Functional trajectories of people with chronic critical illness

Sepsis and multi-organ failure in critically ill patients can cause rapid muscle loss reaching up to 15%reduction in cross-sectional area of the rectus femoris muscle within 7 days of admission to the Intensive Care Unit (ICU) (Puthucheray et al. 2013). This leads to severe disability and prolonged duration of mechanical ventilation. In around 20% of cases, a state of chronic critical illness ensues, which is when the initial reason for admission to critical care is no longer the primary driver of the patient's need for prolonged ventilation. These patients typically stay in the ICU for over 10 days.

Although post ICU recovery trajectories have been explored, little is known about the functional recovery of these patients whilst still in the ICU. In addition, retrospective studies have shown that there are potentially subgroups of patients who persist in a prolonged inflammatory and/or immunosuppressed state that persists after CCU discharge and out into recovery; such patients have a poorer functional status, quality of life and persisting anaemia (Bateman, et al. 2009; Griffiths, et al. 2015).

This project's aim is to explore functional recovery trajectories in the ICU, to characterise subgroups of patients with different functional trajectories and to examine the relationship between immunodeficiency, pro-inflammatory states and functional trajectories.

This study will help to elucidate the complex mechanisms of chronic critical illness and may enable clinicians to identify patients early who are at risk of poorer long-term recovery, allowing a more focused design of clinical pathways for those at the highest risk. If prolonged inflammatory state, immunosuppression, catabolism and anaemia are linked with poorer functional trajectory, it may provide a strong rationale for ongoing interventional research to address these at a physiological level.

Related Research Outputs

Corner EJ, Murray EJ, Brett SJ (2019). Qualitative, grounded theory exploration of patients' experience of early mobilisation, rehabilitation and recovery after critical illness. BMJ Open 9(2):e026348.