Prevalence and experience of fatigue in survivors of critical illness: A mixed-methods systematic review

Bench, S.; Stayt, L.; Shah, A.; Dhinan, P.; Czuber-Dochan, W.

Objective To investigate the prevalence, experience and management of fatigue in adult survivors of critical illness. Data sources An electronic search was performed on seven databases: CINAHL, Medline, EMBASE, PsycINFO, Emcare, British Nursing Index, and Web of Science. Study selection and data extraction Seventy-six peer-reviewed, English language studies that investigated fatigue or vitality in adult patients admitted to an Intensive Care Unit (ICU) and followed up for any period were included. Extracted data were split into three datasets for analysis: data from vitality domain of SF-36 (dataset A), other quantitative data (dataset B), and qualitative data (dataset C). Methodological quality was assessed using the critical appraisal skills programme (CASP) tools. Data synthesis We adopted a segregated approach to mixed-methods synthesis. We merged all datasets, attributing all results to one of four qualitative themes. These were prevalence and severity, contributing factors, impacts on quality of life, assessment and management. Results The prevalence of fatigue ranged from 13.8 to 80.9 %. Fatigue severity reached its nadir at approximately one month post ICU discharge, improved over time but seldom reached reference population scores. Various biological, disease related and psychological factors associated with fatigue were identified including age, poor pre-morbid status and sleep disturbance. No critical illness specific tool to assess fatigue in ICU survivors was identified. A paucity of evidence based interventions for management of fatigue in ICU survivors were identified despite fatigue negatively impacting on survivors quality of life. Conclusions This mixed method review shows that fatigue is highly prevalent in ICU survivors, negatively impacting their recovery. To date, no ICU specific fatigue assessment tool or targeted intervention has been designed to manage this symptom. Our review has identified factors, which may increase or mitigate against fatigue, along with potential management strategies, which should be used to inform future research and practice.