Critical Care

Since the 1980s, dozens of studies have examined the quality of life and functional status of patients after a stay in intensive care units. Some of these studies have concentrated on patients with specific diseases (e.g., cardiac arrest, hematologic malignancy) or with specific characteristics (e.g., the elderly), while others have included all patients cared for in the intensive care unit. Most of these studies assess functional status, while a few studies have used global quality of life or health-related quality of life instruments. To date, studies of specific ICE interventions have not employed QOL outcome measures. This likely represents an important area of research in the future.

Important unresolved issues for assessing the effect of critical care on quality of life include proxy reports and pre-illness assessments. The reliability and validity of obtaining information from a "proxy" such as a family member is an important issue, since many patients cannot complete these instruments during or after critical care. While proxy reports do appear valid in many settings, they do differ from patients' reports. Consequently, this issue must be considered in study design. Also, for many studies, investigators would like to know the baseline quality of life of individuals prior to the critical illness. The validity of asking someone after a recent critical illness about the quality of their life prior to the critical illness has not been fully determined. A review of these issues can be found in Curtis 19981.

Instruments used for patients receiving critical care:

Patients receiving critical care have a wide spectrum of diseases and therefore a disease-specific quality of life or health status instrument for patients in the ICE or after ICE care seems unnecessary. Several of the overall quality of life and generic health-related quality of life instruments have been used for patients receiving care in the ICE.

1. Curtis JR. The "patient-centered" outcomes of critical care: What are they and how should they be used? New Horizons, 1998; 6:26-32.

Generic Health-Related Quality of Life Instruments for Use in Critical Care

Perceived Quality of Life Scale

• Patrick DL, Danis M, Southerland LI, Hong G. Quality of life following intensive care. J Gen Intern Med 1988;3:218-223.
• Patrick DL, Danis M, Southerland LI, Hong G. Quality of life following intensive care. J Gen Intern Med 1988;3:218-223.
• Patrick DL, Danis M, Southerland LI, Hong G. Quality of life following intensive care. J Gen Intern Med 1988;3:218-223.
• Ridley S, Biggam M, Stone P. A cost-utility analysis of intensive therapy. II: quality of life in survivors. Anaesthesia 1994;49:192-196.
• Chelluri L, Pinsky MR, Donahue MP, Grenvik A. Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 1993;269:3119-3123.

Nottingham Health Profile

• Combes A, Costa MA, Trouillet JL, et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation. Crit Care Med. 2003;31(5):1373-81.
• Niskanen M, Ruokonen E, Takala J, Rissanen P, Kari A. Quality of life after prolonged intensive care. Crit Care Med 1999;27:1132-9.
• Yau E, Rohatiner AZS, Lister TA, Hinds CJ. Long term prognosis and quality of life following intensive care for life-threatening complications of hematologic malignancy. Br J Cancer 1991;64:938-942.

Medical Outcomes Study SF-36

• 2-month mortality and functional status of critically ill adult patients receiving prolonged mechanical ventilation. Chest. Feb 2002;121(2):549-558.
• Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 1999;281(4):354-60.
• Perl TM, Dvorak L, Hwang T, Wenzel RP. Long-term survival and function after suspected gram-negative sepsis. JAMA 1995;274:338-345.
• Schelling G, Richter M, Roozendaal B, et al. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med. 2003;31(7):1971-80.
• Weinert CR, Gross CR, Kangas JR, Bury CL, Marinelli WA. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med 1997;156:1120-8.

Sickness Impact Profile

• Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA. Health status of survivors of cardiac arrest and of myocardial infarction controls. Am J Public Health 1985;75:1321-1323.
• Bosscha K, Reijnders K, et al. Quality of life after severe bacterial peritonitis and infected necrotizing pancreatitis treated with open management of the abdomen and planned re-operations. Crit Care Med 2001;29(8): 1539-43.
• Miranda DR. Quality of life after cardiopulmonary resuscitation. Chest 1994;106:524-530.
• Sage WM, Rosenthal MH, Silverman JF. Is intensive care worth it? - An assessment of input and outcome for the critically ill. Crit Care Med 1986;14:777-782.

Quality of Life Index

• Kleinpell RM, Ferrans CE. Quality of life of elderly patients after treatment in the ICU. Res Nurs Health. Jun 2002;25(3):212-221.

EuroQol (EQ-5D)

• Granja C, Teixeira-Pinto A, Costa-Pereira A. Quality of life after intensive care - evaluation with EQ-5D questionnaire. Intensive Care Med. Jul 2002;28(7):898-907.

Condition-Specific Health-Related Quality of Life Instruments for Use in Critical Care

• Davidson TA, Caldwell ES, Curtis JR, Hudson LD, Steinberg KP. Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients. JAMA 1999;281(4):354-60.
• Combes A, Costa MA, Trouillet JL, et al. Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation. Crit Care Med. 2003;31(5):1373-81.
• Curtis JR. The "patient-centered" outcomes of critical care: What are they and how should they be used? New Horizons, 1998; 6:26-32.