Research

Patients' recollections of experiences in the intensive care unit may affect their quality of life

Cristina Granja¹ , Alice Lopes² , Sara Moreira² , Claudia Dias³ , Altamiro Costa-Pereira⁴ , António Carneiro⁵ and for the JMIP Study Group

¹Intensivist, Consultant in Anesthesiology, Medical Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, Portugal

²Consultant in Psychiatry, Department of Psychiatry, Hospital Geral de Santo Antonio, Oporto, Portugal

³Research Assistant, Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Oporto, Oporto, Portugal

⁴Professor and Head of Department, Department of Biostatistics and Medical Informatics, Faculty of Medicine University of Oporto, Oporto, Portugal

⁵Consultant in Internal Medicine, Head of Department of Intensive Care, Intensive Care Unit, Hospital Geral de Santo António, Oporto, Portugal

author email corresponding author email

Critical Care 2005, 9:R96-R109doi:10.1186/cc3026

Published:	31 January 2005

Abstract

Introduction

We wished to obtain the experiences felt by patients during their ICU stay using an original questionnaire and to correlate the memories of those experiences with health-related quality of life (HR-QOL).

Methods

We conducted a prospective study in 10 Portuguese intensive care units (ICUs). Six months after ICU discharge, an original questionnaire on experiences of patients during their ICU stay, the recollection questionnaire, was delivered. HR-QOL was evaluated simultaneously, with the EQ-5D questionnaire. Between 1 September 2002 and 31 March 2003 1433 adult patients were admitted. ICU and hospital mortalities were 21% and 28%, respectively. Six months after ICU discharge, 464 patients completed the recollection questionnaire.

Results

Thirty-eight percent of the patients stated they did not remember any moment of their ICU stay. The ICU environment was described as friendly and calm by 93% of the patients. Sleep was described as being good and enough by 73%. The experiences reported as being more stressful were tracheal tube aspiration (81%), nose tube (75%), family worries (71%) and pain (64%). Of respondents, 51% experienced dreams and nightmares during their ICU stay; of these, 14% stated that those dreams and nightmares disturb their present daily life and they exhibit a worse HR-QOL. Forty-one percent of patients reported current sleep disturbances, 38% difficulties in concentrating in current daily activities and 36% difficulties in remembering recent events. More than half of the patients reported more fatigue than before the ICU stay. Multiple and linear regression analysis showed that older age, longer ICU stay, higher Simplified Acute Physiology Score II, non-scheduled surgery and multiple trauma diagnostic categories, present sleep disturbances, daily disturbances by dreams and nightmares, difficulties in concentrating and difficulties in remembering recent events were independent predictors of worse HR-QOL. Multicollinearity analysis showed that, with the exception of the correlation between admission diagnostic categories and length of ICU stay (0.47), all other correlations between the independent variables and coefficient estimates included in the regression models were weak (below 0.30).

Conclusion

This study suggests that neuropsychological consequences of critical illness, in particular the recollection of ICU experiences, may influence subsequent HR-QOL.