Dr HONG Kam Fai Jeffrey
Abstract
We conducted a retrospective study on the outcome, the functional autonomy and quality of life of the prolonged ICU stay patients (more than or equal to 21 days in ICU); in a multidisciplinary ICU with 14 ICU bed & 8 HDU beds, in a 1500 bed acute tertiary care, Government Hospital. A consecutive cohort of 71 patients admitted to ICU & HDU from 01/1/1997 to 31/12/1997 for more than or equal to 21 day stay in the ICU was studied. 71 patients fulfilled the inclusion criteria. No demographical statistical significance was detected between the survivors and non-survivors in age, sex and APACHE II scores. A higher percentage of patients in both the hospital non-survivors (hospital survivors versus hospital non-survivors: 22.9% versus 47.2% with p =0.028) and ICU non-survivors (ICU survivors versus ICU non-survivors: 38.8% versus 72.7% with p=0.008) had underlying disease. A higher percentage of patients in the hospital non-survival group had pulmonary arterial catheterization as compared to the survival group (47.2& versus 22.9% with p=0.02). The ICU mortality was 30.98% and hospital mortality was 50.7%. The 1-year ICU mortality in the study was 64.8% and 4th years mortality rate of the study group was 71.8%. The 6-month post hospital discharge readmission rate was 54.8% and 1-year readmission rate was 61.3%. The cost of supporting each prolonged stay patient was estimated to be HK $390,000 (~US 50,000). 14 patients completed the quality of life questionnaire. Among those patients, the quality of life scores were lower in the study group as compared to the general population and other disease groups, except in the environmental domain. 2 patients reported deterioration in the functional status, while the functional status of other patients remained unchanged.
Despite the prolonged stay patients had a high mortality rate and consumed a disproportional high amount of our ICU resources, the long-term post-intensive care functional status and perceived quality of life were reasonably well. We concluded that active ongoing management should therefore be pursued if clinicians feel this to be in the interests of individual patients. This study fails to identify which particular group of patients will be benefited by the prolonged therapy.