CHEST Guidelines-Patient-Centered-Outcomes-After-Sepsis

Patient-Centered-Outcomes-After-Sepsis_chest

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The editorial in the "Chest" journal discusses the complex issues surrounding patient-centered outcomes following sepsis and critical illness in ICU survivors. The traditional focus of ICU survivorship research has been on quantifying post-ICU impairments using frameworks like the Post-Intensive Care Syndrome, which categorizes impairments into cognition, mental health, and physical function. Alternatively, health-related quality of life (HRQoL) measures consider participation restrictions and social functioning.<br /><br />Recent studies emphasize the importance of considering how patients perceive their health, not just the impairments quantified through HRQoL. Carey et al.'s work represents a pivotal shift, highlighting the discrepancy between objective health measures and patients' subjective health ratings, finding post-sepsis survivors report worse health ratings initially, but these differences diminish over time, possibly due to psychological adaptation.<br /><br />The research explores the "disability paradox," where individuals with impairments report better than expected quality of life compared to healthy individuals hypothesizing their own potential impairment. This paradox raises questions about psychological resilience and adaptation post-critical illness. The research suggests that ICU survivorship studies should integrate both physical and psychological domains to fully capture patient experiences and outcomes.<br /><br />Additionally, the study acknowledges methodological challenges, like checking biases from the high mortality rates among sepsis survivors, and advocates for sophisticated modeling to handle right censoring issues. Future research directions involve understanding psychological adaptation processes post-sepsis or similar illnesses, potentially affecting interventions aimed at improving ICU survivors' quality of life. The editorial reiterates the need to consider patient perceptions as a formal and valuable component of assessing outcomes after critical illnesses.

Keywords

ICU survivorship

patient-centered outcomes

Post-Intensive Care Syndrome

health-related quality of life

subjective health ratings

disability paradox

psychological resilience

sepsis survivors

methodological challenges

psychological adaptation