The role of memories on health-related quality of life after intensive care unit care: an unforgettable controversy?

Abstract

Background

Decreased health-related quality of life (HRQoL) is a significant problem after an intensive care stay and is affected by several known factors such as age, sex, and previous health-state. The objective of this study was to assess the association between memory and self-reported perceived HRQoL of patients discharged from the intensive care unit (ICU).

Methods

A prospective, multicenter study involving nine general ICUs in Portugal. All adult patients with a length of stay >48 hours were invited to participate in a 6-month follow-up after ICU discharge by answering a set of structured questionnaires, including EuroQol 5-Dimensions and ICU memory tool.

Results

A total of 313 (52% of the eligible) patients agreed to enter the study. The median age of patients was 60 years old, 58% were males, the median Simplified Acute Physiology Score II (SAPS II) was 38, and the median length of stay was 8 days for ICU and 21 days for total hospital stay. Eighty-nine percent (n=276) of the admissions were emergencies. Seventy-eight percent (n=234) of the patients had memories associated with the ICU stay. Patients with no memories had 2.1 higher chances (P=0.011) of being in the bottom half of the HRQoL score (<0.5 Euro-Qol 5-Dimensions index score). Even after adjusting for pre-admission characteristics, having memories was associated with higher perceived HRQoL (adjusted odds ratio =2.1, P=0.022).

Conclusion

This study suggests that most of the ICU survivors have memories of their ICU stay. For the ICU survivors, having memories of the ICU stay is associated with a higher perceived HRQoL 6 months after ICU discharge.

Keywords:

• health-related quality of life
• memory disturbances
• critical care
• outcome

Supplementary material

Table S1 Comparison of clinical and demographic characteristics of patients who returned the questionnaires (n=310) and the non-respondents (n=289) enrolled in the study by ICU memories status

Acknowledgments

The authors would like to thank the ICU staff from the participating hospitals for contribution of data collection for this study.

Study coordinator: António H Carneiro (Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto). Study promoters: António H Carneiro (Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto), Eduardo Silva (Unidade de Cuidados Intensivos Polivalente, Hospital do Desterro, Lisboa), and José Artur Paiva (Unidade de Cuidados Intensivos Polivalente da Urgência, Hospital de São João, Porto). ICU participants: Augusta Amaro Serviço de Cuidados Intensivos Médicos, Hospital Pedro Hispano, Matosinhos; Ernestina Gomes, Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto; Ana Isabel Paixão, Unidade de Cuidados Intensivos Polivalente, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia; Francisco Esteves, Unidade de Cuidados Intensivos, Centro Hospitalar Peso da Régua Vila Real, Vila Real; Piedade Amaro, Unidade de Cuidados Intensivos, Hospital de S. Sebastião, Santa Maria da Feira; Paula Coutinho, Unidade de Cuidados Intensivos, Centro Hospitalar dos Covões, Coimbra; Eduardo Silva, Unidade de Cuidados Intensivos, Hospital do Desterro, Lisboa; Isabel Moniz, Unidade de Cuidados Intensivos, Hospital de Santa Maria, Lisboa; José Vaz, Unidade de Cuidados Intensivos, Hospital de Beja; Orquídea Ribeiro, Altamiro Costa Pereira, Serviço Biostatística e Informática Médica da Faculdade de Medicina da Universidade do Porto - Porto.

Disclosure

Armando Teixeira-Pinto was supported by NHMRC program grant 633003 to the Screening & Test Evaluation Program (STEP). Lotti Orwelius and Cristina Lobo were supported by the grant from Fundação para a Ciência e Tecnologia (PIC/IC/83312/2007). The authors declare that they have no other conflicts of interest in this work.