Thriving, not just surviving after critical illness

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Thriving – Not Just Surviving
Prof Carol Hodgson PhD FACP
Deputy Director ANZIC-RC
Chair TEAM Study, PREDICT Study and Co-...

Increasing survival and discharge to rehabilitation after ICU
Kaukonen et al, JAMA, 2014

N=155
Surrogate markers:
Decreased ICP
Decreased therapies for ICP
Decreased ICU length of stay

= Alive
= Dead
Cooper et al (2011) NEJM 364:1493.
Decompressive
Craniectomy:
Standard Care:

= Full Recovery
= Significant Morbidity
= Dead
Cooper et al (2011) NEJM 364:1493.
Decompressive
Craniectomy:
Standard Care...

Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT) RCT.
The AVERT Trial Collaboration grou...

Thriving – not just surviving
1. Learn from current practice
2. Identify who is at risk
3. Test new strategies

5 Year Outcome of ARDS Survivors

Increased disability after IMV versus hospitalisation
Barnato, AJRCCM, 2011
• Elderly may not chose this
• Outcomes were w...

Trajectory of recovery Iwashyna AJRCCM, 2012

Physical and mental / cognitive baseline status
Acute
illness
Organ function - impairment
Activity - functional limitation...

ANZ CTG Trials and LTOs Hodgson & Iwashyna,, 2016

Domains SF-36 EQ5D
Physical status
Psychological status
Cognitive status
Activities and behaviours
Physical zone of comfor...

Physical and mental / cognitive
baseline status
Acute
illness
Organ function - impairment
Activity - functional limitation...

www.improveLTO.com
16
Contact us: improveLTO@jhmi.edu

17
www.improveLTO.com
improveLTO@jhmi.edu

Core outcome measures for research in ARF Needham et al, AJRCCM, 2017
Core Domains Tool Time (minutes) Cost AUD
Life satis...

Thriving – not just surviving
1. Learn from international practice
2. Identify who is at risk
3. Test new strategies
• Mul...

Disability after ICU Hodgson et al, ICM, 2017

Demographic and hospital data
N=262 Survivors
Age, mean ± SD 59 ± 16
Male, % (N) 67 (175)
APACHE II, mean ± SD 19 ± 8
Tota...

Results – WHODAS at 6 months
• Disability was highest in the areas of physical activity e.g. walking
Disability WHODAS - 2...

Multivariable analysis: Predictors of disability
Predictor Odds Ratio P Value
History of anxiety / depression 1·65 [1·22, ...

Differences in health status (EQ5D-5L) at 6months
No problem No Disability
(N=197)
Disability (N=65) P
Mobility, N (%) 53%...

Return to Work
• One third had not returned to work (if previously working)
• Predictors of being unemployed due to health...

Patient Interviews on Recovery Orford et al, unpublished
Two themes:
1. Physical recovery was hardest
– “even getting dres...

Strategies to improve recovery
1. Learn from international practice
2. Identify who is at risk
3. Test new strategies

Survey of 101 ICU Clinicians
Iwashyna, Hodgson, Pilcher,
Bailey and Bellomo, CCR, 2015

Early ICU Interventions:
Mobilisation – TEAM
Sedation – SPICE
Nutrition – TARGET

• Diaries
• Sleep
• Noise
• Communication
• Family visiting time
• Pet therapy
• Visits outside
• Transition out of ICU

Take home message @chodgsonANZICRC
• Disability is prevalent in Australian ICU survivors
• Disability impacts physical rec...

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