Is de barthelindex bij IC-ontslag voorspellend voor functionele zelfstandigheid op de middellange termijn?

Arkel, J.J. (2017) Is de barthelindex bij IC-ontslag voorspellend voor functionele zelfstandigheid op de middellange termijn? thesis, Medicine.

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Abstract

Introduction: The newly introduced interventions in 2013 at the ICU-MCL, targeted at the post intensive care syndrom (PICS), have led to improved functional independence at ICU discharge. Meanwhile ICU length of stay remained unchanged. This paper tries to determine whether this improvement is still relevant 3 months post-discharge, when patiënts visit the outpatiënt department. Materials & Methods: Ranging through 2012-2016 n=289 IC-MCL admissions where included, that lasted >48h and were seen at the outpatient department. The primary outcome is the Barthelindex (BI), a measure of functional independence, recorded at ICU discharge and the outpatient department. Population characteristics, severity of disease, treatment, BI at ICU discharge and parameters taken at the outpatient department are used to specify the effects of the described interventions. Results: Throughout the years, the patiëntgroup is consistent in its composition. The postintervention group shows a significant reduction length of stay, from 14[5-23] days in 2012 to 10[5-14] days in 2016, and mechanical ventilation duration from 7[4-12] days in 2012 to 5[2-8] days in 2016. The BI at ICU discharge rose significantly from 8[5-12] in 2012 to 13[9-18] in 2016. However, at the outpatient department the BI reaches a ceilling effect where all yearcohorts reach the maximum score. It was observed that a BI of <16 at ICU discharge is significantly predictive for being one of the outliers whom does not reach the maximum BI at the outpatient department. BI at ICU discharge & the scores on subdomains of the BI are predictive for later dissabilities on both the physical and mental spectrum. Discussion: The newly introduced interventions seem to have a limited effect on the physical domain of PICS. Because of the BI’s ceilling effect, other tools are required to adequatily answer the questions this paper poses and to allow for effective followup. Conclusion: The BI ran into a celling effect at 3 months post ICU-discharge. Therefore the BI is not suited for followup of functional independence. A BI of <16 is predictive for not reaching this ceilling effect. The results of the outpatient department show that the interventions leed to improved physical abbilities on the medium-term. They also managed to reduce the ICU length of stay and the duration of mechanical ventilation. The interventions reduce ICU length of stay and duration of mechanical ventilation. They seem to allow patiënts to restore their functional indepence sooner.

Item Type:	Thesis (Thesis)
Supervisor name:	Facultair begeleider: and Boerma, Dr. E.C. and Internist-Intensivist and Locatie: Medisch Centrum Leeuwarden, Intensive Care
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1339

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