How to reduce physical and mental impairment post-ICU? Results from the RAPIT study

For many years, the main focus of intensive care has been to secure patient survival. However, there is now substantial evidence showing that surviving an ICU stay is just the first step of a long journey towards recovery. Many patients have prolonged or even permanent impairments in physical, cognitive and mental health status post-ICU, and there is growing recognition of the need to develop interventions that can reduce post-ICU impairments.

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The aim of the randomised controlled RAPIT trial (Recovery and Aftercare in Post-Intensive Therapy patients) was to test the effectiveness of a post-ICU recovery programme compared to standard care during the first year after ICU discharge.Patients receiving mechanical ventilation for 48 hours or more were eligible to participate in the study. Patients were randomly assigned to either standard care plus a nurse-led intensive care recovery programme or standard care alone. Standard care included ICU care such as light sedation, early mobilisation and delirium assessment, but no post-ICU follow-up. The recovery programme consisted of a “Life after ICU” pamphlet and three consultations conducted by trained study nurses. The first consultation was conducted at the clinic 1-3 months post-ICU where an illness narrative was constructed based on patient photographs taken by ICU nurses. Second and third consultation took place at 5 and 10 months post-ICU and were conducted by phone.

The primary outcome was health-related quality of life (HRQOL) assessed by The Medical Health Survey Short-Form 36 (SF-36) at 12 months and secondary outcomes were sense of coherence (SOC), anxiety, depression, and post-traumatic stress disorder (PTSD) assessed at 3 and 12 months.

The study included 386 adult ICU patients (190 intervention, 196 standard care) from 10 Danish ICUs. No difference in HRQOL was found between intervention and standard care groups. The mean Physical Component Summary scores were 39.1 and 37.7, respectively (p=0.35) and mean Mental Component Summary scores were 51.9 and 50.0, respectively (p=0.21). No differences were found on self-reported SOC, anxiety, depression or PTSD.

Take home Messages from the RAPIT study:

  • This tested recovery programme was not superior to standard care during a 12 month post-ICU follow-up period.
  • Strengths of the study include the multicentre RCT design and well-defined intervention.
  • Limitations include the lack of information on pre-ICU HRQOL.

This article review was submitted by Hanne Irene Jensen, member of the ESICM Ethics Section and the Journal Review Club.


Reference

Jensen JF et al.: A recovery programme to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicentre randomised controlled trial, the RAPIT study. ICM 2016 (E-pub. ahead of print)

Source ESICM

http://www.esicm.org

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