Toronto (Feb. 19, 2003) - The most comprehensive study to date of long-term outcomes in survivors of a severe episode of critical illness shows that even patients who were once among the sickest in the intensive care unit can regain good physical functioning and quality of life.
"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 (ICU) 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—evaluated 109 patients at 3 months, 6 months, and 12 months after discharge from ICU stays at University of Toronto's teaching hospitals: University Health Network, Mount Sinai Hospital, St. Michael's Hospital, and Sunnybrook and Women's College Health Sciences Centre. 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 ICU.
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 ICU discharge
- survivors continued to have functional limitations—namely muscle wasting and weakness
The study highlights the need for long-term outpatient clinics for survivors of critical illness, explains Dr. Herridge.
"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.
Further Implications
- Survivors of critical illness and their families can be optimistic about recovery over time, although intensive physical rehabilitation is often necessary beyond one year.
- More research is needed to determine whether the muscle weakness and wasting experienced by ARDS survivors is a feature common to all survivors after a severe episode of critical illness.
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, the Ontario Thoracic Society, and a five-year Ontario Ministry of Health-Health Services Research Career Scientist Award (held by collaborator Dr. Angela Cheung).
About University Health Network
University Health Network is a major landmark in Canada's health-care system, and a teaching partner of the University of Toronto. Building on the strengths and reputation of each of our three remarkable hospitals, Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital, UHN brings together the innovation, talent and resources needed to achieve global impact on the health care scene and provide exemplary patient care.
