This cross-sectional study is focused on conducting post ICU discharge general health survey. Our study illustrates that ICU survivors within one year following ICU discharge have report good wellbeing and they are satisfied with the level of their quality of life. Our study findings are different than the findings of one study that reported lower quality of life of MERS survivors following critical illness in Saudi Arabia11. QoL understanding and acceptance of general health measures in our population is different compared to low health wellbeing internationally. A justification to this, might be cultural and religious believe of our participants especially being thankful to survive the critical illness. Also, we conducted the survey on mixed ICU population, surgical ICU survivors who admitted for close observation after operation might have better general health and quality of life due to better baseline condition and less comorbidities.
Nonetheless, conducting an early post hospital discharge to assess overall health survey is important to be conducted by multidisciplinary team of health care providers to identify early health related issues. Nurses, physicians, and pharmacists can work with together to assure the wellbeing of ICU survivors and to optimize their QoL and drugs related problems. There are several services can be provided to ICU survivors, included but not limited to conduct phone surveys following ICU discharge to early identify health issues, perform comprehensive medication management services, counsel ICU survivors and their relatives, and address health preventive measures. A recent opinion paper identified and described services for the management of ICU survivors and support of their caregivers in intensive care unit recovery clinics (ICU-RCs). The paper concluded that an interprofessional team in ICU-RCs can play a vital role to promote education on as post-intensive care syndrome (PICS), improve medication adherence, ensure comprehensive medication management and medication reconciliation, provide assessment of inappropriate and appropriate medications after hospitalization, and address adverse drug events (ADEs)13.
Our findings related to ICU survivors’ pain and requirement of medical treatment to perform daily functional activities is similar to those reported in ICU follow up studies. A prospective study conducted to assess functional status of ICU survivors three months after discharge, has concluded a fall in the physical activities following ICU discharge14. An important aspect that needs to be addressed for ICU survivors in Saudi Arabia is which patients are at higher risk of functional status decline following ICU discharge. A prospective multicenter trial conducted in Canada reported that the level of frailty of ICU survivors was linked with greater impairment in health-related quality of life, functional dependence, and disability compared with those not frail15.
Within one-year post ICU discharge, most of participants in our study have reported mental health related issues such as depression, anxiety and/or blue mood, this findings in agreement with one of the well-known major health related problems post ICU discharge. Most patients who survive an ICU admission develop health-related issues which are defined as post-intensive care syndrome (PICS) that start in the ICU and persist after discharge. This syndrome can affect the patient’s physical, mental, and emotional well- being. PICS is considered one of the challenges for ICU survivors and their families because half of patients never return to their baseline status2,3,16,17. One meta-analysis conducted to evaluate anxiety symptoms one year following ICU discharge and found that one third of ICU survivors experience anxiety symptoms that are persistent during their first year of recovery18. Post ICU anxiety and other psychiatric related issues for ICU survivors deserve national efforts in to standardize their management and follow up.
ICU survivors in our study reported satisfaction with family, social and medical support within one year following discharge. Family support has been reported in several studies as a key factor in improving ICU survivorship. According to one study, social support has a direct proportion with QoL improvement, showing that subjects who have good support have a better HRQoL8.. Identifying patients’ support needs following critical illness is another aspect worth further investigation to help organizations and decision makers to understand the needs at different transition periods.
ICU LoS were not correlated with the general health status following ICU discharge within one year. Our study is not intendent to assess the determinants of QoL, but it helps to bring attention to this aspect in ICU survivor for more investigation on determinants of HRQoL after ICU.
Our study is subject to several limitations. First, selection bias may be present, this small study sample in one center may not represent all ICU survivor health status in Saudi Arabia. Second, due to limited medical documentation, specifically information related to severity of illness, dependence on ventilator and exposure to sedatives or neuromuscular blocking agents which might be an important factor in HRQoL outcomes assessment. Third, we conducted the abbreviated survey via phone and not in person so validation of phone versus self-administered survey and accuracy of participant understanding is questionable. Lastly, our findings are limited to be generalized outside Saudi Arabia especially the family support part as this is an obligatory part of the family structure, also is limited to generalize the results, due to having a mixed SICU and MICU patients, a future study that take in consideration specific ICU survivors is needed.
This cross-sectional study has provided some preliminary information regarding the general health status and support for ICU survivors in Saudi Arabia. Prospective longitudinal multicenter studies to assess the correlation between ICU admission and Post ICU health related outcomes are highly needed. Information from these studies will help in services provision and will stimulate different initiatives related to improvement of ICU survivor’s quality of life.