A Systematic Review of tools used to report long-term outcomes in Chronically Critically Ill patients
CCCF ePoster library. Biswas S. Oct 2, 2017; 198225
Sharmistha Biswas
Sharmistha Biswas
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Abstract
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A Systematic Review of non-mortality tools used to report long-term outcomes in Chronically Critically Ill patients.

Sharmistha Biswas, Marc Brosseau, Genevieve Gore, Jason Shahin



1)Biswas, Sharmistha

Department of Medicine, division of critical care, McGill University, Montreal, Canada



2) Brosseau, Marc

Department of Medcine, division of critical care, Mcgill University, Montreal, Canada



3) Gore, Genevieve

Mcgill University, Montreal, Canada



4) Shahin, Jason

Department of Medcine, division of critical care, Mcgill University, Montreal, Canada


Introduction:
Modern critical care medicine has improved survival among the critically ill population. Increasing number of critically ill patients survive the acute phase of illness and go on to a state of prolonged intensive care utilization and chronic critical illness. These patients experience high mortality and poor long-term outcomes.
Objective: To systematically review available literature for tools employed to report long-term outcomes in the chronically critically ill.
Methods: Literature search was performed using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy was limited to French and English languages with no date limit to publication period. Literature review and data extraction was performed independently and crosschecked by 2 reviewers using a predefined data extraction form. Study inclusion criteria included randomized and observational study designs, conducted in participants with ≥16 years of age, admitted to an intensive care unit who received mechanical ventilation for ≥6 days with median mechanical ventilation of ≥ 14 days and or a tracheostomy for prolonged ventilation support. A snowballing process, which included relevant review articles, was carried out to identify any additional studies. We used the World Health Organization’s International Classification of Functioning, Disability and Health framework to categorize the tools.
Results: Of 4877 titles screened, 23 studies, published between 1999 and 2017 were included. More than three quarters of the studies (83%) were included based on duration of mechanical ventilation being ≥ 14 days and the other 17% based on the presence of a tracheostomy. Most studies (52%) were performed in North America and where mostly cohort (69%) and single center (74%) studies. Mean age of prolonged ventilated patients ranged from 39 years to 79 years with proportion of male patients ranging from 48% to 74.4%. Mean mechanical ventilation duration reported ranged from 14 days to 45 days and ICU stay ranged from 16 days to 49 days. Outcome assessment tools differed amongst the studies: Majority of the tools were dedicated towards assessment of Tissue Impairment (51%); followed by Quality of life (27%) and Activity limitation (19%). The Medical Outcomes Study-SF-36 questionnaire being the most frequently reported tool (n=7) followed by the 6-minute-walk-test (n=4). Discharge disposition was reported in 61% of the studies and only few studies reported socio-demographic factors: family status (n= 3); education (n=4); income or employment status (n=4); race/ ethnicity (n=4). Two studies reported on Perceived Social Support.
Conclusions: Various tools have been employed to assess long-term outcomes across studies. There is a paucity of studies looking at the phases of Activity Limitations and Participation Restrictions, which inform Quality of Life. A standardized approach and more research in these phases of disablement process would enable study analysis and comparisons to help targeting of long-term patient care towards developing an outcome-oriented care propositions in this emerging patient population. The World Health Organization’s International Classification of Functioning, Disability and Health could serve as a helpful framework.

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