Both the change in HRQOL during ICU admission and its immediate recovery following ICU discharge have never been studied. This long-term prospective study evaluated the impact of critical illness on the perceived HRQOL in patients admitted to the ICU for > 48 h and surviving up to 6 months following ICU discharge. Before ICU admission, HRQOL was already impaired when compared to the healthy population. This was even more pronounced in the nonsurvivors. Critical illness caused a significant drop in all HRQOL dimensions (except for BP) and the component scores. Interestingly, the recovery of HRQOL during the general ward stay was the most significant improvement in HRQOL for the whole follow-up period of 6 months. At the end of the follow-up, the RE and MH dimensions had returned to pre-ICU admission values. However, PF, RP, GH, and SF dimensions remained lower than the pre-ICU admission values and the values for the healthy population.
In this study, we used the SF-36 questionnaire to assess the quality of life. Other questionnaires, like the EuroQol-5D, have been used in the ICU and would have required significantly less time to com-plete. However, the EuroQol-5D has not been clearly validated for ICU patients. In addition, the SF-36 covers much more domains and is more precise, although imbalances between the different domains in the SF-36 are present. We and others have validated the use of proxies and found good agreement between proxy and patient. Although others have reported poor correlation when using substitute decision makers, a retrospective assessment at 3 months following ICU discharge of the pre-ICU admission HRQOL by the patient was used, and it was unclear whether the substitute decision makers were in close contact with the patient on a regular basis. In addition, we found that proxies, although in close contact, scored the HRQOL in patients with advanced age (ie, > 80 years of age) lower than in patients of younger age (ie, < 80 years of age).