"This is the first time we have understood in detail what happens to patients after they leave the intensive care unit. It is encouraging to us as critical care physicians to know that so many people regain good function, especially given how severe their illness was while we were treating them in hospital," says the study's lead author, Dr. Margaret Herridge, Associate Director of the Medical-Surgical Intensive Care Unit at University Health Network, and Assistant Professor of Medicine at the University of Toronto.
The study-the lead article in this week's issue of the New England Journal of Medicine-followed 109 patients at 3 months, 6 months, and 12 months after discharge from intensive care units at University of Toronto's teaching hospitals: University Health Network, Mount Sinai Hospital, St. Michael's Hospital, and Sunnybrook and Women's Hospital. All patients had suffered from acute respiratory distress syndrome (ARDS), a severe inflammation of the lungs, which is associated with the development of multiple organ failure. The illness has a mortality rate of 60 per cent in the intensive care unit.
Using indicators such as distance walked in six minutes, ability to work, and a quality of life questionnaire, researchers found that those who do survive ARDS show slow but steady improvement, their most persistent problem being muscle wasting and weakness.
At one year:
- survivors achieved 66% of the exercise capacity of healthy, normal patients
- 49 per cent had returned to work-the majority to their original position
- survivors' quality of life steadily improved from the time of intensive care unit discharge
- survivors continued to have functional limitations- namely muscle wasting and weakness
The study highlights the need for a greater understanding of the barriers to recovery from critical illness.
"All of the members of the interdisciplinary team in the intensive care unit need to understand the long-term effects of critical illness and how our treatment choices in the intensive care unit impact on the long term function of ARDS patients and other critically ill patients," explains Dr. Herridge.
This study also highlights the need for long-term outpatient clinics for survivors of critical illness.
"Traditionally, there has been no pathway for these patients, so critical care physicians could not understand the long-term effects of critical illness-and how we should intervene after the ICU to facilitate recovery," says Dr. Herridge.
The findings are reason for survivors and their families to be optimistic about recovery, although they should know that this can be a lengthy process requiring intensive physical rehabilitation. More research is needed to determine whether the muscle weakness and wasting experienced by ARDS survivors is specific to this illness, or a feature common to all survivors of a severe episode of critical illness.
FUNDING/SUPPORT
The study was conducted in cooperation with the Canadian Critical Care Trials Group, and was supported by funding from the Canadian Intensive Care Foundation, the Physicians' Services Incorporated Foundation, and the Ontario Thoracic Society.
TORONTO GENERAL HOSPITAL, UNIVERSITY HEALTH NETWORK
Toronto General Hospital is a partner in University Health Network, along with Toronto Western and Princess Margaret Hospitals. The scope of research and complexity of cases at Toronto General Hospital has made it a national and international source for discovery, education and patient care. It has one of the largest hospital-based research programs in Canada, with major research projects in cardiology, transplantation, surgical innovation, infectious diseases, and genomic medicine. Toronto General Hospital is a teaching hospital affiliated with the University of Toronto.
Journal
New England Journal of Medicine