Skip to main content
SpringerLink
Log in

Long-term survival from intensive care: a review

  • Systematic Review
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To determine whether the long-term benefit of an ICU requires prolonged patient follow-up we reviewed long-term survival of patients from general ICUs.

Method

We carried out a computerised search of online databases Medline (1966–2004), Embase (1966–2004) and Cochrane Library (1966–2004) for studies reporting patients’ long-term survival for greater than 12 months from general ICUs.

Selected studies

We identified 19 studies that met the selection criteria. The casemix and severity of illness varied. Differences included the services provided, investigator inclusion/exclusion criteria and proportion of medical patients (range 13–79%).

Results

Mean reported ICU length of stay was 5.3 days. The study initiation time for follow-up varied (mostly from time of ICU admission), as did the duration of follow-up (16 months–13 years). ICU and hospital mortality rates ranged from 8% to 33% and 11% to 64%, respectively. The reported 5-year mortality ranged from 40% to 58%.

Conclusions

Well designed studies on long-term outcomes are needed to demonstrate the value of intensive care. Deficiencies in design, methodology, and reporting make interpretation and comparison difficult. Recommendations are made for the reporting of outcome from the ICU. Optimum duration of follow-up has not been determined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Halpern NA, Bettes L, Greenstein R (1994) Federal and nationwide intensive care units and healthcare costs: 1986–1992. Crit Care Med 22:2001–2007

    PubMed  Google Scholar 

  2. Halpern NA, Pastores SM, Greenstein RJ (2004) Critical care medicine in the United States 1985–2000: an analysis of bed numbers, use, and costs. Crit Care Med 32:1254–1259

    Article  PubMed  Google Scholar 

  3. Audit Commission for Local Authorities & NHS in England & Wales (1999) Critical to Success. The place of efficient and effective critical care services within the acute hospital. Audit Commission, London

  4. Acute Health Division DoHS (1997) Review of intensive care in Victoria (phase 1 report). Department of Human Services, Melbourne

  5. Keenan SP, Dodek P, Chan K, Hogg RS, Craib KJ, Anis AH, Spinelli JJ (2002) Intensive care unit admission has minimal impact on long-term mortality. Crit Care Med 30:501–507

    Article  PubMed  Google Scholar 

  6. Flaatten H, Kvale R (2001) Survival and quality of life 12 years after ICU. A comparison with the general Norwegian population. Intensive Care Med 27:1005–1011

    Article  PubMed  Google Scholar 

  7. Kerridge RK, Glasziou PP, Hillman KM (1995) The use of “quality-adjusted life years” (QALYs) to evaluate treatment in intensive care. Anaesth Intensive Care 23:322–331

    PubMed  Google Scholar 

  8. Mendelsohn AB, Belle SH, Fischhoff B, Wisniewski SR, Degenholtz H, Chelluri L, Investigators Q-MS (2002) How patients feel about prolonged mechanical ventilation 1 year later. Crit Care Med 30:1439–1445

    Article  PubMed  Google Scholar 

  9. Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J (2003) Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation. Crit Care Med 31:1373–1381

    Article  PubMed  Google Scholar 

  10. Heyland DK, Konopad E, Noseworthy TW, Johnston R, Gafni A (1998) Is it ‘worthwhile’ to continue treating patients with a prolonged stay (>14 days) in the ICU? An economic evaluation. Chest 114:192–198

    PubMed  Google Scholar 

  11. Lipsett PA, Swoboda SM, Dickerson J, Ylitalo M, Gordon T, Breslow M, Campbell K, Dorman T, Pronovost P, Rosenfeld B (2000) Survival and functional outcome after prolonged intensive care unit stay. Ann Surg 231:262–268

    Article  PubMed  Google Scholar 

  12. Niskanen M, Ruokonen E, Takala J, Rissanen P, Kari A (1999) Quality of life after prolonged intensive care. Crit Care Med 27:1132–1139

    Article  PubMed  Google Scholar 

  13. Chelluri L, Mendelsohn AB, Belle SH, Rotondi AJ, Angus DC, Donahoe MP, Sirio CA, Schulz R, Pinsky MR (2003) Hospital costs in patients receiving prolonged mechanical ventilation: does age have an impact? Crit Care Med 31:1746–1751

    Article  PubMed  Google Scholar 

  14. Djaiani G, Ridley S (1997) Outcome of intensive care in the elderly. Anaesthesia 52:1130–1136

    Article  PubMed  Google Scholar 

  15. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  PubMed  Google Scholar 

  16. Quartin AA, Schein RM, Kett DH, Peduzzi PN (1997) Magnitude and duration of the effect of sepsis on survival. Department of Veterans Affairs Systemic Sepsis Cooperative Studies Group. JAMA 277:1058–1063

    Article  PubMed  Google Scholar 

  17. Brun-Buisson C, Doyon F, Carlet J, Dellamonica P, Gouin F, Lepoutre A, Mercier JC, Offenstadt G, Regnier B (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 274:968–974

    Article  PubMed  Google Scholar 

  18. Perl TM, Dvorak L, Hwang T, Wenzel RP (1995) Long-term survival and function after suspected gram-negative sepsis. JAMA 274:338–345

    Article  PubMed  Google Scholar 

  19. Angus DC, Musthafa AA, Clermont G, Griffin MF, Linde-Zwirble WT, Dremsizov TT, Pinsky MR (2001) Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 163:1389–1394

    PubMed  Google Scholar 

  20. Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS, Canadian Critical Care Trials G (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693

    Article  PubMed  Google Scholar 

  21. Davidson TA, Rubenfeld GD, Caldwell ES, Hudson LD, Steinberg KP (1999) The effect of acute respiratory distress syndrome on long-term survival. Am J Respir Crit Care Med 160:1838–1842

    PubMed  Google Scholar 

  22. Schelling G, Stoll C, Vogelmeier C, Hummel T, Behr J, Kapfhammer HP, Rothenhausler HB, Haller M, Durst K, Krauseneck T, Briegel J (2000) Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Med 26:1304–1311

    Article  PubMed  Google Scholar 

  23. Patton RM, Miller R (1999) Prolonged intensive care unit length of stays. J Trauma 46:204

    Google Scholar 

  24. Fakhry SM, Kercher KW, Rutledge R (1996) Survival, quality of life, and charges in critically III surgical patients requiring prolonged ICU stays. J Trauma 41:999–1007

    PubMed  Google Scholar 

  25. Vazquez Mata G, Rivera Fernandez R, Perez Aragon A, Gonzalez Carmona A, Fernandez Mondejar E, Navarrete Navarro P (1996) Analysis of quality of life in polytraumatized patients two years after discharge from an intensive care unit. J Trauma 41:326–332

    PubMed  Google Scholar 

  26. Frutiger A, Ryf C, Bilat C, Rosso R, Furrer M, Cantieni R, Ruedi T, Leutenegger A (1991) Five years’ follow-up of severely injured ICU patients. J Trauma 31:1216–1225

    PubMed  Google Scholar 

  27. Bashour C, Yared J, Ryan T, Rady M, Mascha E, Leventhal M, Starr N (2000) Long-term survival and functional capacity in cardiac surgery patients after prolonged intensive care. Crit Care Med 28:3847–3853

    Article  PubMed  Google Scholar 

  28. Engoren M, Buderer NF, Zacharias A (2000) Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery. Crit Care Med 28:2742–2749

    Article  PubMed  Google Scholar 

  29. Caine N, Sharples LD, Wallwork J (1999) Prospective study of health related quality of life before and after coronary artery bypass grafting: outcome at five years. Heart 81:347–351

    PubMed  Google Scholar 

  30. Gopal I, Bhonagiri S, Ronco C, Bellomo R (1997) Out of hospital outcome and quality of life in survivors of combined acute multiple organ and renal failure treated with continuous venovenous hemofiltration/hemodiafiltration. Intensive Care Med 23:766–772

    Article  PubMed  Google Scholar 

  31. Korkeila M, Ruokonen E, Takala J (2000) Costs of care, long-term prognosis and quality of life in patients requiring renal replacement therapy during intensive care. Intensive Care Med 26:1824–1831

    PubMed  Google Scholar 

  32. Hurel D, Loirat P, Saulnier F, Nicolas F, Brivet F (1997) Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale. Intensive Care Med 23:331–337

    Article  PubMed  Google Scholar 

  33. Mundt DJ, Gage RW, Lemeshow S, Pastides H, Teres D, Avrunin JS (1989) Intensive care unit patient follow-up. Mortality, functional status, and return to work at six months. Arch Intern Med 149:68–72

    Article  PubMed  Google Scholar 

  34. Wehler M, Martus P, Geise A, Bost A, Mueller A, Hahn EG, Strauss R (2001) Changes in quality of life after medical intensive care. Intensive Care Med 27:154–159

    Article  PubMed  Google Scholar 

  35. Zaren B, Bergstrom R (1989) Survival compared to the general population and changes in health status among intensive care patients. Acta Anaesthesiol Scand 33:6–12

    PubMed  Google Scholar 

  36. Wright JC, Plenderleith L, Ridley SA (2003) Long-term survival following intensive care: subgroup analysis and comparison with the general population. Anaesthesia 58:637–642

    Article  PubMed  Google Scholar 

  37. Potgieter PD, Rosenthal E, Benatar SR (1985) Immediate and long-term survival in patients admitted to a respiratory ICU. Crit Care Med 13:798–802

    PubMed  Google Scholar 

  38. Douglas SL, Daly BJ, Gordon N, Brennan PF (2002) Survival and quality of life: short-term versus long-term ventilator patients. Crit Care Med 30:2655–2662

    Article  PubMed  Google Scholar 

  39. Loes O, Smith-Erichsen N, Lind B (1987) Intensive care: cost and benefit. Acta Anaesthesiol Scand Suppl 84:3–19

    PubMed  Google Scholar 

  40. Ridley S, Plenderleith L (1994) Survival after intensive care. Comparison with a matched normal population as an indicator of effectiveness. Anaesthesia 49:933–935

    PubMed  Google Scholar 

  41. Ridley S, Jackson R, Findlay J, Wallace P (1990) Long term survival after intensive care. BMJ 301:1127–1130

    PubMed  Google Scholar 

  42. Kvåle R, Flaatten H (2002) Changes in intensive care from 1987 to 1997-has outcome improved? A single centre study. Intensive Care Med 28:1110–1116

    Article  PubMed  Google Scholar 

  43. Niskanen M, Kari A, Halonen P (1996) Five-year survival after intensive care-comparison of 12:180 patients with the general population. Finnish ICU Study Group. Crit Care Med 24:1962–1967

    Article  PubMed  Google Scholar 

  44. Thoner J (1987) Outcome and costs of intensive care. A follow-up study on patients requiring prolonged mechanical ventilation. Acta Anaesthesiol Scand 31:693–698

    PubMed  Google Scholar 

  45. Dragsted L (1991) Outcome from intensive care. A five year study of 1:308 patients. Dan Med Bull 38:365–374

    PubMed  Google Scholar 

  46. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    PubMed  Google Scholar 

  47. Le Gall JR, Loirat P, Alperovitch A, Glaser P, Granthil C, Mathieu D, Mercier P, Thomas R, Villers D (1984) A simplified acute physiology score for ICU patients. Crit Care Med 12:975–977

    PubMed  Google Scholar 

  48. Davis H, 2nd, Lefrak SS, Miller D, Malt S (1980) Prolonged mechanically assisted ventilation. An analysis of outcome and charges. JAMA 243:43–45

    Article  PubMed  Google Scholar 

  49. Schmidt CD, Elliott CG, Carmelli D, Jensen RL, Cengiz M, Schmidt JC, Tolman ED, Clemmer TP (1983) Prolonged mechanical ventilation for respiratory failure: a cost-benefit analysis. Crit Care Med 11:407–411

    PubMed  Google Scholar 

  50. Sage WM, Rosenthal MH, Silverman JF (1986) Is intensive care worth it? An assessment of input and outcome for the critically ill. Crit Care Med 14:777–782

    PubMed  Google Scholar 

  51. Jacobs CJ, van der Vliet JA, van Roozendaal MT, van der Linden CJ (1988) Mortality and quality of life after intensive care for critical illness. Intensive Care Med 14:217–220

    Article  PubMed  Google Scholar 

  52. Parno JR, Teres D, Lemeshow S, Brown RB, Avrunin JS (1984) Two-year outcome of adult intensive care patients. Med Care 22:167–176

    PubMed  Google Scholar 

  53. Nunn JF, Milledge JS, Singaraya J (1979) Survival of patients ventilated in an intensive therapy unit. BMJ 1:1525–1527

    PubMed  Google Scholar 

  54. Jacobson S, Laws A, Rosenthal M (1982) Quality of well being after intensive care unit hospitalization [Abstract]. Anesthesiology 57:A144

    Google Scholar 

  55. Havill JH, Walker L, Sceats JE (1989) Three hundred admissions to the Waikato Hospital intensive therapy unit-survival, costs, and quality of life after two years. N Z Med J 102:179–181

    PubMed  Google Scholar 

  56. Brooks R, Kerridge R, Hillman K, Bauman A, Daffurn K (1997) Quality of life outcomes after intensive care. Comparison with a community group. Intensive Care Med 23:581–586

    Article  PubMed  Google Scholar 

  57. Zimmerman JE, Knaus WA, Judson JA, Havill JH, Trubuhovich RV, Draper EA, Wagner DP (1988) Patient selection for intensive care: a comparison of New Zealand and United States hospitals. Crit Care Med 16:318–326

    PubMed  Google Scholar 

  58. Chelluri L, Im KA, Belle SH, Schulz R, Rotondi AJ, Donahoe MP, Sirio CA, Mendelsohn AB, Pinsky MR (2004) Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 32:61–69

    Article  PubMed  Google Scholar 

  59. Rockwood K, Noseworthy TW, Gibney RT, Konopad E, Shustack A, Stollery D, Johnston R, Grace M (1993) One-year outcome of elderly and young patients admitted to intensive care units. Crit Care Med 21:687–691

    PubMed  Google Scholar 

  60. Kaplan V, Angus DC (2002) Surviving intensive care. Crit Care Med 30:703–705

    Article  PubMed  Google Scholar 

  61. Lam S, Ridley S (1999) Critically ill medical patients, their demographics and outcome. Anaesthesia 54:845–852

    Article  PubMed  Google Scholar 

  62. Badia X, Diaz-Prieto A, Gorriz MT, Herdman M, Torrado H, Farrero E, Cavanilles JM (2001) Using the EuroQol-5D to measure changes in quality of life 12 months after discharge from an intensive care unit. Intensive Care Med 27:1901–1907

    Article  PubMed  Google Scholar 

  63. Ridley S, Burchett K, Gunning K, Burns A, Kong A, Wright M, Hunt P, Ross S (1997) Heterogeneity in intensive care units: fact or fiction? Anaesthesia 52:531–537

    Article  PubMed  Google Scholar 

  64. Angus DC, Sirio CA, Clermont G, Bion J (1997) International comparisons of critical care outcome and resource consumption. Crit Care Clin 13:389–407

    Article  PubMed  Google Scholar 

  65. Block BM, Sirio CA, Cooper GS, DiGiuseppe DL, Rosenthal GE (2000) Use of intensive care-specific interventions in major teaching and other hospitals: a regional comparison. Crit Care Med 28:1204–1207

    Article  PubMed  Google Scholar 

  66. Sirio CA, Tajimi K, Taenaka N, Ujike Y, Okamoto K, Katsuya H (2002) A cross-cultural comparison of critical care delivery: Japan and the United States. Chest 121:539–548

    Article  PubMed  Google Scholar 

  67. Cook CH, Martin LC, Howard B, Flancbaum LJ (1999) Survival of critically ill surgical patients discharged to extended care facilities. J Am Coll Surg 189:437–441

    Article  PubMed  Google Scholar 

  68. Rubenfeld GD, Angus DC, Pinsky MR, Curtis JR, Connors AF Jr, Bernard GR (1999) Outcomes research in critical care: results of the American Thoracic Society Critical Care Assembly Workshop on Outcomes Research. The Members of the Outcomes Research Workshop. Am J Respir Crit Care Med 160:358–367

    PubMed  Google Scholar 

  69. Ridley S, Purdie J (1992) Cause of death after critical illness. Anaesthesia 47:116–119

    PubMed  Google Scholar 

  70. Short TG, Buckley TA, Rowbottom MY, Wong E, Oh TE (1999) Long-term outcome and functional health status following intensive care in Hong Kong. Crit Care Med 27:51–57

    Article  PubMed  Google Scholar 

  71. Roche VM, Kramer A, Hester E, Welsh CH (1999) Long-term functional outcome after intensive care. J Am Geriatr Soc 47:18–24

    PubMed  Google Scholar 

  72. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 9:591–597

    PubMed  Google Scholar 

  73. Le Gall JR, Brun-Buisson C, Trunet P, Latournerie J, Chantereau S, Rapin M (1982) Influence of age, previous health status, and severity of acute illness on outcome from intensive care. Crit Care Med 10:575–577

    PubMed  Google Scholar 

  74. Angus DC, Carlet J, Brussels Roundtable P (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377

    PubMed  Google Scholar 

  75. Dragsted L, Qvist J (1989) Outcome from intensive care. I. A 5-year study of 1308 patients: methodology and patient population. Eur J Anaesthesiol 6:23–37

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Royal Perth Hospital, 6000, Wellington, St. Perth, WA, Australia

    Teresa A. Williams, Geoffrey J. Dobb & Steve A. R. Webb

  2. School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, 6009, Crawley, WA, Australia

    Geoffrey J. Dobb & Steve A. R. Webb

  3. School of Population Health, University of Western Australia, 35 Stirling Highway, 6009, Crawley, WA, Australia

    Teresa A. Williams & Judith C. Finn

Authors
  1. Teresa A. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Geoffrey J. Dobb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Judith C. Finn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steve A. R. Webb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geoffrey J. Dobb.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Williams, T.A., Dobb, G.J., Finn, J.C. et al. Long-term survival from intensive care: a review. Intensive Care Med 31, 1306–1315 (2005). https://doi.org/10.1007/s00134-005-2744-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-005-2744-8

Keywords

Search

Navigation