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Research Review.

Citation

Eakin, M.N., Patel, V., Mendea-Tellez, P, Dinglas, V.D., Needham, D.M., & Turnbull, A.E. (2017). Patients' outcomes after acute respiratory failure: A qualitative study with the PROMIS framework. American Journal of Critical Care, 26, 456-654. http://dx.doi.org/10.4037/ajcc201734

Background

As patients survive critical illness and are discharged from ICU, many experience long-lasting physical, cognitive, and mental health problems.

Purpose of the study

To describe the experience of surviving acute respiratory failure among patients using the Patient Reported Outcomes Measurement Information System (PROMIS) (Cella et al., 2010).

Research approach and methods

Design. The researchers used a qualitative design for this study. They collected data for each patient using a semi-structured telephone interview.

Setting and Sample

The study was conducted as part of a larger longitudinal study of the ARDS Network Long-term Outcomes Study and the Recovery of Muscle After ARF study. Survivors of acute respiratory failure were recruited from six hospitals in Baltimore, Maryland, and interviewed between five and 18 months after the start of mechanical ventilation. The first part of the interview consisted of open-ended questions about the patient's health, well-being, and recovery after being hospitalized with acute respiratory failure. The second part of the interview consisted of open-ended questions related to the physical, mental, and social health domains using the PROMIS framework. All interviews were conducted by two researchers, audiotaped, and then transcribed. Transcripts were analyzed by using NVivo software.

Findings

Participants reported issues in physical health as one of their biggest concerns during recovery. Specifically, they experienced problems with mobility and the need for aids, activities of daily living, balance/stability, pain, muscle weakness, muscle soreness, inflammation, numbness, coughing, shortness of breath, and other symptoms. In addition to these, participants identified impairments in gastrointestinal, neuromuscular, sensory, fatigue, and urological function.

Participants reported mental health symptoms, changes in cognitive functioning, and psychosocial impacts of mental health. The primary complaints included posttraumatic stress disorder, anxiety, and depression. They also experienced impairments to cognitive functioning (e.g., memory, organization, planning, and difficulties in finding words). Some participants noted a positive outcome by experiencing gratitude for their life or valuing their health more.

Survivors reported problems in all aspects of social health such as a change in employment status, disability, hobbies, household chores, caregiving, family and friend activities, social events, and loneliness or isolation. On a positive note, some participants experienced feeling closer to loved ones.

Commentary

Empirical evidence of the lasting effects of critical illness on physical, cognitive, mental health, sleep and employment status of survivors has been well documented. Therefore, some of the findings in this study are not surprising and do validate what has been discovered before. What is unique to this study are the findings of newfound gratitude for life and closer relationships with family and friends among the survivors.

One factor to note in this study is the use of the PROMIS framework among this patient population. The PROMIS measuring instruments were developed for patients with chronic disease, so we cannot assume they are well matched to the experiences of survivors of critical illness. Unlike chronic diseases, which usually have a slow onset and a stable or worsening progression, critical illness often has an abrupt onset and a decline in function followed by an uncertain recovery.

An important strength of this study is that critical care nurses and healthcare providers who care for patients in the ICU may benefit from understanding the impact of critical illness on patients and their families. We should not assume that all patients experience a smooth progression toward recovery after they leave the ICU. Many will experience long-term physical, cognitive, emotional, and mental health problems.

Paula Price, PhD, RN

Editor CJCCN

Acting Director, School of Nursing and Midwifery

Mount Royal University

REFERENCES

Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., ... PROMIS Cooperative Group. (2010). The patient reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. Journal of Clinical Epidemiology, 63, 1179-1194.
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Article Details
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Title Annotation:outcome of acute respiratory failure
Author:Price, Paula
Publication:The Canadian Journal of Critical Care Nursing
Article Type:Report
Geographic Code:1CANA
Date:Mar 22, 2018
Words:671
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