Lauren R Pollack1, Nathan E Goldstein2, Wendy C Gonzalez1, Craig D Blinderman1, Mathew S Maurer1, David J Lederer1,3, Matthew R Baldwin1,4. 1. Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, New York. 2. Mount Sinai Beth Israel, Division of Palliative Care, Icahn School of Medicine at Mount Sinai, New York, New York. 3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York. 4. Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York.
Abstract
OBJECTIVES: To assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs. DESIGN: A prospective cohort study. SETTING: Urban tertiary care hospital and community hospital. PARTICIPANTS: Medical ICU survivors of mechanical ventilation aged 65 and older (N = 125). MEASUREMENTS: Baseline measurements of the Edmonton Symptom Assessment Scale (ESAS), categorized as mild (0-3), moderate (4-6), and severe (7-10), and the frailty phenotype were made during the week before hospital discharge. Functional recovery was defined as a return to a Katz activity of daily living dependency count less than or equal to the prehospitalization dependency count within 3 months. In the last 29 participants recruited, we made additional assessments of fatigue and ESAS both at baseline and 1 month after discharge. RESULTS: Fatigue was the most-prevalent moderate to severe symptom (74%), followed by dyspnea (53%), drowsiness (50%), poor appetite (47%), pain (45%), depression (42%), anxiety (36%), and nausea (17%). At 1-month follow-up, there were no significant differences in the proportions of participants with moderate to severe symptoms. Each increase in baseline ESAS fatigue severity category was associated with 55% lower odds of functional recovery (odds ratio = 0.45, 95% confidence interval = 0.24-0.84), independent of age, sex, comorbidities, and critical illness severity. Frail participants had a higher median baseline total ESAS symptom distress score (34, interquartile range (IQR) 23-44) than nonfrail participants (13, IQR 9-22) (P < .001). CONCLUSION: Older ICU survivors have a high burden of palliative care needs that persist 1 month after discharge. Fatigue is the most-prevalent symptom and may interfere with recovery. Post-ICU frailty may be a useful trigger for palliative care consultation and a treatment target.
OBJECTIVES: To assess symptoms in older intensive care unit (ICU) survivors and determine whether post-ICU frailty identifies those with the greatest palliative care needs. DESIGN: A prospective cohort study. SETTING: Urban tertiary care hospital and community hospital. PARTICIPANTS: Medical ICU survivors of mechanical ventilation aged 65 and older (N = 125). MEASUREMENTS: Baseline measurements of the Edmonton Symptom Assessment Scale (ESAS), categorized as mild (0-3), moderate (4-6), and severe (7-10), and the frailty phenotype were made during the week before hospital discharge. Functional recovery was defined as a return to a Katz activity of daily living dependency count less than or equal to the prehospitalization dependency count within 3 months. In the last 29 participants recruited, we made additional assessments of fatigue and ESAS both at baseline and 1 month after discharge. RESULTS:Fatigue was the most-prevalent moderate to severe symptom (74%), followed by dyspnea (53%), drowsiness (50%), poor appetite (47%), pain (45%), depression (42%), anxiety (36%), and nausea (17%). At 1-month follow-up, there were no significant differences in the proportions of participants with moderate to severe symptoms. Each increase in baseline ESAS fatigue severity category was associated with 55% lower odds of functional recovery (odds ratio = 0.45, 95% confidence interval = 0.24-0.84), independent of age, sex, comorbidities, and critical illness severity. Frail participants had a higher median baseline total ESAS symptom distress score (34, interquartile range (IQR) 23-44) than nonfrail participants (13, IQR 9-22) (P < .001). CONCLUSION: Older ICU survivors have a high burden of palliative care needs that persist 1 month after discharge. Fatigue is the most-prevalent symptom and may interfere with recovery. Post-ICU frailty may be a useful trigger for palliative care consultation and a treatment target.
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Joseph W Shega; William Dale; Melissa Andrew; Judith Paice; Kenneth Rockwood; Debra K Weiner Journal: J Am Geriatr Soc Date: 2011-12-08 Impact factor: 5.562
Authors: David Hui; Omar Shamieh; Carlos Eduardo Paiva; Pedro Emilio Perez-Cruz; Jung Hye Kwon; Mary Ann Muckaden; Minjeong Park; Sriram Yennu; Jung Hun Kang; Eduardo Bruera Journal: Cancer Date: 2015-06-08 Impact factor: 6.860
Authors: Lukas Radbruch; Florian Strasser; Frank Elsner; Jose Ferraz Gonçalves; Jon Løge; Stein Kaasa; Friedemann Nauck; Patrick Stone Journal: Palliat Med Date: 2008-01 Impact factor: 4.762
Authors: Lauren E Ferrante; Margaret A Pisani; Terrence E Murphy; Evelyne A Gahbauer; Linda S Leo-Summers; Thomas M Gill Journal: Am J Respir Crit Care Med Date: 2016-08-01 Impact factor: 21.405
Authors: Andrew M Courtwright; Derek Zaleski; Michael Tevald; Joe Adler; Jonathan P Singer; Edward E Cantu; Christian A Bermudez; Joshua M Diamond Journal: Clin Transplant Date: 2019-09-08 Impact factor: 2.863
Authors: Andrew M Courtwright; Derek Zaleski; Lisa Gardo; Vivek N Ahya; Jason D Christie; Maria Crespo; Denis Hadjiliadis; James Lee; Maria Molina; Namrata Patel; Mary Porteous; Edward E Cantu; Christian Bermudez; Joshua M Diamond Journal: Transplantation Date: 2018-05 Impact factor: 4.939
Authors: Lauren T Starr; Connie M Ulrich; Paul Junker; Liming Huang; Nina R O'Connor; Salimah H Meghani Journal: Am J Hosp Palliat Care Date: 2020-06-30 Impact factor: 2.500
Authors: Jordi Amblàs-Novellas; Scott A Murray; Ramon Oller; Anna Torné; Joan Carles Martori; Sébastien Moine; Nadina Latorre-Vallbona; Joan Espaulella; Sebastià J Santaeugènia; Xavier Gómez-Batiste Journal: BMJ Open Date: 2021-04-21 Impact factor: 2.692
Authors: Oded Mousai; Lola Tafoureau; Tamar Yovell; Hans Flaatten; Bertrand Guidet; Christian Jung; Dylan de Lange; Susannah Leaver; Wojciech Szczeklik; Jesper Fjolner; Peter Vernon van Heerden; Leo Joskowicz; Michael Beil; Gal Hyams; Sigal Sviri Journal: Intensive Care Med Date: 2022-09-02 Impact factor: 41.787