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Objectives: To compare ICU survivors' subjective mental and functional health before ICU admission and after discharge and to assess determinants of subjective health decline or improvement., Design: Secondary analysis of the multicenter cluster-randomized Enhanced Recovery after Intensive Care trial ( ClinicalTrials.gov : NCT03671447)., Setting: Ten ICU clusters in Germany., Patients: Eight hundred fifty-five patients with 1478 follow-up assessments., Interventions: None., Measurements and Main Results: At two patient follow-ups scheduled 3 and 6 months after ICU discharge, patients rated their subjective mental and functional/physical health on two separate visual analog scales from 0 (worst) to 10 (best) in the previous week and before ICU admission. We compared pre-ICU and post-ICU subjective health and used mixed-effects regression to assess determinants of a health decline or improvement. At the first follow-up, 20% ( n = 165/841) and 30% ( n = 256/849) of patients reported a decline in subjective mental and functional health of at least three points, respectively; 16% ( n = 133/841 and n = 137/849) outlined improvements of mental and functional health. For 65% ( n = 543/841) and 54% ( n = 456/849), mental and functional health did not change three points or more at the first follow-up. Multivariable mixed-effects logistic regressions revealed that the ICU length of stay was a predictor of mental (adjusted odds ratio [OR] per ICU day, 1.04; 95% CI, 1.00-1.09; p = 0.038) and functional health (adjusted OR per ICU day, 1.06; 95% CI, 1.01-1.12; p = 0.026) decline. The odds of a mental health decline decreased with age (adjusted OR per year, 0.98; 95% CI, 0.96-0.99; p = 0.003) and the odds of a functional health decline decreased with time after discharge (adjusted OR per month, 0.86; 95% CI, 0.79-0.94; p = 0.001)., Conclusions: The majority of ICU survivors did not experience substantial changes in their subjective health status, but patients with long ICU stays were prone to subjective mental and functional health decline. Hence, post-ICU care in post-ICU clinics could focus on these patients., Competing Interests: Drs. Paul’s, Cittadino’s, Spies’s, and Weiss’s institution received funding from the German Innovation Fund of the Federal Joint Committee during the conduct of the study. Outside the submitted work, Dr. Paul reports financial support for attending meetings and travel from Teladoc Health. Dr. Spies’ institution received funding from the Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)/German Aerospace Center and the Einstein Stiftung Berlin/Einstein Foundation Berlin; she disclosed Inner University Grants, grants from Projektträger im Deutsches Zentrum für Luft- und Raumfahrt e. V., Project Management Agency, grants from Stifterverband, Nonprofit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from the Federal Ministry for Economic Affairs and Climate Action, personal fees from Georg Thieme Verlag, grants from Dr. Franz Köhler Chemie GmbH, grants from Sintetica GmbH, grants from Max-Planck-Gesellschaft zur Förderung der Wissenschaften e. V., grants from Stifterverband für die deutsche Wissenschaft e. V., Metronic, grants from Philips Electronics Nederland BV, grants from Federal Ministry of Education and Research (BMBF), grants from BMBF/Robert Koch Institute (RKI), and grants from Deutsche Forschungsgemeinschaft/German Research Society; she disclosed ownership of patent 15753 627.7 issued in Europe (Germany/Austria/Switzerland/Liechtenstein/France/United Kingdom/The Netherlands) as inventor, a U.S. patent PCT/EP 2015/067731 issued as inventor, a patent 3 174 588 issued in Europe (Germany/Switzerland/Liechtenstein/France/The Netherlands) as inventor, an international patent 10 2014 215 211.9 licensed, an international patent 10 2018 114 364.8 licensed, an international patent 10 2018 110 275.5 licensed, an international patent 50 2015 010 534.8 licensed, an international patent 50 2015 010 347.7 licensed, and an international patent 10 2014 215 212.7 licensed; she disclosed an unpaid role in the Association of the Scientific Medical Societies in Germany, an unpaid role in the German Research Foundation review boards, and an unpaid membership role in the German National Academy of Sciences—Leopoldina. Dr. Weiss’ institution received funding from the Federal Joint Committee (Enhanced Recovery after Intensive Care 01NVF16011); he received funding from the German Ministry of Health, Orion Pharma, Dr. Franz Köhler Chemie, and Teladoc Health GmbH; he disclosed participation on the Delirium-Task-Force Advisory Board of the European Society of Intensive Care Medicine; and he disclosed position as regional chair of the state of Berlin of the German Society of Anesthesiology and Intensive Care. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)

Objectives: Survivors of critical illness commonly show impaired health-related quality of life (HrQoL). We investigated if HrQoL can be approximated by brief, easily applicable items to be used in primary care., Design: Secondary analysis of data from the multicenter, cluster-randomized controlled Enhanced Recovery after Intensive Care trial ( ClinicalTrials.gov : NCT03671447) and construct validity study., Setting: Ten participating clusters of ICUs in the metropolitan area of Berlin, Germany., Patients: Eight hundred fifty ICU survivors enrolled in a mixed, medical or surgical ICU when they had an expected ICU length of stay of at least 24 hours, were at least 18 years old, and had statutory health insurance coverage., Interventions: None., Measurements and Main Results: Patients received follow-ups scheduled 3 and 6 months after ICU discharge. HrQoL was assessed with the EuroQol 5-Dimension 5-Level (EQ-5D-5L), and patients were asked to rate their current mental and physical health state from 0 (worst) to 10 (best). We fitted prediction models for the EQ-5D-5L index value using these two items and additional covariates, applying stepwise regression and adaptive lasso. Subjective mental health (Spearman: 0.59) and subjective physical health (Spearman: 0.68) correlated with EQ-5D-5L index values and were better predictors of EQ-5D-5L index values in the two-item regression (normalized root mean squared error [nRMSE] 0.164; normalized mean absolute error [nMAE] 0.118; R2adj 0.43) than the EQ-5D Visual Analog Scale (nRMSE 0.175; nMAE 0.124; R2adj 0.35). Stepwise regression with additional covariates further increased prediction performance (nRMSE 0.133; nMAE 0.1; R2adj 0.51)., Conclusions: Asking patients to rate their subjective mental and physical health can be an easily applicable tool for a first impression of the HrQoL in primary care settings., Competing Interests: Drs. Paul, Weiss, and Spies reports grants from Gemeinsamer Bundesausschuss (G-BA)/Federal Joint Committee—Innovationsfonds during the conduct of the study. Drs. Cittadino, Krampe, and Denke declare no conflicts of interest. Outside the submitted work, Dr. Weiss reports grants from the European Society of Intensive Care Medicine (ESICM), consulting fees from OrionPharma Ltd., honoraria from Dr. F. Köhler Chemie, support for attending meetings and travel from Teladoc Health, a leadership role as ESICM NEXT Chair, a member role in the ESICM ARDS Guideline group, and a member role in the COVRIIN Group of the Robert Koch Institute. Outside the submitted work, Dr. Spies reports grants from Deutsche Forschungsgemeinschaft/German Research Society, grants from Deutsches Zentrum für Luft- und Raumfahrt e. V. (DLR)/German Aerospace Center, grants from Projektträger im DLR/Project Management Agency, grants from Stifterverband/Non-Profit Society Promoting Science and Education, grants from European Society of Anaesthesiology and Intensive Care, grants from Baxter Deutschland GmbH, grants from Cytosorbents Europe GmbH, grants from Edwards Lifesciences Germany GmbH, grants from Fresenius Medical Care, grants from Grünenthal GmbH, grants from Masimo Europe Ltd., grants from Pfizer Pharma PFE GmbH, personal fees from Georg Thieme Verlag, grants from Dr. F. Köhler Chemie GmbH, grants from Sintetica GmbH, grants from Stifterverband für die deutsche Wissenschaft e.V./Philips, grants from Stiftung Charité, grants from AGUETTANT Deutschland GmbH, grants from AbbVie Deutschland GmbH & Co. KG, grants from Amomed Pharma GmbH, grants from InTouch Health, grants from Copra System GmbH, grants from Correvio GmbH, grants from G-BA/Federal Joint Committee—Innovationsfonds, grants from Max-Planck-Gesellschaft zur Förderung der Wissenschaften e.V., grants from Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin, grants from Stifterverband für die deutsche Wissenschaft e.V./Metronic, grants from Philips ElectronicsNederland BV, grants from BMBF—Federal Ministry of Education and Research, grants from BMBF/RKI, grants from Deutsche Forschungsgemeinschaft/German Research Society, and grants from Drägerwerk AG & Co. KGaA; in addition, Dr. Spies has a patent 10 2014 215 211.9 licensed, a patent 10 2018 114 364.8 licensed, a patent 10 2018 110 275.5 licensed, a patent 50 2015 010 534.8 licensed, a patent 50 2015 010 347.7 licensed, and a patent 10 2014 215 212.7 licensed., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)

Background and Objectives: In 2012, the umbrella term post-intensive care syndrome (PICS) was introduced to capture functional long-term impairments of survivors of critical illness. We present a bibliometric network analysis of the PICS research field. Materials and Methods: The Web of Science core database was searched for articles published in 2012 or later using 'post-intensive care syndrome' and variant spellings. Using VOSviewer, we computed co-authorship networks of countries, institutions, and authors, as well as keyword co-occurrence networks. We determined each country's relative research effort and Category Normalized Citation Index over time and analyzed the 100 most-cited articles with respect to article type, country of origin, and publishing journal. Results: Our search yielded 379 articles, of which 373 were analyzed. Annual PICS research output increased from 11 (2012) to 95 articles (2020). Most PICS research originates from the US, followed by England, Australia, the Netherlands, and Germany. We found various collaborations between countries, institutions, and authors, with recent collaborative networks of English and Australian institutions. Article keywords cover aspects of cognitive, mental health, and physical impairments, and more recently, COVID-19. Only a few keywords and articles pertained to PICS prevention and treatment. Conclusions: Our analysis of Web of Science-indexed PICS articles highlights the stark increase in PICS research output in recent years, primarily originating from US- and Europe-based authors and institutions. Despite the research field's growth, knowledge gaps with respect to PICS prevention and treatment remain.