A Randomized Clinical Trial to Evaluate the Effect of Post-intensive Care Multidisciplinary Consultations on Mortality and the Quality of Life at 1 Year

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2024 Apr 8

PMID 38587553

Authors

Tarek Sharshar

Lamiae Grimaldi-Bensouda

Shidasp Siami

Alain Cariou

Abdel Ben Salah

Pierre Kalfon

Romain Sonneville

Nicolas Meunier-Beillard

Jean-Pierre Quenot

Bruno Megarbane

Stephane Gaudry

Haikel Oueslati

Segolene Robin-Lagandre

Carole Schwebel

Aurelien Mazeraud

Djillali Annane

Lionelle Nkam

Diane Friedman

Affiliations

Soon will be listed here.

Abstract

Purpose: Critical illness is associated with long-term increased mortality and impaired quality of life (QoL). We assessed whether multidisciplinary consultations would improve outcome at 12 months (M12) after intensive care unit (ICU) discharge.

Methods: We performed an open, multicenter, parallel-group, randomized clinical trial. Eligible are patients discharged alive from ICU in 11 French hospitals between 2012 and 2018. The intervention group had a multidisciplinary face-to-face consultation involving an intensivist, a psychologist, and a social worker at ICU discharge and then at M3 and M6 (optional). The control group had standard post-ICU follow-up. A consultation was scheduled at M12 for all patients. The QoL was assessed using the EuroQol-5 Dimensions-5 Level (Euro-QoL-5D-5L) which includes five dimensions (mobility, self-care, usual activities, pain, and anxiety/depression), each ranging from 1 to 5 (1: no, 2: slight, 3: moderate, 4: severe, and 5: extreme problems). The primary endpoint was poor clinical outcome defined as death or severe-to-extreme impairment of at least one EuroQoL-5D-5L dimension at M12. The information was collected by a blinded investigator by phone. Secondary outcomes were functional, psychological, and cognitive status at M12 consultation.

Results: 540 patients were included (standard, n = 272; multidisciplinary, n = 268). The risk for a poor outcome was significantly greater in the multidisciplinary group than in the standard group [adjusted odds ratio 1.49 (95% confidence interval, (1.04-2.13)]. Seventy-two (13.3%) patients died at M12 (standard, n = 32; multidisciplinary, n = 40). The functional, psychological, and cognitive scores at M12 did not statistically differ between groups.

Conclusions: A hospital-based, face-to-face, intensivist-led multidisciplinary consultation at ICU discharge then at 3 and 6 months was associated with poor outcome 1 year after ICU.

Citing Articles

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