70 CHAPTER 4 the Netherlands. Results may not be identical in a different, for example academic or international, setting. Furthermore, the number of lost-to-followup has the potential to create unaccounted bias, although the percentage is lower than reported in previous literature on post-ICU follow-up services and research.4 Moreover, as this study has a longer and more extensive follow-up than our regular specialised outpatient clinic, it is notable that the researchers managed to complete the follow up the majority of participants despite the ongoing COVID-19 pandemic. Group characteristics of these dropouts make it unlikely to contribute to a substantially lower percentage of non-recovery (S1 Table). In conclusion, long-term recovery after critical illness is limited in a proportion of ICU-survivors. This lack of recovery is reflected in overall impaired HRQoL and untenable consequences for patients’ healthcare needs, as well as their ability to reintegrate in society. In our study, baseline HRQoL appeared to be an important predictor of long-term outcomes, but not CFS. And (proxy-derived) HRQoL may help to identify patients at risk of long-term nonrecovery. It is essential to investigate rehabilitation potential of patients that are unable to recover within the current aftercare setting. Personalised preventative and aftercare interventions to support patients at risk are urgently needed.
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