Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study

Sumeet Rai; Teresa Neeman; Rhonda Brown; Krishnaswamy Sundararajan; Arvind Rajamani; Michelle Miu; Rakshit Panwar; Mary Nourse; Frank M P van Haren; Imogen Mitchell; Dale M Needham; PRICE study investigators

doi:10.1016/j.ccrj.2023.10.011

Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study

Crit Care Resusc. 2023 Dec 13;26(1):8-15. doi: 10.1016/j.ccrj.2023.10.011. eCollection 2024 Mar.

Authors

Sumeet Rai^{1

2}, Teresa Neeman³, Rhonda Brown^{4

5}, Krishnaswamy Sundararajan^{6

7}, Arvind Rajamani^{8

9}, Michelle Miu¹⁰, Rakshit Panwar¹¹, Mary Nourse², Frank M P van Haren^{1

12}, Imogen Mitchell^{1

2}, Dale M Needham^{13

14}; PRICE study investigators

Affiliations

¹ School of Medicine and Psychology, Australian National University, Canberra, Australia.
² Intensive Care Unit, Canberra Hospital, Canberra, Australia.
³ Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia.
⁴ Research School of Psychology, Australian National University, Canberra, Australia.
⁵ School of Psychology, University of New England, Armidale, NSW, Australia.
⁶ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia.
⁷ Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
⁸ Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia.
⁹ Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia.
¹⁰ Nepean Hospital, Kingswood, Sydney, Australia.
¹¹ Intensive Care Unit, John Hunter Hospital, New Lambton, Australia.
¹² Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia.
¹³ Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA.
¹⁴ John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA.

Abstract

Objective: To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors.

Design: Prospective, multicentre observational cohort study.

Setting: Four tertiary medical-surgical ICUs in Australia.

Participants: Intubated and non-intubated adult ICU survivors.

Main outcome measures: Primary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire.

Results: Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66-3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53-3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions.

Conclusions: Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.

Keywords: Intensive care; Psychology; Quality of life; Survivorship.