Long-term psychological outcome after discharge from intensive care

ABSTRACT Objective: To investigate the longterm psychological outcome in survivors of critical illness after intensive care unit discharge. Methods: A prospective cohort of survivors admitted to a mixed intensive care unit between January and September 2010 was evaluated six months and five years after hospital discharge. The Dementia Rating Scale-2, the Hospital Anxiety and Depression Scale, the Posttraumatic stress syndrome 14-questions inventory, the Euro Quality of Life 5 Dimensions (EQ-5-D), and the Visual Analogue Scale (EQ VAS) were assessed at both follow-up periods. Results: Of 267 patients, 25 patients were evaluated at 6 months after discharge (62 ± 16 years); 12 (48%) presented cognitive impairment, 6 (24%) anxiety, 4 (16%) depression, and 4 (16%) post-traumatic stress disorder. Among those re-evaluated five years after discharge (n = 17; 65 ± 15 years), the frequency of cognitive impairment dropped from 8 (47%) to 3 (18%) (p = 0.063), due to improvement in these patients over time, and other patients did not acquire any dysfunction after discharge. At five years after discharge, only two patients (12%) reported anxiety, and none had depression or post-traumatic stress disorder. No differences were found between the six-month and five-year follow-ups regarding EQ-5-D and EQ VAS. Conclusion: Survivors do not show a progressive decline in cognitive function or quality of life within five years after intensive care unit discharge. Psychopathological symptoms tend to decrease with time.

摘要
研究目的：探讨重症监护病房（intensive care unit, ICU）出院后重症患者幸存者的长期心理转归。
方法：针对2010年1月至9月入住混合重症监护病房的患者幸存者开展前瞻性队列研究，分别于患者出院后6个月及5年时进行随访评估。两次随访均采用以下评估工具：第二版痴呆评定量表（Dementia Rating Scale-2）、医院焦虑抑郁量表（Hospital Anxiety and Depression Scale）、创伤后应激综合征14项问卷（Posttraumatic stress syndrome 14-questions inventory）、欧洲五维健康量表（Euro Quality of Life 5 Dimensions, EQ-5-D）以及视觉模拟评分量表（EQ VAS）。
结果：共计267例患者中，25例完成出院后6个月随访（年龄62±16岁），其中12例（48%）存在认知功能损害，6例（24%）伴焦虑症状，4例（16%）伴抑郁症状，4例（16%）罹患创伤后应激障碍。完成5年随访的17例患者（年龄65±15岁）中，认知功能损害的发生率从8例（47%）降至3例（18%）（p=0.063），该变化与该类患者随时间推移症状改善相关，其余患者出院后未出现新发功能障碍。出院后5年时，仅2例患者（12%）报告存在焦虑症状，无抑郁或创伤后应激障碍病例。6个月与5年随访的EQ-5-D及EQ VAS评分无显著差异。
结论：重症监护病房出院后的幸存者在5年内未出现认知功能或生活质量的进行性下降，精神病理症状随时间推移呈减轻趋势。