- and long-term mortality is high despite ICU care and ventilatory treatment. Non-invasive ventilation should be the first line treatment on admission. NIV has short- and long-term benefits compared to invasive ventilation, without increasing mortality risk in case of failure. After discharge from the ICU and recovery, the HRQL of COPD patients is lower than in the general population, but comparable to COPD patients not treated on the ICU.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 67 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1294
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-100738 (URN)10.3384/diss.diva-100738 (DOI)978-91-7519-959-7 (ISBN)
Public defence
2013-12-13, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
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Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2014-03-24Bibliographically approved

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Berkius, JohanOrwelius, LottiSjöberg, FolkeFredrikson, MatsWalther, Sten M

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Division of Cardiovascular MedicineFaculty of Health SciencesDepartment of Anaesthesiology and Intensive Care in NorrköpingDepartment of Anaesthesiology and Intensive Care in LinköpingDepartment of Clinical and Experimental MedicineDivision of Clinical SciencesDepartment of Hand and Plastic SurgeryDivision of Inflammation MedicineDepartment of Thoracic and Vascular SurgeryPhysiology
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