Home page Description:
A new model can determine the risk of disability after treatment in the intensive care unit.
Posted On: May 09, 2016
Image Caption:
A mechanical ventilation machine (depicted above) helps people to breathe through a tube that is inserted into the airway.
Critically ill people are treated in the intensive care unit (ICU) of a hospital. As part of their care, those with life-threatening conditions or those recovering from major surgery may require mechanical ventilation, a form of assisted breathing.
The burden of the illness—and of the intensive care—makes the recovery process challenging, and those in recovery can experience significant disabilities. Models to predict long-term disability would help clinicians and patients plan appropriately for rehabilitation. Such models exist for specific patient groups; however, a universally applicable model is not available.
Dr. Margaret Herridge (TGHRI Scientist), Dr. Jill Cameron (TRI Affiliate Scientist and University of Toronto Associate Professor) and their team of researchers initiated a study to address this issue. The team analyzed data about critically ill people in the ICU who required at least one week of mechanical ventilation. They looked at data that included age, length of stay and ability to perform daily activities independently. They then followed the recovery of the study participants over the course of one year.
The team found that patients could be categorized into one of four disability risk groups using a combination of their age and length of stay in the ICU. Those who were younger and stayed a shorter length of time recovered well, whereas those who were older and stayed longer did not recover as well. Moreover, a patient’s level of independence after being released from the ICU could be used to predict his or her degree of disability one year later.
“This model is applicable to all patients, regardless of the reason that they are admitted to the ICU,” says Dr. Herridge. “The results of this study will inform health care utilization, and help patients and clinicians to make decisions that better promote improved long-term outcomes.”
This work was supported by the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, the University of Toronto, the John MacNaughton Family Fund, the Jason Tham and Andrea Chan Family Fund, the Don and Jane Luck Family Fund and the Toronto General & Western Hospital Foundation. M Cypel holds a Tier 2 Canada Research Chair in Lung Transplantation.
The RECOVER Program: Disability risk groups & one year outcome after ≥ 7 days of mechanical ventilation. Herridge MS, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehta S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NK, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, Dos Santos C, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hebert P, Slutsky AS, Marshall JC, Cook D, Cameron JI; RECOVER Program Investigators (Phase 1: towards RECOVER) and the Canadian Critical Care Trials Group. American Journal of Respiratory and Critical Care Medicine. doi: 10.1164/rccm.201512-2343OC. 2016 Mar 14. [Pubmed abstract]
The burden of the illness—and of the intensive care—makes the recovery process challenging, and those in recovery can experience significant disabilities. Models to predict long-term disability would help clinicians and patients plan appropriately for rehabilitation. Such models exist for specific patient groups; however, a universally applicable model is not available.
Dr. Margaret Herridge (TGHRI Scientist), Dr. Jill Cameron (TRI Affiliate Scientist and University of Toronto Associate Professor) and their team of researchers initiated a study to address this issue. The team analyzed data about critically ill people in the ICU who required at least one week of mechanical ventilation. They looked at data that included age, length of stay and ability to perform daily activities independently. They then followed the recovery of the study participants over the course of one year.
The team found that patients could be categorized into one of four disability risk groups using a combination of their age and length of stay in the ICU. Those who were younger and stayed a shorter length of time recovered well, whereas those who were older and stayed longer did not recover as well. Moreover, a patient’s level of independence after being released from the ICU could be used to predict his or her degree of disability one year later.
“This model is applicable to all patients, regardless of the reason that they are admitted to the ICU,” says Dr. Herridge. “The results of this study will inform health care utilization, and help patients and clinicians to make decisions that better promote improved long-term outcomes.”
This work was supported by the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, the University of Toronto, the John MacNaughton Family Fund, the Jason Tham and Andrea Chan Family Fund, the Don and Jane Luck Family Fund and the Toronto General & Western Hospital Foundation. M Cypel holds a Tier 2 Canada Research Chair in Lung Transplantation.
The RECOVER Program: Disability risk groups & one year outcome after ≥ 7 days of mechanical ventilation. Herridge MS, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehta S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NK, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, Dos Santos C, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hebert P, Slutsky AS, Marshall JC, Cook D, Cameron JI; RECOVER Program Investigators (Phase 1: towards RECOVER) and the Canadian Critical Care Trials Group. American Journal of Respiratory and Critical Care Medicine. doi: 10.1164/rccm.201512-2343OC. 2016 Mar 14. [Pubmed abstract]