• Nicholas E Ingraham, Victor Vakayil, Kathryn M Pendleton, Alexandria J Robbins, Rebecca L Freese, Elise F Northrop, Melissa E Brunsvold, Anthony Charles, Jeffrey G Chipman, and Christopher J Tignanelli.
• Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
• Crit. Care Med. 2020 Nov 1; 48 (11): 1556-1564.

ObjectivesPhysical and psychologic deficits after an ICU admission are associated with lower quality of life, higher mortality, and resource utilization. This study aimed to examine the prevalence and secular changes of functional status deterioration during hospitalization among nonsurgical critical illness survivors over the past decade.DesignWe performed a retrospective longitudinal cohort analysis.SettingAnalysis performed using the Cerner Acute Physiology and Chronic Health Evaluation outcomes database which included manually abstracted data from 236 U.S. hospitals from 2008 to 2016.PatientsWe included nonsurgical adult ICU patients who survived their hospitalization and had a functional status documented at ICU admission and hospital discharge. Physical functional status was categorized as fully independent, partially dependent, or fully dependent.InterventionsNone.Measurements And Main ResultsFunctional status deterioration occurred in 38,116 patients (29.3%). During the past decade, functional status deterioration increased in each disease category, as well as overall (prevalence rate ratio, 1.15; 95% CI, 1.13-1.17; p < 0.001). Magnitude of functional status deterioration also increased over time (odds ratio, 1.03; 95% CI, 1.03-1.03; p < 0.001) with hematological, sepsis, neurologic, and pulmonary disease categories having the highest odds of severe functional status deterioration.ConclusionsFollowing nonsurgical critical illness, the prevalence of functional status deterioration and magnitude increased in a nationally representative cohort, despite efforts to reduce ICU dysfunction over the past decade. Identifying the prevalence of functional status deterioration and primary etiologies associated with functional status deterioration will elucidate vital areas for further research and targeted interventions. Reducing ICU debilitation for key disease processes may improve ICU survivor mortality, enhance quality of life, and decrease healthcare utilization.

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