Margaret S. Herridge, Leslie M. Chu, Andrea Matte, George Tomlinson, Linda Chan, Claire Thomas, Jan O. Friedrich, Sangeeta Mehta, Francois Lamontagne, Melanie Levasseur, Niall D. Ferguson, Neill K. J. Adhikari, Jill C. Rudkowski, Hilary Meggison, Yoanna Skrobik, John Flannery, Mark Bayley, Jane Batt, Claudia dos Santos, Susan E. Abbey, Adrienne Tan, Vincent Lo, Sunita Mathur, Matteo Parotto, Denise Morris, Linda Flockhart, Eddy Fan, Christie M. Lee, M. Elizabeth Wilcox, Najib Ayas, Karen Choong, Robert Fowler, Damon C. Scales, Tasnim Sinuff, Brian H. Cuthbertson, Louise Rose, Priscila Robles, Stacey Burns, Marcelo Cypel, Lianne Singer, Cecelia Chaparro, Chung-Wai Chow, Shaf Keshavjee, Laurent Brochard, Paul Hebert, Arthur S. Slutsky, John C. Marshall, Deborah Cook, and Jill I. Cameron Am. J. Resp. Crit. Care Med. 1 Oct 2016, vol. 194, no. 7: 831-844
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.