PDF(Pubmed)
Abstract：
Patients discharged from intensive care are at risk for post-intensive care syndrome (PICS), which consists of physical, psychological, and/or neurological impairments. This study aimed to analyze PICS at 24 months follow-up, to identify potential risk factors for PICS, and to assess health-related quality of life in a long-term cohort of adult cardiac arrest survivors. This prospective cohort study included adult cardiac arrest survivors admitted to the intensive care unit of a Swiss tertiary academic medical center. The primary endpoint was the prevalence of PICS at 24 months follow-up, defined as impairments in physical (measured through the European Quality of Life 5-Dimensions-3-Levels instrument [EQ-5D-3L]), neurological (defined as Cerebral Performance Category Score > 2 or Modified Rankin Score > 3), and psychological (based on the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised) domains. Among 107 cardiac arrest survivors that completed the 2-year follow-up, 46 patients (43.0%) had symptoms of PICS, with 41 patients (38.7%) experiencing symptoms in the physical domain, 16 patients (15.4%) in the psychological domain, and 3 patients (2.8%) in the neurological domain. Key predictors for PICS in multivariate analyses were female sex (adjusted odds ratio [aOR] 3.17, 95% CI 1.08 to 9.3), duration of no-flow interval during cardiac arrest (minutes) (aOR 1.17, 95% CI 1.02 to 1.33), post-discharge job-loss (aOR 31.25, 95% CI 3.63 to 268.83), need for ongoing psychological support (aOR 3.64, 95% CI 1.29 to 10.29) or psychopharmacologic treatment (aOR 9.49, 95% CI 1.9 to 47.3), and EQ-visual analogue scale (points) (aOR 0.88, 95% CI 0.84 to 0.93). More than one-third of cardiac arrest survivors experience symptoms of PICS 2 years after resuscitation, with the highest impairment observed in the physical and psychological domains. However, long-term survivors of cardiac arrest report intact health-related quality of life when compared to the general population. Future research should focus on appropriate prevention, screening, and treatment strategies for PICS in cardiac arrest patients.
摘要：
从重症监护出院的患者有发生重症监护后综合征（PICS）的风险，它由物理组成，心理,和/或神经损伤。本研究旨在分析24个月随访时的PICS，为了确定PICS的潜在风险因素，并在成人心脏骤停幸存者的长期队列中评估与健康相关的生活质量。这项前瞻性队列研究包括瑞士三级学术医疗中心重症监护病房的成年心脏骤停幸存者。主要终点是24个月随访时的PICS患病率，定义为身体损伤（通过欧洲生活质量5维3水平仪器[EQ-5D-3L]测量），神经学（定义为脑功能分类评分>2或改良Rankin评分>3），和心理领域(基于医院焦虑和抑郁量表和事件量表修订的影响)。在完成2年随访的107名心脏骤停幸存者中，46例患者（43.0%）有PICS症状，41名患者(38.7%)出现身体领域的症状，16例患者（15.4%）在心理领域，神经领域的3例患者（2.8％）。多变量分析中PICS的关键预测因子是女性（调整后的比值比[aOR]3.17，95％CI1.08至9.3），心脏骤停期间无血流间期持续时间(分钟)(aOR1.17,95%CI1.02~1.33),出院后失业（AOR31.25，95%CI3.63至268.83），需要持续的心理支持（aOR3.64，95％CI1.29至10.29）或精神药物治疗（aOR9.49，95％CI1.9至47.3），和EQ-视觉模拟量表（分）（aOR0.88，95％CI0.84至0.93）。超过三分之一的心脏骤停幸存者在复苏后2年出现PICS症状，在生理和心理领域观察到最高的损害。然而,与普通人群相比,心脏骤停的长期幸存者报告健康相关生活质量完整.未来的研究应该集中在适当的预防上，筛选,心脏骤停患者PICS的治疗策略。
