Commentary Long-term sequelae of critical illness: memories and health- related quality of life

Impaired health-related quality of life after critical illness has been demonstrated in a number of studies. It is not clear exactly how or why critical illness and intensive care lead to impaired health status, but understanding this association is an important step to improving long-term outcomes of the critically ill. There is growing evidence that neuro-psychological symptoms play a significant role in this impairment and that management of patients in the intensive care unit (ICU) may influence these symptoms. This commentary examines a recent study and places this study in the context of previous studies suggesting that both amnesia and persisting nightmares of the ICU experience are associated with impaired quality of life. Further research is needed if we are effectively to understand, prevent and treat the negative sequelae of critical illness. In their large, multicenter follow-up study of survivors of critical illness, Granja and colleagues [1] asked the question, ‘Are memories of the intensive care experience associated with long-term health related quality of life?’ The study adds to the growing body of literature that addresses long-term outcomes after critical illness, and specifically the effect of critical illness on long-term health-related quality of life. That health-related quality of life is impaired after critical illness has been demonstrated in a number of studies over the past decade [2–5]. It is still not clear exactly how or why critical illness and intensive care lead to impaired health status. For example, studies of patients with acute lung injury (ALI) show that most survivors have impaired quality of life, despite rapid resolution in lung function in the majority of survivors [2]. This observation led to detailed follow-up studies of ALI survivors that looked for other contributors to impaired health status apart from pulmonary function. These innovative studies showed that ALI survivors suffered from a number of problems that impair quality of life, including muscle weakness [5], cognitive impairments [6], sleep difficulties [7], and symptoms of post-traumatic stress disorder (PTSD) [8]. Furthermore, one study [3] suggested that health-related quality of life is worse in survivors of ALI than among critically ill patients with similar severity of illness on admission but who did not develop ALI. This body of literature suggests that critical care clinicians and researchers need to understand and work to minimize the long-term effects of critical illness on the quality of their patients’ lives.