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Li D, Zhang X, Lu Y, Jing L, Hu H, Song Y, Wu S, Zhu W. Post-sepsis psychiatric disorder: Pathophysiology, prevention, and treatment. Neurol Sci 2024; 45:3093-3105. [PMID: 38381393 PMCID: PMC11176234 DOI: 10.1007/s10072-024-07409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
Post-sepsis psychiatric disorder, encompassing anxiety, depression, post-traumatic stress disorder and delirium, is a highly prevalent complication secondary to sepsis, resulting in a marked increase in long-term mortality among affected patients. Regrettably, psychiatric impairment associated with sepsis is frequently disregarded by clinicians. This review aims to summarize recent advancements in the understanding of the pathophysiology, prevention, and treatment of post-sepsis mental disorder, including coronavirus disease 2019-related psychiatric impairment. The pathophysiology of post-sepsis psychiatric disorder is complex and is known to involve blood-brain barrier disruption, overactivation of the hypothalamic-pituitary-adrenal axis, neuroinflammation, oxidative stress, neurotransmitter dysfunction, programmed cell death, and impaired neuroplasticity. No unified diagnostic criteria for this disorder are currently available; however, screening scales are often applied in its assessment. Modifiable risk factors for psychiatric impairment post-sepsis include the number of experienced traumatic memories, the length of ICU stay, level of albumin, the use of vasopressors or inotropes, daily activity function after sepsis, and the cumulative dose of dobutamine. To contribute to the prevention of post-sepsis psychiatric disorder, it may be beneficial to implement targeted interventions for these modifiable risk factors. Specific therapies for this condition remain scarce. Nevertheless, non-pharmacological approaches, such as comprehensive nursing care, may provide a promising avenue for treating psychiatric disorder following sepsis. In addition, although several therapeutic drugs have shown preliminary efficacy in animal models, further confirmation of their potential is required through follow-up clinical studies.
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Affiliation(s)
- Dayong Li
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Xujie Zhang
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Yuru Lu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Liang Jing
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Hongjie Hu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Yaqin Song
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Shuhui Wu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China
| | - Wei Zhu
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Intensive Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, Hubei, China.
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Elmunzer BJ, Palsson OS, Forbes N, Zakaria A, Davis C, Canakis A, Qayed E, Bick B, Pawa S, Tierney WM, McLeod CG, Taylor J, Patel H, Mendelsohn RB, Bala G, Sloan I, Merchant AA, Smith ZL, Sendzischew Shane MA, Aroniadis OC, Ordiah CO, Ruddy JM, Simren M, Tack J, Drossman D. Prolonged Gastrointestinal Manifestations After Recovery From COVID-19. Clin Gastroenterol Hepatol 2024; 22:1098-1107.e3. [PMID: 37995983 DOI: 10.1016/j.cgh.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/15/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND & AIMS Acute enteric infections are well known to result in long-term gastrointestinal (GI) disorders. Although COVID-19 is principally a respiratory illness, it demonstrates significant GI tropism, possibly predisposing to prolonged gut manifestations. We aimed to examine the long-term GI impact of hospitalization with COVID-19. METHODS Nested within a large-scale observational cohort study of patients hospitalized with COVID-19 across North America, we performed a follow-up survey of 530 survivors 12-18 months later to assess for persistent GI symptoms and their severity, and for the development of disorders of gut-brain interaction (DGBIs). Eligible patients were identified at the study site level and surveyed electronically. The survey instrument included the Rome IV Diagnostic Questionnaire for DGBI, a rating scale of 24 COVID-related symptoms, the Gastrointestinal Symptoms Rating Scale, and the Impact of Events-Revised trauma symptom questionnaire (a measure of posttraumatic stress associated with the illness experience). A regression analysis was performed to explore the factors associated with GI symptom severity at follow-up. RESULTS Of the 530 invited patients, 116 responded (52.6% females; mean age, 55.2 years), and 73 of those (60.3%) met criteria for 1 or more Rome IV DGBI at follow-up, higher than the prevalence in the US general population (P < .0001). Among patients who experienced COVID-related GI symptoms during the index hospitalization (abdominal pain, nausea, vomiting, or diarrhea), 42.1% retained at least 1 of these symptoms at follow-up; in comparison, 89.8% of respondents retained any (GI or non-GI) COVID-related symptom. The number of moderate or severe GI symptoms experienced during the initial COVID-19 illness by self-report correlated with the development of DGBI and severity of GI symptoms at follow-up. Posttraumatic stress disorder (Impact of Events-Revised score ≥33) related to the COVID-19 illness experience was identified in 41.4% of respondents and those individuals had higher DGBI prevalence and GI symptom severity. Regression analysis revealed that higher psychological trauma score (Impact of Events-Revised) was the strongest predictor of GI symptom severity at follow-up. CONCLUSIONS In this follow-up survey of patients 12-18 months after hospitalization with COVID-19, there was a high prevalence of DGBIs and persistent GI symptoms. Prolonged GI manifestations were associated with the severity of GI symptoms during hospitalization and with the degree of psychological trauma related to the illness experience.
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Affiliation(s)
- B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Olafur S Palsson
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina
| | - Nauzer Forbes
- Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ali Zakaria
- Division of Gastroenterology, Department of Medicine, Ascension Providence Hospital/Michigan State University-College of Human Medicine, Southfield, Michigan
| | - Christian Davis
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Andrew Canakis
- Section of Gastroenterology, Department of Medicine, Boston University Medical Center, Boston, Massachusetts
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Grady Memorial Hospital, Atlanta, Georgia
| | - Benjamin Bick
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Swati Pawa
- Division of Gastroenterology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - William M Tierney
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Caroline G McLeod
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jason Taylor
- Division of Gastroenterology and Hepatology, Department of Medicine, Saint Louis University, St. Louis, Missouri
| | - Harsh Patel
- Department of Gastroenterology, Ochsner Health, New Orleans, Louisiana
| | - Robin B Mendelsohn
- Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gokul Bala
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ian Sloan
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ambreen A Merchant
- Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Zachary L Smith
- Division of Gastroenterology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Morgan A Sendzischew Shane
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Olga C Aroniadis
- Division of Gastroenterology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Collins O Ordiah
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Johannah M Ruddy
- Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Magnus Simren
- Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Institute of Medicine, Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jan Tack
- Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Douglas Drossman
- Rome Foundation Research Institute and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Yuan Y, Meng Y, Li Y, Zhou J, Wang J, Jiang Y, Ma L. DEVELOPMENT AND VALIDATION OF A NOMOGRAM FOR PREDICTING 28-DAY IN-HOSPITAL MORTALITY IN SEPSIS PATIENTS BASED ON AN OPTIMIZED ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION II SCORE. Shock 2024; 61:718-727. [PMID: 38517232 DOI: 10.1097/shk.0000000000002335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Purpose : The objective of this study is to establish a nomogram that correlates optimized Acute Physiology and Chronic Health Evaluation II (APACHE II) score with sepsis-related indicators, aiming to provide a robust model for early prediction of sepsis prognosis in clinical practice and serve as a valuable reference for improved diagnosis and treatment strategies. Methods : This retrospective study extracted sepsis patients meeting the inclusion criteria from the MIMIC-IV database to form the training group. An optimized APACHE II score integrated with relevant indicators was developed using a nomogram for predicting the prognosis of sepsis patients. External validation was conducted using data from the intensive care unit at Lanzhou University Second Hospital. Results : The study enrolled 1805 patients in the training cohort and 203 patients in the validation cohort. A multifactor analysis was conducted to identify factors affecting patient mortality within 28 days, resulting in the development of an optimized score by simplifying evaluation indicators from APACHE II score. The results showed that the optimized score (area under the ROC curve [AUC] = 0.715) had a higher area under receiver operating characteristic curve than Sequential Organ Failure Assessment score (AUC = 0.637) but slightly lower than APACHE II score (AUC = 0.720). Significant indicators identified through multifactor analysis included platelet count, total bilirubin level, albumin level, prothrombin time, activated partial thromboplastin time, mechanical ventilation use and renal replacement therapy use. These seven indicators were combined with optimized score to construct a nomogram based on these seven indicators. The nomogram demonstrated good clinical predictive value in both training cohort (AUC = 0.803) and validation cohort (AUC = 0.750). Calibration curves and decision curve analyses also confirmed its good predictive ability, surpassing the APACHE II score and Sequential Organ Failure Assessment score in identifying high-risk patients. Conclusions : The nomogram was established in this study using the MIMIC-IV database and validated with external data, demonstrating its robust discriminability, calibration, and clinical practicability for predicting 28-day mortality in sepsis patients. These findings aim to provide substantial support for clinicians' decision making.
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Affiliation(s)
| | - Yanfei Meng
- Department of Critical Care Medicine, The Second Hospital of Lanzhou University, Lanzhou, China
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Gao J, Yang Y, Yin W, Zhao X, Qu Y, Yang X, Wu Y, Xiang L, Man Y. A nomogram prediction of implant apical non-coverage on bone-added transcrestal sinus floor elevation: A retrospective cohort study. Clin Oral Implants Res 2024; 35:282-293. [PMID: 38108637 DOI: 10.1111/clr.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/18/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To identify the risk indicators and develop and validate a nomogram prediction model of implant apical non-coverage by comprehensively analyzing clinical and radiographic factors in bone-added transcrestal sinus floor elevation (TSFE). MATERIAL AND METHODS A total of 260 implants in 195 patients receiving bone-added TSFE were included in the study. The population was divided into a development (180 implants) and a validation (80 implants) cohort. According to 6 months post-surgery radiographic images, implants were categorized as "apical non-coverage" or "apical covered." The association of risk factors including clinical and radiographic parameters with implant apical non-coverage was assessed using regression analyses. A nomogram prediction model was developed, and its validation and discriminatory ability were analyzed. RESULTS The nomogram predicting bone-added TSFE's simultaneously placed implant's apex non-coverage after 6 months. This study revealed that sinus angle, endo-sinus bone gain, implant protrusion length, graft contact walls, and distal angle were predictors of implant apical non-coverage. The generated nomogram showed a strong predictive capability (area under the curve [AUC] = 0.845), confirmed by internal validation using 10-fold cross-validation (Median AUC of 0.870) and temporal validation (AUC = 0.854). The calibration curve and decision curve analysis demonstrated good performance and high net benefit of the nomogram, respectively. CONCLUSIONS The clinical implementation of the present nomogram is suitable for predicting the apex non-coverage of implants placed simultaneously with bone-added TSFE after 6 months.
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Affiliation(s)
- Jiayu Gao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yufei Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Wumeng Yin
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xiangqi Zhao
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yili Qu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xingmei Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yingying Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Lin Xiang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yi Man
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Schmidt KFR, Gensichen JS, Schroevers M, Kaufmann M, Mueller F, Schelling G, Gehrke-Beck S, Boede M, Heintze C, Wensing M, Schwarzkopf D. Trajectories of post-traumatic stress in sepsis survivors two years after ICU discharge: a secondary analysis of a randomized controlled trial. Crit Care 2024; 28:35. [PMID: 38287438 PMCID: PMC10823628 DOI: 10.1186/s13054-024-04815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Post-traumatic stress has been identified as a frequent long-term complication in survivors of critical illnesses after sepsis. Little is known about long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. Study objective was to explore and compare different clinical trajectories of post-traumatic stress symptoms in sepsis survivors up to two years after discharge from ICU. METHODS Data on post-traumatic stress symptoms by means of the Post-traumatic Symptom Scale (PTSS-10) were collected in sepsis survivors at one, six, 12 and 24 months after discharge from ICU. Data on chronic psychiatric diagnoses prior ICU were derived from the primary care provider's health records, and data on intensive care treatment from ICU documentation. Trajectories of post-traumatic symptoms were identified ex post, discriminating patterns of change and k-means clustering. Assignment to the trajectories was predicted in multinomial log-linear models. RESULTS At 24 months, all follow-up measurements of the PTSS-10 were completed in N = 175 patients. Three clusters could be identified regarding clinical trajectories of PTSS levels: stable low symptoms (N = 104 patients [59%]), increasing symptoms (N = 45 patients [26%]), and recovering from symptoms (N = 26 patients [15%]). Patients with initially high post-traumatic symptoms were more likely to show a decrease (OR with 95% CI: 1.1 [1.05, 1.16]). Females (OR = 2.45 [1.11, 5.41]) and patients reporting early traumatic memories of the ICU (OR = 4.04 [1.63, 10]) were at higher risk for increasing PTSS levels. CONCLUSION Post-traumatic stress is a relevant long-term burden for sepsis patients after ICU stay. Identification of three different trajectories within two years after ICU discharge highlights the importance of long-term observation, as a quarter of patients reports few symptoms at discharge yet an increase in symptoms in the two years following. Regular screening of ICU survivors on post-traumatic stress should be considered even in patients with few symptoms and in particular in females and patients reporting traumatic memories of the ICU.
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Affiliation(s)
- Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany.
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany.
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany.
| | - Jochen S Gensichen
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336, Munich, Germany
| | - Maya Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB, Groningen, The Netherlands
| | - Martina Kaufmann
- Office of Good Scientific Practice, Charité University Medicine, D-10117, Berlin, Germany
| | - Friederike Mueller
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Department of Child and Youth Psychiatry, Psychosomatics and Psychotherapy, Asklepios Hospital Luebben, D-15907, Luebben, Germany
| | - Gustav Schelling
- Department of Anesthesiology, University Hospital of the Ludwig-Maximilians-University Munich, D-80336, Munich, Germany
| | - Sabine Gehrke-Beck
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany
| | - Monique Boede
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, D-69120, Heidelberg, Germany
| | - Daniel Schwarzkopf
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, D-07747, Jena, Germany
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Ferreira FM, Gomes SV, Carvalho LCF, de Alcantara AC, da Cruz Castro ML, Perucci LO, Pio S, Talvani A, de Abreu Vieira PM, Calsavara AJC, Costa DC. Potential of piperine for neuroprotection in sepsis-associated encephalopathy. Life Sci 2024; 337:122353. [PMID: 38104862 DOI: 10.1016/j.lfs.2023.122353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
AIMS Sepsis-associated encephalopathy (SAE) is a common complication that increases mortality and leads to long-term cognitive impairment in sepsis survivors. However, no specific or effective therapy has been identified for this complication. Piperine is an alkaloid known for its anti-inflammatory, antioxidant, and neuroprotective properties, which are important characteristics for treatment of SAE. The objective of this study was to evaluate the neuroprotective effect of piperine on SAE in C57BL/6 mice that underwent cecum ligation and perforation surgery (CLP). MAIN METHODS C57BL/6 male mice were randomly assigned to groups that underwent SHAM surgery or CLP. Mice in the CLP group were treated with piperine at doses of 20 or 40 mg/kg for short- (5 days) or long-term (10 days) periods after CLP. KEY FINDINGS Our results revealed that untreated septic animals exhibited increased concentrations of IL-6, TNF, VEGF, MMP-9, TBARS, and NLRP3, and decreased levels of BDNF, sulfhydryl groups, and catalase in the short term. Additionally, the levels of carbonylated proteins and degenerated neuronal cells were increased at both time points. Furthermore, short-term and visuospatial memories were impaired. Piperine treatment reduced MMP-9 activity in the short term and decreased the levels of carbonylated proteins and degenerated neuronal cells in the long term. It also lowered IL-6 and TBARS levels at both time points evaluated. Moreover, piperine increased short-term catalase and long-term BDNF factor levels and improved memory at both time points. SIGNIFICANCE In conclusion, our data demonstrate that piperine exerts a neuroprotective effect on SAE in animals that have undergone CLP.
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Affiliation(s)
- Flavia Monteiro Ferreira
- Laboratory of Metabolic Biochemistry (LBM), Department of Biological Sciences (DECBI), Graduate Program in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Sttefany Viana Gomes
- Laboratory of Metabolic Biochemistry (LBM), Department of Biological Sciences (DECBI), Graduate Program in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Luana Cristina Faria Carvalho
- Laboratory of Metabolic Biochemistry (LBM), Department of Biological Sciences (DECBI), Graduate Program in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Ana Carolina de Alcantara
- Laboratory of Cognition and Health (LACOS), School of Medicine, Department of Pediatric and Adult Clinics (DECPA), Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Maria Laura da Cruz Castro
- Laboratory of Metabolic Biochemistry (LBM), Department of Biological Sciences (DECBI), Graduate Program in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Luiza Oliveira Perucci
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences (DECBI), Graduate Program in Health and Nutrition, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Sirlaine Pio
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences (DECBI), Graduate Program in Health and Nutrition, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - André Talvani
- Laboratory of Immunobiology of Inflammation, Department of Biological Sciences (DECBI), Graduate Program in Health and Nutrition, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Paula Melo de Abreu Vieira
- Morphopathology Laboratory, Department of Biological Sciences (DECBI), Graduate Program in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Allan Jefferson Cruz Calsavara
- Laboratory of Cognition and Health (LACOS), School of Medicine, Department of Pediatric and Adult Clinics (DECPA), Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Daniela Caldeira Costa
- Laboratory of Metabolic Biochemistry (LBM), Department of Biological Sciences (DECBI), Graduate Program in Biological Sciences, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil.
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Matias ME, Radulski DR, Rodrigues da Silva T, Raymundi AM, Stern CAJ, Zampronio AR. Involvement of cannabinoid receptors and neuroinflammation in early sepsis: Implications for posttraumatic stress disorder. Int Immunopharmacol 2023; 123:110745. [PMID: 37541107 DOI: 10.1016/j.intimp.2023.110745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/20/2023] [Accepted: 07/29/2023] [Indexed: 08/06/2023]
Abstract
Sepsis is associated with several comorbidities in survivors, such as posttraumatic stress disorder (PTSD). This study investigated whether rats that survive sepsis develop the generalization of fear memory as a model of PTSD. Responses to interventions that target the endothelin-1 (ET-1)/cannabinoid system and glial activation in the initial stages of sepsis were evaluated. As a control, we evaluated hyperalgesia before fear conditioning. Sepsis was induced by cecal ligation and puncture (CLP) in Wistar rats. CLP-induced sepsis with one or three punctures resulted in fear generalization in the survivors 13 and 20 days after the CLP procedure, a process that was not associated with hyperalgesia. Septic animals were intracerebroventricularly treated with vehicle, the endothelin receptor A (ETA) antagonist BQ123, the cannabinoid CB1 and CB2 receptor antagonists AM251 and AM630, respectively, and the glial blocker minocycline 4 h after CLP. The blockade of either CB1 or ETA receptors increased the survival rate, but only the former reversed fear memory generalization. The endothelinergic system blockade is important for improving survival but not for fear memory. Treatment with the CB2 receptor antagonist or minocycline also reversed the generalization of fear memory but did not increase the survival rate that was associated with CLP. Minocycline treatment also reduced tumor necrosis factor-α levels in the hippocampus suggesting that neuroinflammation is important for the generalization of fear memory induced by CLP. The influence of CLP on the generalization of fear memory was not related to Arc protein expression, a regulator of synaptic plasticity, in the dorsal hippocampus.
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Affiliation(s)
| | | | | | - Ana Maria Raymundi
- Department of Pharmacology, Federal University of Paraná, Curitiba, PR, Brazil
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Wintermann GB, Weidner K, Strauss B, Rosendahl J. Rates and predictors of mental health care utilisation in patients following a prolonged stay on intensive care unit: a prospective cohort study. BMJ Open 2023; 13:e063468. [PMID: 36693695 PMCID: PMC9884925 DOI: 10.1136/bmjopen-2022-063468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES An acute critical illness and secondary complications may necessitate a prolonged treatment on an intensive care unit (ICU). As long-term consequences, ICU survivors may suffer from both physical and psychological sequelae. To improve the aftercare of these patients, the present study aimed to assess the use of mental healthcare and associated factors following prolonged ICU stay. METHODS N=197 patients with a primary diagnosis of critical illness polyneuropathy/myopathy were enrolled within 4 weeks (T1) and interviewed three (T2) and six (T3) months following the transfer from acute-care to postacute ICU. Symptoms and a current diagnosis of major depression/post-traumatic stress disorder (PTSD) were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. The potential need for mental healthcare, its current and past use and reasons for non-use were raised. RESULTS Full syndromal and subsyndromal major depression/PTSD were diagnosed in 8.3%/15.6% at T2, 12.2%/23.5% at T3. About 29% of the patients reported mental healthcare utilisation. Considering somatic complaints, more important was a common reason for the non-use of mental healthcare. Female gender, previous mental healthcare, number of sepsis episodes and pension receipt increased the chance for mental healthcare utilisation, a pre-existing mental disorder decreased it. CONCLUSION Every fourth patient surviving prolonged ICU treatement makes use of mental healthcare . Particularly male patients with pre-existing mental disorders should be targeted preventively, receiving specific psychoeducation about psychological long-term sequelae and mental healthcare options post-ICU.Trial registration numberDRKS00003386.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Universitätsklinikum Jena, Jena, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Friedrich-Schiller University, Universitätsklinikum Jena, Jena, Germany
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9
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Lv B, Hu L, Fang H, Sun D, Hou Y, Deng J, Zhang H, Xu J, He L, Liang Y, Chen C. Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients. Front Med (Lausanne) 2022; 8:765818. [PMID: 35004737 PMCID: PMC8740271 DOI: 10.3389/fmed.2021.765818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 01/16/2023] Open
Abstract
Backgrounds: The plasma colloid osmotic pressure (COP) values for predicting mortality are not well-estimated. A user-friendly nomogram could predict mortality by incorporating clinical factors and scoring systems to facilitate physicians modify decision-making when caring for patients with serious neurological conditions. Methods: Patients were prospectively recruited from March 2017 to September 2018 from a tertiary hospital to establish the development cohort for the internal test of the nomogram, while patients recruited from October 2018 to June 2019 from another tertiary hospital prospectively constituted the validation cohort for the external validation of the nomogram. A multivariate logistic regression analysis was performed in the development cohort using a backward stepwise method to determine the best-fit model for the nomogram. The nomogram was subsequently validated in an independent external validation cohort for discrimination and calibration. A decision-curve analysis was also performed to evaluate the net benefit of the insertion decision using the nomogram. Results: A total of 280 patients were enrolled in the development cohort, of whom 42 (15.0%) died, whereas 237 patients were enrolled in the validation cohort, of which 43 (18.1%) died. COP, neurological pathogenesis and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were predictors in the prediction nomogram. The derived cohort demonstrated good discriminative ability, and the area under the receiver operating characteristic curve (AUC) was 0.895 [95% confidence interval (CI), 0.840–0.951], showing good correction ability. The application of this nomogram to the validation cohort also provided good discrimination, with an AUC of 0.934 (95% CI, 0.892–0.976) and good calibration. The decision-curve analysis of this nomogram showed a better net benefit. Conclusions : A prediction nomogram incorporating COP, neurological pathogenesis and APACHE II score could be convenient in predicting mortality for critically ill neurological patients.
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Affiliation(s)
- Bo Lv
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of General Practice, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Linhui Hu
- Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China.,Department of Clinical Research Center, Maoming People's Hospital, Maoming, China
| | - Heng Fang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
| | - Dayong Sun
- Department of Emergency, Longgang District Central Hospital, Shenzhen, China
| | - Yating Hou
- Department of General Practice, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Department of Oncology, Maoming People's Hospital, Maoming, China
| | - Jia Deng
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huidan Zhang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Xu
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Linling He
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yufan Liang
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunbo Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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10
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Bourhy L, Mazeraud A, Costa LHA, Levy J, Rei D, Hecquet E, Gabanyi I, Bozza FA, Chrétien F, Lledo PM, Sharshar T, Lepousez G. OUP accepted manuscript. Brain 2022; 145:1391-1409. [PMID: 35441215 PMCID: PMC9128826 DOI: 10.1093/brain/awab475] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lena Bourhy
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Université Paris Cité, Collège doctoral, F-75005 Paris, France
| | - Aurélien Mazeraud
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Université Paris Cité, Collège doctoral, F-75005 Paris, France
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuro-anesthésie réanimation, Paris, France
| | - Luis H. A. Costa
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- Department of Basic and Oral Biology, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jarod Levy
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Damien Rei
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Estéban Hecquet
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
| | - Ilana Gabanyi
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Institut Pasteur, Université Paris Cité, Microenvironment and Immunity Unit, F-75015 Paris, France
| | - Fernando A. Bozza
- National Institute of Infectious Disease Evandro Chagas (INI), OswaldoCruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Fabrice Chrétien
- Institut Pasteur, Université Paris Cité, Laboratory for Experimental Neuropathology, F-75015 Paris, France
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuropathologie, Paris, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Correspondence may also be addressed to: Pierre-Marie Lledo E-mail:
| | - Tarek Sharshar
- GHU Paris Psychiatrie Neurosciences, Service hospitalo-universitaire de Neuro-anesthésie réanimation, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), INSERM UMR 1266, F-75014 Paris, France
| | - Gabriel Lepousez
- Institut Pasteur, Université Paris Cité, CNRS UMR 3571, Perception and Memory Unit, F-75015 Paris, France
- Correspondence to: Gabriel Lepousez Laboratory for Perception and Memory Institut Pasteur 25 rue du Docteur Roux, 75724 Paris Cedex 15, France E-mail:
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11
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Song IA, Park HY, Oh TK. Sleep Disorder and Long-Term Mortality Among Sepsis Survivors: A Nationwide Cohort Study in South Korea. Nat Sci Sleep 2021; 13:979-988. [PMID: 34234601 PMCID: PMC8254539 DOI: 10.2147/nss.s319769] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to investigate the association of sleep disorder diagnosis among sepsis survivors with 5-year all-cause mortality. METHODS Using the National Health Insurance Service (NHIS) database of South Korea, we included adult sepsis survivors who were primarily diagnosed with sepsis between 2011 and 2014 and survived for more than one year after diagnosis. The diagnosis of sleep disorders was evaluated using the International Classification of Diseases, 10th revision codes of G47* in the NHIS database. RESULTS In total, 45,826 survivors of sepsis were included in this analysis. Among the sepsis survivors, 2935 (6.4%) were newly diagnosed with a sleep disorder within 1 year after the date of sepsis diagnosis, while 7938 (17.3%) were already diagnosed with sleep disorder before the date of sepsis diagnosis. In the multivariable Cox regression, the risk of 5-year all-cause mortality in the pre- and post-sepsis sleep disorder groups was 1.19-fold (hazard ratio: 1.19, 95% confidence interval: 1.14-1.24; P<0.001) and 1.79-fold (hazard ratio: 1.79, 95% confidence interval: 1.70-1.89; P<0.001) higher than that of the control group. CONCLUSION A 6.4% of sepsis survivors in South Korea were newly diagnosed with a sleep disorder within 1 year of sepsis diagnosis. Although both pre- and post-sepsis sleep disorders were associated with a higher 5-year all-cause mortality rate, the risk of the 5-year all-cause mortality in the post-sepsis sleep disorder group was higher than that in the pre-sepsis sleep disorder group.
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Affiliation(s)
- In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hye Yoon Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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12
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Ginty AT, Young DA, Tyra AT, Hurley PE, Brindle RC, Williams SE. Heart Rate Reactivity to Acute Psychological Stress Predicts Higher Levels of Posttraumatic Stress Disorder Symptoms During the COVID-19 Pandemic. Psychosom Med 2021; 83:351-357. [PMID: 32796336 DOI: 10.1097/psy.0000000000000848] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Increased autonomic arousal is a proposed risk factor for posttraumatic stress disorder (PTSD). Few studies have prospectively examined the association between physiological responses to acute psychological stress before a traumatic event and later PTSD symptoms. The present prospective study examined whether cardiovascular responses to an acute psychological stress task before the COVID-19 global pandemic predicted PTSD symptoms related to the ongoing pandemic. METHODS Participants (n = 120) were a subsample of an ongoing research study. Phase 1 consisted of a 10-minute baseline and 4-minute acute psychological stress task with blood pressure and heart rate recorded throughout. Phase 2 was initiated 2 weeks after the COVID-19 pandemic declaration. Participants completed the Impact of Event Scale-Revised (IES-R) with respect to the ongoing pandemic. Hierarchical linear regression analyses were used to examine whether cardiovascular stress reactivity predicted COVID-19 PTSD symptoms. RESULTS Heart rate reactivity significantly predicted IES intrusion (β = -0.208, t = -2.28, p = .025, ΔR2 = 0.041, confidence interval = -0.021 to -0.001) and IES hyperarousal (β = -0.224, t = -2.54, p = .012, ΔR2 = 0.047, confidence interval = -0.22 to - 0.003), but not IES avoidance (p = .077). These results remained statistically significant after adjustment for sex, socioeconomic status, baseline cardiovascular activity, neuroticism, race, ethnicity, body mass index, and adverse childhood experiences. There were no statistically significant associations between blood pressure and any of the Impact of Event Scale-Revised subscales (p values > .12). CONCLUSIONS Diminished heart rate responses (i.e., lower physiological arousal) to acute psychological stress before the COVID-19 pandemic significantly predicted reported PTSD symptoms during the crisis.
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Affiliation(s)
- Annie T Ginty
- From the Department of Psychology and Neuroscience (Ginty, Young, Tyra, Hurley), Baylor University, Waco, Texas; Department of Cognitive and Behavioral Science and Neuroscience Program (Brindle), Washington and Lee University, Lexington, Virginia; and School of Sport, Exercise, and Rehabilitation Sciences (Williams), University of Birmingham, Birmingham, United Kingdom
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13
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Calsavara AJ, Costa PA, Nobre V, Teixeira AL. Prevalence and risk factors for post-traumatic stress, anxiety, and depression in sepsis survivors after ICU discharge. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:269-276. [PMID: 33053073 PMCID: PMC8136386 DOI: 10.1590/1516-4446-2020-0986] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Sepsis survivors present a wide range of sequelae; few studies have evaluated psychiatric disorders after sepsis. The objective of this study was to define the prevalence of and risk factors for anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in sepsis survivors. METHOD Anxiety, depression and post-traumatic stress symptoms in severe sepsis and septic shock survivors 24 h and 1 year after intensive care unit (ICU) discharge were assessed using the Beck Anxiety/Depression Inventories and the PTSD Checklist-Civilian Version. Differences in psychiatric symptoms over time and the influence of variables on these symptoms were calculated with marginal models. RESULTS A total of 33 patients were enrolled in the study. The frequencies of anxiety, depression and PTSD 24 h after ICU discharge were 67%, 49%, and 46%, respectively and, among patients re-evaluated 1 year after ICU discharge, the frequencies were 38%, 50%, and 31%, respectively. Factors associated with PTSD included serum S100B level, age, and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) score. Factors associated with depression included patient age and cumulative dose of dobutamine. IQCODE score and cumulative dose of haloperidol in the ICU were associated with anxiety after ICU discharge. CONCLUSION Patients who survive sepsis have high levels of psychiatric symptoms. Sepsis and associated treatment-related exposures may have a role in increasing the risk of subsequent depression, anxiety, and PTSD.
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Affiliation(s)
- Allan J Calsavara
- Escola de Medicina, Universidade Federal de Ouro Preto (UFOP), Ouro Preto, MG, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical (PPG-IMT), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Vandack Nobre
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical (PPG-IMT), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Antonio L Teixeira
- Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical (PPG-IMT), Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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14
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Griton M, Dhaya I, Nicolas R, Raffard G, Periot O, Hiba B, Konsman JP. Experimental sepsis-associated encephalopathy is accompanied by altered cerebral blood perfusion and water diffusion and related to changes in cyclooxygenase-2 expression and glial cell morphology but not to blood-brain barrier breakdown. Brain Behav Immun 2020; 83:200-213. [PMID: 31622656 DOI: 10.1016/j.bbi.2019.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022] Open
Abstract
Sepsis-associated encephalopathy (SAE) refers to brain dysfunction, including delirium, occurs during severe infection and is associated with development of post-traumatic stress disorder. SAE has been proposed to be related to reduced cerebral blood flow (CBF), blood-brain barrier breakdown (BBB), white matter edema and disruption and glia cell activation, but their exact relationships remain to be determined. In the present work, we set out to study CBF using Arterial Spin Labeling (ASL) and grey and white matter structure with T2- and diffusion magnetic resonance imaging (dMRI) in rats with cecal ligation and puncture (CLP)-induced encephalopathy. Using immunohistochemistry, the distribution of the vasoactive prostaglandin-synthesizing enzyme cyclooxygenase-2 (COX-2), perivascular immunoglobulins G (IgG), aquaporin-4 (AQP4) and the morphology of glial cell were subsequently assessed in brains of the same animals. CLP induced deficits in the righting reflex and resulted in higher T2-weighted contrast intensities in the cortex, striatum and at the base of the brain, decreased blood perfusion distribution to the cortex and increased water diffusion parallel to the fibers of the corpus callosum compared to sham surgery. In addition, CLP reduced staining for microglia- and astrocytic-specific proteins in the corpus callosum, decreased neuronal COX-2 and AQP4 expression in the cortex while inducing perivascular COX-2 expression, but did not induce widespread perivascular IgG diffusion. In conclusion, our findings indicate that experimental SAE can occur in the absence of BBB breakdown and is accompanied by increased water diffusion anisotropy and altered glia cell morphology in brain white matter.
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Affiliation(s)
- Marion Griton
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; Service de Réanimation Anesthésie Neurochirurgicale, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Ibtihel Dhaya
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; Laboratoire de Neurophysiologie Fonctionnelle et Pathologies, UR/11ES09, Faculté des Sciences Mathématiques, Physiques et Naturelles, Université de Tunis El Manar, Tunis, Tunisia
| | - Renaud Nicolas
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France
| | - Gérard Raffard
- CNRS, Résonance Magnétique des Systèmes Biologiques, UMR 5536, Bordeaux, France; Univ. Bordeaux, RMSB, UMR 5536, Bordeaux, France
| | - Olivier Periot
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; Service de Médecine Nucléaire, Centre Hospitalier Universitaire (CHU) de Bordeaux, Bordeaux, France
| | - Bassem Hiba
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France; CNRS UMR 5229, Centre de Neurosciences Cognitives Marc Jeannerod, Bron, France
| | - Jan Pieter Konsman
- INCIA, Institut de Neurosciences Cognitive et Intégrative d'Aquitaine, UMR 5287, Bordeaux, France; Univ. Bordeaux, INCIA, UMR 5287, Bordeaux, France.
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15
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Abstract
OBJECTIVE To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock. DESIGN A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations. METHODS Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (Supplemental Table 1, Supplemental Digital Content 2, http://links.lww.com/CCM/D636) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. RESULTS The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: 1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; 2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; 3) should rapid diagnostic tests be implemented in clinical practice?; 4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; 5) what are the predictors of sepsis long-term morbidity and mortality?; and 6) what information identifies organ dysfunction? CONCLUSIONS While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.
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16
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Frijling J, Olff M, van Zuiden M. Pharmacological Prevention of PTSD: Current Evidence for Clinical Practice. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190604-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:213. [PMID: 31186070 PMCID: PMC6560853 DOI: 10.1186/s13054-019-2489-3] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/22/2019] [Indexed: 01/11/2023]
Abstract
Background As more patients are surviving intensive care, mental health concerns in survivors have become a research priority. Among these, post-traumatic stress disorder (PTSD) can have an important impact on the quality of life of critical care survivors. However, data on its burden are conflicting. Therefore, this systematic review and meta-analysis aimed to evaluate the prevalence of PTSD symptoms in adult critical care patients after intensive care unit (ICU) discharge. Methods We searched MEDLINE, EMBASE, LILACS, Web of Science, PsycNET, and Scopus databases from inception to September 2018. We included observational studies assessing the prevalence of PTSD symptoms in adult critical care survivors. Two reviewers independently screened studies and extracted data. Studies were meta-analyzed using a random-effects model to estimate PTSD symptom prevalence at different time points, also estimating confidence and prediction intervals. Subgroup and meta-regression analyses were performed to explore heterogeneity. Risk of bias was assessed using the Joanna Briggs Institute tool and the GRADE approach. Results Of 13,267 studies retrieved, 48 were included in this review. Overall prevalence of PTSD symptoms was 19.83% (95% confidence interval [CI], 16.72–23.13; I2 = 90%, low quality of evidence). Prevalence varied widely across studies, with a wide range of expected prevalence (from 3.70 to 43.73% in 95% of settings). Point prevalence estimates were 15.93% (95% CI, 11.15–21.35; I2 = 90%; 17 studies), 16.80% (95% CI, 13.74–20.09; I2 = 66%; 13 studies), 18.96% (95% CI, 14.28–24.12; I2 = 92%; 13 studies), and 20.21% (95% CI, 13.79–27.44; I2 = 58%; 7 studies) at 3, 6, 12, and > 12 months after discharge, respectively. Conclusion PTSD symptoms may affect 1 in every 5 adult critical care survivors, with a high expected prevalence 12 months after discharge. ICU survivors should be screened for PTSD symptoms and cared for accordingly, given the potential negative impact of PTSD on quality of life. In addition, action should be taken to further explore the causal relationship between ICU stay and PTSD, as well as to propose early measures to prevent PTSD in this population. Trial registration PROSPERO, CRD42017075124, Registered 6 December 2017. Electronic supplementary material The online version of this article (10.1186/s13054-019-2489-3) contains supplementary material, which is available to authorized users.
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18
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Hu L, Nie Z, Zhang Y, Zhang Y, Ye H, Chi R, Hu B, Lv B, Chen L, Zhang X, Wang H, Chen C. Development and validation of a nomogram for predicting self-propelled postpyloric placement of spiral nasoenteric tube in the critically ill: Mixed retrospective and prospective cohort study. Clin Nutr 2018; 38:2799-2805. [PMID: 30579668 DOI: 10.1016/j.clnu.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Equipment-aided or experience-dependent methods for postpyloric nasoenteric tube placement are not so readily accessible in the critically ill setting. Self-propelled postpyloric placement of a spiral nasoenteric tube can serve as an alternative approach. However, the success rate of this method is relatively low despite using prokinetics. This study aims to develop a user-friendly nomogram incorporating clinical markers to individually predict the probability of successful postpyloric nasoenteric tube placement and facilitate intensivists with improved decision-making before tube insertion. METHODS Patients consecutively recruited in the stage between May 2012 through December 2016 constituted the development cohort for retrospective analysis to internally test the nomogram, and patients in the stage between January 2017 through March 2018 constituted the validation cohort for prospective analysis to external validate the nomogram. A multivariate logistic regression analysis was firstly performed in the development cohort by a backward stepwise method to identify the best-fit model, from which a nomogram was obtained. The nomogram was validated in the independent external validation cohort concerning discrimination, calibration. A decision curve analysis was also performed to evaluate the net benefit of insertion decision with the nomogram. RESULTS A total of 364 and 119 patients, 52.7% and 55.5% with successful postpyloric placement, were included in the development and validation cohort, respectively. Predictors contained in the prediction nomogram included primary diagnosis, APACHE II score, AGI grade. The derived model showed good discrimination, with an area under the receiver operating characteristic curve (AUROC) of 0.809 (95%CI, 0.765-0.853) and good calibration. Application of the nomogram in the validation cohort also gave good discrimination with an AUROC of 0.776 (95%CI, 0.694-0.859) and good calibration. The decision curve analysis of the nomogram provided better net benefit than the alternate options (insert-all or insert-none). CONCLUSIONS A prediction nomogram that incorporates primary diagnosis, together with APACHE II score and AGI grade can be conveniently used to facilitate the pre-insertion individualized prediction of postpyloric nasoenteric tube placement in critically ill patients.
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Affiliation(s)
- Linhui Hu
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510080, Guangdong, China.
| | - Zhiqiang Nie
- Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 ZhongshanEr Road, Guangzhou 510080, Guangdong, China.
| | - Yichen Zhang
- Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, 396 Tongfuzhong Road, Guangzhou 510220, Guangdong, China.
| | - Yanlin Zhang
- Department of Critical Care Medicine, Xinjiang Kashgar Region's First People's Hospital, 66 Airport Road, Kashgar Region 844099, Xinjiang, China.
| | - Heng Ye
- Department of Critical Care Medicine, Guangzhou Nansha Central Hospital, 105 Fengzhedong Road, Guangzhou 511457, Guangdong, China.
| | - Ruibin Chi
- Department of Critical Care Medicine, Xiaolan People's Hospital of Zhongshan, 65 Jucheng Road, Zhongshan 528415, Guangdong, China.
| | - Bei Hu
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
| | - Bo Lv
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
| | - Lifang Chen
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
| | - Xiunong Zhang
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
| | - Huajun Wang
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China.
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510080, Guangdong, China.
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19
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Jacq G, Melot K, Bezou M, Foucault L, Courau-Courtois J, Cavelot S, Lang A, Bedos JP, Le-Boeuf D, Boussard JM, Legriel S. Music for pain relief during bed bathing of mechanically ventilated patients: A pilot study. PLoS One 2018; 13:e0207174. [PMID: 30427906 DOI: 10.1371/journal.pone.0207174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pain is a universal issue and is of particular concern in mechanically ventilated patients, as they require intensive nursing care and multiple invasive procedures, while being unable to communicate verbally. The aim of this study was to assess the effect of music on pain experienced by mechanically ventilated patients during morning bed bathing. METHODS Of the 60 mechanically ventilated patients enrolled in this single-center pilot study between March 2013 and October 2015, the first 30 received no music and the next 30 the music intervention, during the morning bed bath. The Behavioral Pain Scale (BPS) score was determined during and at the end of the bath then 30, 60, and 120 minutes after the bath. BPS score changes over time were assessed and the proportions of bath times spent with a BPS score ≥5 and with the maximal BPS score were determined. RESULTS At baseline, no patient had pain (defined as a BPS score <5) and the median BPS score was 3 [IQR, 3;3] in both groups (P = 0.43). After bed bath initiation, 88% of patients experienced pain. The maximum BPS value during the bath was lower in the music group (5 [5;6.7] vs. 7 [5;7]). Proportions of total bath time spent with BPS≥5 and with the maximum BPS were significantly lower in the music group than in the control group (2.0 [0.3;4.0] vs. 10 [4.3;18.0]; P < .0001 and 1.5 [0;3.0] vs. 3.5 [2.0;6.0]; P = .005; respectively). Two hours after the end of the bath, the BPS values had returned to baseline in both groups. CONCLUSION In our population, music significantly decreased pain intensity and duration during the morning bed bath in mechanically ventilated patients. These results warrant further assessment in a large multicenter randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT02883959.
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Affiliation(s)
- Gwenaëlle Jacq
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Karine Melot
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Mathilde Bezou
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Laura Foucault
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Josette Courau-Courtois
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Sebastien Cavelot
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Annie Lang
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Jean-Pierre Bedos
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Dominique Le-Boeuf
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
| | - Jean-Marc Boussard
- Direction des soins, GHT Sud Yvelines, Centre hospitalier de Rambouillet, Rambouillet, FRANCE
| | - Stephane Legriel
- Intensive Care Department, GHT Sud Yvelines, Centre Hospitalier de Versailles-Site André Mignot, Le Chesnay Cedex, FRANCE
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20
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Pereira S, Cavaco S, Fernandes J, Moreira I, Almeida E, Seabra-Pereira F, Castro H, Malheiro MDJ, Cardoso AF, Aragão I, Cardoso T. Long-term psychological outcome after discharge from intensive care. Rev Bras Ter Intensiva 2018; 30:28-34. [PMID: 29742217 PMCID: PMC5885228 DOI: 10.5935/0103-507x.20180008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the longterm psychological outcome in survivors of critical
illness after intensive care unit discharge. Methods A prospective cohort of survivors admitted to a mixed intensive care unit
between January and September 2010 was evaluated six months and five years
after hospital discharge. The Dementia Rating Scale-2, the Hospital Anxiety
and Depression Scale, the Posttraumatic stress syndrome 14-questions
inventory, the Euro Quality of Life 5 Dimensions (EQ-5-D), and the Visual
Analogue Scale (EQ VAS) were assessed at both follow-up periods. Results Of 267 patients, 25 patients were evaluated at 6 months after discharge (62
± 16 years); 12 (48%) presented cognitive impairment, 6 (24%)
anxiety, 4 (16%) depression, and 4 (16%) post-traumatic stress disorder.
Among those re-evaluated five years after discharge (n = 17; 65 ± 15
years), the frequency of cognitive impairment dropped from 8 (47%) to 3
(18%) (p = 0.063), due to improvement in these patients over time, and other
patients did not acquire any dysfunction after discharge. At five years
after discharge, only two patients (12%) reported anxiety, and none had
depression or post-traumatic stress disorder. No differences were found
between the six-month and five-year follow-ups regarding EQ-5-D and EQ
VAS. Conclusion Survivors do not show a progressive decline in cognitive function or quality
of life within five years after intensive care unit discharge.
Psychopathological symptoms tend to decrease with time.
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Affiliation(s)
- Sara Pereira
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Sara Cavaco
- Unidade de Neuropsicologia, Departamento de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Joana Fernandes
- Unidade de Neuropsicologia, Departamento de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Moreira
- Unidade de Neuropsicologia, Departamento de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Eduarda Almeida
- Unidade de Neuropsicologia, Departamento de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Filipa Seabra-Pereira
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Heloísa Castro
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Maria de Jesus Malheiro
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Filipa Cardoso
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Irene Aragão
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Teresa Cardoso
- Unidade de Terapia Intensiva, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
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21
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Wintermann GB, Rosendahl J, Weidner K, Strauß B, Petrowski K. Predictors of Major Depressive Disorder following Intensive Care of Chronically Critically Ill Patients. Crit Care Res Pract 2018; 2018:1586736. [PMID: 30155292 PMCID: PMC6093074 DOI: 10.1155/2018/1586736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 06/05/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients. MATERIALS AND METHODS In a prospective cohort study, patients with long-term mechanical ventilation requirements (n=131) were assessed with respect to a diagnosis of MDD, using the Structured Clinical Interview for DSM-IV, three and six months after the transfer from acute ICU to post-acute ICU. Sociodemographic, psychological, and clinical risk factors with p values ≤ 0.1 were identified in a univariate logistic regression analysis and entered in a multivariable logistic regression model. A mediator analysis was run using the bootstrapping method, testing the mediating effect of perceived helplessness during the ICU stay, between the recalled traumatic experience from the ICU and a post-ICU MDD. RESULTS 17.6% (n=23) of the patients showed a full- or subsyndromal MDD. Perceived helplessness, recalled experiences of a traumatic event from the ICU, symptoms of acute stress disorder, and the diagnosis of posttraumatic stress disorder (PTSD) after ICU could be identified as significant predictors of MDD. In a mediator analysis, perceived helplessness could be proved as a mediator. CONCLUSIONS Every fifth CCI patient suffers from MDD up to six months after being discharged from ICU. Particularly, perceived helplessness during the ICU stay seems to mainly affect the long-term evolvement of MDD. CCI patients with symptoms of acute stress disorder/PTSD should also be screened for MDD.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jenny Rosendahl
- Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Katja Petrowski
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Medical Psychology and Medical Sociology, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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22
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Coopersmith CM, De Backer D, Deutschman CS, Ferrer R, Lat I, Machado FR, Martin GS, Martin-Loeches I, Nunnally ME, Antonelli M, Evans LE, Hellman J, Jog S, Kesecioglu J, Levy MM, Rhodes A. Surviving sepsis campaign: research priorities for sepsis and septic shock. Intensive Care Med 2018; 44:1400-1426. [PMID: 29971592 PMCID: PMC7095388 DOI: 10.1007/s00134-018-5175-z] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
Abstract
Objective To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock. Design A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations. Methods Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 - supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction? Conclusions While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock. Electronic supplementary material The online version of this article (10.1007/s00134-018-5175-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Daniel De Backer
- Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium.
| | - Clifford S Deutschman
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.,The Feinstein Institute for Medical Research/Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Ishaq Lat
- Rush University Medical Center, Chicago, IL, USA
| | | | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, Trinity Centre for Health Sciences, St James's University Hospital, Dublin, Ireland
| | | | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A.Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura E Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Bellevue Hospital Center and New York University School of Medicine, New York, NY, USA
| | - Judith Hellman
- University of California, San Francisco, San Francisco, CA, USA
| | - Sameer Jog
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mitchell M Levy
- Rhode Island Hospital, Alpert Medical School at Brown University, Providence, RI, USA
| | - Andrew Rhodes
- Department of Adult Critical Care, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
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23
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Barichello T, Sayana P, Giridharan VV, Arumanayagam AS, Narendran B, Della Giustina A, Petronilho F, Quevedo J, Dal-Pizzol F. Long-Term Cognitive Outcomes After Sepsis: a Translational Systematic Review. Mol Neurobiol 2018; 56:186-251. [PMID: 29687346 DOI: 10.1007/s12035-018-1048-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/27/2018] [Indexed: 01/04/2023]
Abstract
Sepsis is systemic inflammatory response syndrome with a life-threatening organ dysfunction that is caused by an unbalanced host immune response in an attempt to eliminate invasive microorganisms. We posed questions, "Does sepsis survivor patients have increased risk of neuropsychiatric manifestations?" and "What is the mechanism by which sepsis induces long-term neurological sequelae, particularly substantial cognitive function decline in survivor patients and in pre-clinical sepsis models?" The studies were identified by searching PubMed/MEDLINE (National Library of Medicine), PsycINFO, EMBASE (Ovid), LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographical Index in Spanish in Health Sciences), and Web of Science databases for peer-reviewed journals that were published until January 2018. A total of 3555 papers were included in the primary screening. After that, 130 articles were selected for the study. A number of pre-clinical studies have shown an auto amplification of pro-inflammatory cytokines such as tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, and IL-6 in the first few hours after sepsis induction, also increased blood-brain barrier permeability, elevated levels of matrix metalloproteinases, increased levels of damage-associated molecular patterns were demonstrated. In addition, the rodents presented long-term cognitive impairment in different behavioral tasks that were prevented by blocking the mechanism of action of these inflammatory mediators. Clinical studies have showed that sepsis survivors presented increased bodily symptoms such as fatigue, pain, visual disturbances, gastrointestinal problems, and neuropsychiatric problems compared to before sepsis. Sepsis leaves the survivors with an aftermath of physiological, neuropsychiatric, and functional impairment. Systematic review registration: CRD42017071755.
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Affiliation(s)
- Tatiana Barichello
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA. .,Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil.
| | - Pavani Sayana
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA
| | - Vijayasree V Giridharan
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA
| | | | - Boomadevi Narendran
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - Amanda Della Giustina
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA.,Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of South Santa Catarina, Tubarao, SC, Brazil
| | - Fabricia Petronilho
- Laboratory of Neurobiology of Inflammatory and Metabolic Processes, Postgraduate Program in Health Sciences, University of South Santa Catarina, Tubarao, SC, Brazil
| | - João Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, 1941 East Road, Houston, TX, 77054, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina-UNESC, Criciúma, SC, Brazil.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Felipe Dal-Pizzol
- Laboratory of Experimental Pathophysiology, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
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24
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Milton A, Brück E, Schandl A, Bottai M, Sackey P. Early psychological screening of intensive care unit survivors: a prospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:273. [PMID: 29121983 PMCID: PMC5679508 DOI: 10.1186/s13054-017-1813-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/07/2017] [Indexed: 11/26/2022]
Abstract
Background A majority of patients survive their episode of critical illness but up to 30% of patients suffer from psychological problems such as post-traumatic stress, anxiety and depression in the year after intensive care unit (ICU) stay. A method to identify discharged patients at risk for adverse psychological outcome would be helpful in the triage for ICU follow-up and could enable early intervention. The aim of this study was to evaluate whether early screening with validated questionnaires after ICU discharge can identify patients at risk for symptoms of post-traumatic stress, anxiety and depression 3 months after ICU stay. Methods We performed a prospective observational cohort study in the general ICU at the Karolinska University Hospital Solna, Stockholm, Sweden. All adult patients surviving ≥ 24 hours in the ICU in a 9-month period were eligible for inclusion. Patients with mental disability, serious auditory and visual disorder, aphasia or who were unable to understand Swedish were excluded. One hundred and thirty-two patients were included and visited by a follow-up nurse within 1 week after ICU discharge. The Hospital Anxiety and Depression Scale (HADS) and the Post-Traumatic Stress Symptoms Checklist-10 (PTSS-10) were administered. Three months after ICU discharge the patients received the same questionnaires by postal mail. We assessed the predictive values of the questionnaires using the area under the receiver operating characteristic curve (AUROC). For correlation calculations, we used Spearman’s rank correlation coefficient. Negative and positive predictive values for each questionnaire were calculated. Results Eighty-two patients returned the follow-up questionnaires. We found correlation between early and late scores and reasonable predictive precision regarding 3-month outcomes, with an AUROC of 0.90 for PTSS-10 part B, 0.80 for the HADS anxiety subscale and 0.75 for the HADS depression subscale. Conclusions Symptoms of post-traumatic stress, anxiety and depression assessed 1 week after ICU stay correlate with 3-month psychological outcome. The HADS and PTSS-10 may be useful aids to identify ICU survivors at high risk for clinically significant symptoms of post-traumatic stress, anxiety and depression 3 months post ICU stay.
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Affiliation(s)
- Anna Milton
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. .,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Emily Brück
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Anna Schandl
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Department of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Sackey
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden
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25
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Abstract
The main aim of this study was to investigate factors associated with a delayed-onset posttraumatic stress disorder (PTSD) after the intensive care unit (ICU) treatment of patients with a chronic critical illness (CCI). Patients (n = 97) with critical illness polyneuropathy or critical illness myopathy were interviewed via the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. The diagnosis of the acute stress disorder was assessed within 1 month (t1), the diagnosis of PTSD at 3 (t2) and 6 (t3) months after transfer from the acute care ICU to the post-acute ICU. Patients showing a delayed-onset or persistent course of PTSD were subsumed in one group; 24.7% (n = 24) showed a delayed-onset PTSD. Significant risk factors were as follows: the severity of the medical illness, the perceived fear of dying at the ICU, the number of traumatic memories from the ICU, and the presence of a coronary heart disease. Every fourth patient with CCI showed a delayed-onset PTSD up to 6 months after the ICU treatment. Markers for a delayed-onset PTSD should already be assessed at the time of discharge from the ICU.
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26
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Günther A, Sackey P, Bjärtå A, Schandl A. The relation between skin conductance responses and recovery from symptoms of PTSD. Acta Anaesthesiol Scand 2017; 61:688-695. [PMID: 28421596 DOI: 10.1111/aas.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose was to investigate if potentially stressful reminders of the intensive care unit (ICU) stay influenced variability in transient skin conductance responses, and whether such changes were associated with post-traumatic stress symptoms (PTSS), and development of symptoms over time. METHODS Thirty patients with an ICU length of stay > 48 h were included in the study. Within the week after ICU discharge (T1), patients were exposed to authentic ICU sound and questions regarding traumatic ICU memories while skin conductance reactivity was monitored. PTSS was assessed using PTSS-10 at T1 and again 3 months later (T2). Changes in number of skin conductance fluctuations per second (NSCF) between baseline and during the cueing conditions and in relation to PTSS scores (T1) were investigated. PTSS scores at T2 and changes between T1 and T2 (PTSS-CS) were used to investigate if reactivity in NSCF could predict symptoms of PTSD. RESULTS The results showed increases in NSCF during both situational and verbal cueing, compared to baseline. However, no relation to PTSS scores was indicated. Negative correlations between NSCF during situational cueing and both PTSS-T2 and PTSS-CS were found among women, but not among men. CONCLUSION A low variability, or reactivity in skin conductance responses to situational cues could imply a risk of developing, or not being able to recover from, symptoms of PTSD in women. As such, the measurement could be used to predict this risk in women. However, further studies are necessary to evaluate this area of application.
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Affiliation(s)
- A. Günther
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
- Department of Cardiothoracic Surgery and Anaesthesiology; Karolinska University Hospital Solna; Stockholm Sweden
| | - P. Sackey
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
- Institution of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| | - A. Bjärtå
- Department of Psychology; Division of Social Sciences; Mid Sweden University; Östersund Sweden
| | - A. Schandl
- Perioperative Medicine and Intensive care; Karolinska University Hospital Solna; Stockholm Sweden
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Abrahamian H, Lebherz-Eichinger D. The role of psychosomatic medicine in intensive care units. Wien Med Wochenschr 2017; 168:67-75. [PMID: 28616666 DOI: 10.1007/s10354-017-0575-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/19/2017] [Indexed: 12/16/2022]
Abstract
Critically ill patients, their relatives, and intensive care staff are consistently exposed to stress. The principal elements of this exceptional burden are confrontation with a life-threatening disease, specific environmental conditions at the intensive care unit, and the social characteristics of intensive care medicine. The short- and long-term consequences of these stressors include a feeling of helplessness, distress, anxiety, depression, and even posttraumatic stress disorders. Not only the patients, but also their relatives and intensive care staff are at risk of developing such psychopathologies. The integration of psychosomatic medicine into the general concept of intensive care medicine is an essential step for the early identification of fear and anxiety and for understanding biopsychosocial coherence in critically ill patients. Preventive measures such as the improvement of individual coping strategies and enhancing the individual's resistance to stress are crucial aspects of improving wellbeing, as well as the overall outcome of disease. Additional stress-reducing measures reported in the published literature, such as hearing music, the use of earplugs and eye-masks, or basal stimulation, have been successful to a greater or lesser extent.
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Affiliation(s)
- Heidemarie Abrahamian
- Department of Internal Medicine, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria.
| | - Diana Lebherz-Eichinger
- Department of Internal Medicine, Otto Wagner Hospital, Baumgartner Höhe 1, 1140, Vienna, Austria
- Department of Anesthesia, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Gawlytta R, Niemeyer H, Böttche M, Scherag A, Knaevelsrud C, Rosendahl J. Internet-based cognitive-behavioural writing therapy for reducing post-traumatic stress after intensive care for sepsis in patients and their spouses (REPAIR): study protocol for a randomised-controlled trial. BMJ Open 2017; 7:e014363. [PMID: 28232467 PMCID: PMC5337733 DOI: 10.1136/bmjopen-2016-014363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION As a consequence of sepsis and intensive care, considerable proportions of patients but also of their spouses develop a post-traumatic stress disorder (PTSD). However, only a very small number receive psychotherapeutic treatment. Internet-based cognitive-behavioural writing therapy (IB-CBWT) has proven to be an effective treatment option for PTSD. It seems to fit the specific needs of this cohort and to overcome treatment barriers. Aim of the REPAIR trial is to examine the efficacy, safety and applicability of IB-CBWT for PTSD in patients and their spouses after intensive care for sepsis. METHODS AND ANALYSIS Participants will be assigned randomly either to a treatment or a wait-list (WL) control group. The treatment group receives IB-CBWT for PTSD, actively involving the partners of the participants. IB-CBWT will be guided by a therapist and comprises two written assignments per week over a 5 week period. After completing the assignments, the participants obtain individual responses from the therapist. Participants of the WL control group will receive treatment after a waiting period of 5 weeks. The primary outcome is PTSD symptom severity in self-rated PTSD Checklist for Diagnostic and Statistical Manual Fifth Edition at the end of treatment and waiting time, respectively. Secondary outcomes are remission of PTSD, depression, anxiety, and somatisation measured by the Brief Symptom Inventory-18, marital satisfaction measured by the Relationship Assessment Scale, health-related quality of life measured by the EQ-5D-5L, and the feasibility of IB-CBWT for this cohort (ie, dropout rate). Statistical analysis will be performed according to the intent-to-treat principle. ETHICS AND DISSEMINATION The study is conducted according to the principles of Good Clinical Practice and has been approved by the ethics committee of the Friedrich-Schiller University Jena, Germany. Results will be disseminated at scientific conferences, published in peer-reviewed journals, and provided to consumers of healthcare. TRIAL REGISTRATION NUMBER Pre-results, DRKS00010676.
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Affiliation(s)
- Romina Gawlytta
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Helen Niemeyer
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
- Berlin Center for Torture Victims, Zentrum ÜBERLEBEN, Berlin, Germany
| | - André Scherag
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
- Integrated Research and Treatment Center, Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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Mazeraud A, Pascal Q, Verdonk F, Heming N, Chrétien F, Sharshar T. Neuroanatomy and Physiology of Brain Dysfunction in Sepsis. Clin Chest Med 2017; 37:333-45. [PMID: 27229649 DOI: 10.1016/j.ccm.2016.01.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Sepsis-associated encephalopathy (SAE), a complication of sepsis, is often complicated by acute and long-term brain dysfunction. SAE is associated with electroencephalogram pattern changes and abnormal neuroimaging findings. The major processes involved are neuroinflammation, circulatory dysfunction, and excitotoxicity. Neuroinflammation and microcirculatory alterations are diffuse, whereas excitotoxicity might occur in more specific structures involved in the response to stress and the control of vital functions. A dysfunction of the brainstem, amygdala, and hippocampus might account for the increased mortality, psychological disorders, and cognitive impairment. This review summarizes clinical and paraclinical features of SAE and describes its mechanisms at cellular and structural levels.
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Affiliation(s)
- Aurelien Mazeraud
- Institut Pasteur - Unité Histopathologie Humaine et Modèles Animaux, Département Infection et Épidémiologie, Rue du docteur roux, Paris 75724 Cedex 15, France; Sorbonne Paris Cité, Paris Descartes University, Rue de l'école de médecine, Paris 75006, France; General Intensive Care, Assistance Publique Hopitaux de Paris, Raymond Poincaré Teaching Hosptal, Garches 92380, France
| | - Quentin Pascal
- Institut Pasteur - Unité Histopathologie Humaine et Modèles Animaux, Département Infection et Épidémiologie, Rue du docteur roux, Paris 75724 Cedex 15, France
| | - Franck Verdonk
- Institut Pasteur - Unité Histopathologie Humaine et Modèles Animaux, Département Infection et Épidémiologie, Rue du docteur roux, Paris 75724 Cedex 15, France; Sorbonne Paris Cité, Paris Descartes University, Rue de l'école de médecine, Paris 75006, France
| | - Nicholas Heming
- General Intensive Care, Assistance Publique Hopitaux de Paris, Raymond Poincaré Teaching Hosptal, Garches 92380, France
| | - Fabrice Chrétien
- Institut Pasteur - Unité Histopathologie Humaine et Modèles Animaux, Département Infection et Épidémiologie, Rue du docteur roux, Paris 75724 Cedex 15, France; Sorbonne Paris Cité, Paris Descartes University, Rue de l'école de médecine, Paris 75006, France; Laboratoire de Neuropathologie, Centre Hospitalier Sainte Anne, 1 rue cabanis, Paris 75014, France
| | - Tarek Sharshar
- Institut Pasteur - Unité Histopathologie Humaine et Modèles Animaux, Département Infection et Épidémiologie, Rue du docteur roux, Paris 75724 Cedex 15, France; General Intensive Care, Assistance Publique Hopitaux de Paris, Raymond Poincaré Teaching Hosptal, Garches 92380, France; Versailles-Saint Quentin University, Avenue de Paris, Versailles 78000, France.
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Sadat Z, Abdi M, Aghajani M. Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e28466. [PMID: 26848472 PMCID: PMC4733532 DOI: 10.5812/atr.28466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 12/04/2022]
Abstract
Background Posttraumatic Stress Disorder (PTSD) is a severe anxiety disorder occurred due to past adverse experiences. Several researches have demonstrated that PTSD is quite common among patients discharged from critical care unit. Objectives This study aimed to investigate the prevalence of PTSD and its related factors among patients discharged from critical care units in Kashan, Iran, during 2014. Patients and Methods A descriptive prospective study was performed on 332 patients admitted to critical care units of Kashan Shahid Beheshti Hospital using a convenience sampling method. Data were collected in wards during hospitalization and one month after their discharge from hospital using questionnaires on demographic, medical information and PTSD Checklist (PCL). The PCL scores of 45 or more were considered as PTSD. Data were analyzed using chi-square, t-test, Mann-Whitney U and logistic regression. Results From a total of 332 patients, 160 cases (48.2%) had PTSD and the mean total PCL score in participants was 44.24 ± 19.89. There was a significant difference between the total score of PTSD and its domains in patients with and without PTSD. the univariate analysis showed a significant association between PTSD and increasing age, increased length of hospital stay, more children, having additional comorbidities, unemployed, use of mechanical ventilation (P < 0.001), drug abuse (P = 0.003) and single patients (P = 0.028). However, there was no significant association between PTSD and gender, type of the critical care unit, level of education and admission due to trauma. However, in multivariate analysis using logistic regression, factors associated with PTSD were older age of the participants, use of mechanical ventilation having additional comorbidities, unemployed (P<0.001) and being single (P=0.04) Conclusions Prevalence of PTSD is high among patients discharged from ICUs and some medical individual factors such as elderly, unemployed, being single, using mechanical ventilation and pre-existing diseases are risk factors. Therefore, it is recommended to perform appropriative educational plan for these patients to reduce the risk of PTSD.
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Affiliation(s)
- Zohreh Sadat
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Abdi
- Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohammad Abdi, Department of Nursing, School of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-36155540021, Fax: +98-36155546633, E-mail:
| | - Mohammad Aghajani
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
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Andresen M, Guic E, Orellana A, Diaz MJ, Castro R. Posttraumatic stress disorder symptoms in close relatives of intensive care unit patients: Prevalence data resemble that of earthquake survivors in Chile. J Crit Care 2015. [DOI: 10.1016/j.jcrc.2015.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Stress disorders following prolonged critical illness in survivors of severe sepsis. Crit Care Med 2015; 43:1213-22. [PMID: 25760659 DOI: 10.1097/ccm.0000000000000936] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To examine the frequency of acute stress disorder and posttraumatic stress disorder in chronically critically ill patients with a specific focus on severe sepsis, to classify different courses of stress disorders from 4 weeks to 6 months after transfer from acute care hospital to postacute rehabilitation, and to identify patients at risk by examining the relationship between clinical, demographic, and psychological variables and stress disorder symptoms. DESIGN Prospective longitudinal cohort study, three assessment times within 4 weeks, 3 months, and 6 months after transfer to postacute rehabilitation. SETTING Patients were consecutively enrolled in a large rehabilitation hospital (Clinic Bavaria, Kreischa, Germany) admitted for ventilator weaning from acute care hospitals. PATIENTS We included 90 patients with admission diagnosis critical illness polyneuropathy or critical illness myopathy with or without severe sepsis, age between 18 and 70 years with a length of ICU stay greater than 5 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Acute stress disorder and posttraumatic stress disorder were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria by a trained and experienced clinical psychologist using a semistructured clinical interview for Diagnostic and Statistical Manual of Mental Disorders. We further administered the Acute Stress Disorder Scale and the Posttraumatic Symptom Scale-10 to assess symptoms of acute stress disorder and posttraumatic stress disorder. Three percent of the patients had an acute stress disorder diagnosis 4 weeks after transfer to postacute rehabilitation. Posttraumatic stress disorder was found in 7% of the patients at 3-month follow-up and in 12% after 6 months, respectively. Eighteen percent of the patients showed a delayed onset of posttraumatic stress disorder. Sepsis turned out to be a significant predictor of posttraumatic stress disorder symptoms at 3-month follow-up. CONCLUSIONS A regular screening of post-ICU patients after discharge from hospital should be an integral part of aftercare management. The underlying mechanisms of severe sepsis in the development of posttraumatic stress disorder need further examination.
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Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient. Eur J Anaesthesiol 2015; 32:147-51. [DOI: 10.1097/eja.0000000000000107] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Most older patients adapt after catastrophic medical diagnoses and treatments, but a significant number may develop posttraumatic stress disorder (PTSD) symptoms. PTSD symptoms create added burden for the individual, family, and health care system for the patient's recovery. Medical-related PTSD may be underdiagnosed by providers who may be unaware that these health problems can lead to PTSD symptoms. Treatment research is lacking, but pharmacologic and nonpharmacologic approaches to treatment may be extrapolated and adjusted from the literature focusing on younger adults. Additional study is needed.
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Our paper 20 years later: 1-year survival and 6-month quality of life after intensive care. Intensive Care Med 2015; 41:605-14. [PMID: 25605472 DOI: 10.1007/s00134-015-3654-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION In the early 1990s, the in-hospital mortality rate of intensive care unit (ICU) patients dropped, and interest in the quality of life (QOL) of ICU survivors increased. In 1996, we published a study to investigate 1-year survival after hospital discharge and 6-month QOL after intensive care. Now, we compare our previous results with those reported in the recent literature to appraise any changes, and new knowledge in the area. RESULTS The 1-year survival of ICU patients after hospital discharge is substantial, lower than in the general population, and different among subgroups. Some studies showed a reduction in QOL at 6 months, as in our study, while others showed an improvement. Different results seem to be related mainly to the case mix. Studies on different types of patients found long-term cognitive impairment in ICU survivors, possibly not disease specific. The proportions of patients with neuropsychological morbidities such as posttraumatic stress disorder, anxiety, and depression, described after our study, did not show any change over time. CONCLUSIONS Differences between studies on long-term survival and QOL do not allow conclusions to be drawn about change over time. No change was found in neuropsychological morbidities. However, a lack of change may not be viewed negatively, because critically ill patients who survive ICU today may be at higher risk for poor long-term outcome than in the past due to the higher severity of their illness and the more aggressive treatments received. Future studies may provide understanding of the relationships between psychiatric symptoms, cognitive impairment, functional disability, and QOL.
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Moye J, Rouse SJ. Posttraumatic stress in older adults: when medical diagnoses or treatments cause traumatic stress. Clin Geriatr Med 2014; 30:577-89. [PMID: 25037296 DOI: 10.1016/j.cger.2014.04.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most older patients adapt after catastrophic medical diagnoses and treatments, but a significant number may develop posttraumatic stress disorder (PTSD) symptoms. PTSD symptoms create added burden for the individual, family, and health care system for the patient's recovery. Medical-related PTSD may be underdiagnosed by providers who may be unaware that these health problems can lead to PTSD symptoms. Treatment research is lacking, but pharmacologic and nonpharmacologic approaches to treatment may be extrapolated and adjusted from the literature focusing on younger adults. Additional study is needed.
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Affiliation(s)
- Jennifer Moye
- VA Boston Health Care System, MA, USA; Department of Psychiatry, Harvard Medical School, MA, USA.
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Identification and prevalence of PTSD risk factors in ECMO patients: A single centre study. Aust Crit Care 2014; 28:31-6. [PMID: 24844865 DOI: 10.1016/j.aucc.2014.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/07/2014] [Accepted: 04/22/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is one of the most invasive rescue therapies for acute heart and/or lung failure. Survivors have high rates of adverse mental health outcomes, such as post-traumatic stress symptoms (PTSS) and manifest post-traumatic stress disorder (PTSD). Yet no study to date has identified and explored PTSD risk factors in these patients. OBJECTIVES The primary aim of this study was to determine and explore post-traumatic stress risk factors for patients treated with ECMO. It also aimed to provide a baseline profile for future hypothesis testing with respect to risk factor exposure, level of exposure and post-traumatic stress outcomes in these patients. METHODS DESIGN Retrospective cohort study. SETTING The study was conducted at the Alfred Hospital Melbourne, Australia. PARTICIPANTS Patients were selected in 2012 from an Intensive Care Unit (ICU) registry that prospectively included all patients admitted to ICU and treated with ECMO. DATA EXTRACTION AND ANALYSIS Data were extracted from the ICU ECMO registry, ICU and ward charts, progress notes, referrals, drug charts and discharge letters. Data were descriptively analysed. RESULTS Patients treated with ECMO are exposed to almost all investigated PTSD risk factors. These included psychiatric history (psychiatric comorbidities), admission to ICU and treatment (prolonged ventilation during prolonged ICU stay), and drug therapy (all patients treated with PTSD risk related drugs). CONCLUSION ECMO patients are exposed to PTSD risk factors such as young age, mechanical ventilation, drug administration, delirium and agitation. Younger age, heterogeneous conditions, profound illness severity and prolonged ICU stay describe the case complexity of patients and may explain these findings. Patients in ICU are increasingly conscious during active treatment and this may have positive or negative psychological effects. "Awake" ECMO in which patients are conscious while on active life support may represent a unique PTSD risk factor in this perspective.
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Bienvenu OJ, Gellar J, Althouse BM, Colantuoni E, Sricharoenchai T, Mendez-Tellez PA, Shanholtz C, Dennison CR, Pronovost PJ, Needham DM. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychol Med 2013; 43:2657-71. [PMID: 23438256 PMCID: PMC10885773 DOI: 10.1017/s0033291713000214] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Survivors of critical illnesses often have clinically significant post-traumatic stress disorder (PTSD) symptoms. This study describes the 2-year prevalence and duration of PTSD symptoms after acute lung injury (ALI), and examines patient baseline and critical illness/intensive care-related risk factors. METHOD This prospective, longitudinal cohort study recruited patients from 13 intensive care units (ICUs) in four hospitals, with follow-up 3, 6, 12 and 24 months after ALI onset. The outcome of interest was an Impact of Events Scale - Revised (IES-R) mean score ≥1.6 ('PTSD symptoms'). RESULTS During the 2-year follow-up, 66/186 patients (35%) had PTSD symptoms, with the greatest prevalence by the 3-month follow-up. Fifty-six patients with post-ALI PTSD symptoms survived to the 24-month follow-up, and 35 (62%) of these had PTSD symptoms at the 24-month follow-up; 50% had taken psychiatric medications and 40% had seen a psychiatrist since hospital discharge. Risk/protective factors for PTSD symptoms were pre-ALI depression [hazard odds ratio (OR) 1.96, 95% confidence interval (CI) 1.06-3.64], ICU length of stay (for a doubling of days, OR 1.39, 95% CI 1.06-1.83), proportion of ICU days with sepsis (per decile, OR 1.08, 95% CI 1.00-1.16), high ICU opiate doses (mean morphine equivalent ≥100 mg/day, OR 2.13, 95% CI 1.02-4.42) and proportion of ICU days on opiates (per decile, OR 0.83, 95% CI 0.74-0.94) or corticosteroids (per decile, OR 0.91, 95% CI 0.84-0.99). CONCLUSIONS PTSD symptoms are common, long-lasting and associated with psychiatric treatment during the first 2 years after ALI. Risk factors include pre-ALI depression, durations of stay and sepsis in the ICU, and administration of high-dose opiates in the ICU. Protective factors include durations of opiate and corticosteroid administration in the ICU.
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Affiliation(s)
- O J Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kasparian NA, Fidock B, Sholler GF, Camphausen C, Murphy DN, Cooper SG, Kaul R, Jones O, Winlaw DS, Kirk EP. Parents’ perceptions of genetics services for congenital heart disease: the role of demographic, clinical, and psychological factors in determining service attendance. Genet Med 2013; 16:460-8. [DOI: 10.1038/gim.2013.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 09/19/2013] [Indexed: 11/09/2022] Open
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Schandl A, Bottai M, Hellgren E, Sundin O, Sackey PV. Developing an early screening instrument for predicting psychological morbidity after critical illness. Crit Care 2013; 17:R210. [PMID: 24063256 PMCID: PMC4057163 DOI: 10.1186/cc13018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 09/24/2013] [Indexed: 11/16/2022] Open
Abstract
Introduction Guidelines recommend follow-up for patients after an intensive care unit (ICU) stay. Methods for identifying patients with psychological problems after intensive care would be of value, to optimize treatment and to improve adequate resource allocation in ICU follow-up of ICU survivors. The aim of the study was to develop a predictive screening instrument, for use at ICU discharge, to identify patients at risk for post-traumatic stress, anxiety or depression. Methods Twenty-one potential risk factors for psychological problems - patient characteristics and ICU-related variables - were prospectively collected at ICU discharge. Two months after ICU discharge 252 ICU survivors received the questionnaires Post-Traumatic Stress Symptom scale -10 (PTSS-10) and Hospital Anxiety and Depression Scale (HADS) to estimate the degree of post-traumatic stress, anxiety and depression. Results Of the 150 responders, 46 patients (31%) had adverse psychological outcome, defined as PTSS-10 >35 and/or HADS subscales ≥8. After analysis, six predictors were included in the screening instrument: major pre-existing disease, being a parent to children younger than 18 years of age, previous psychological problems, in-ICU agitation, being unemployed or on sick-leave at ICU admission and appearing depressed in the ICU. The total risk score was related to the probability for adverse psychological outcome in the individual patient. The predictive accuracy of the screening instrument, as assessed with area under the receiver operating characteristic curve, was 0.77. When categorizing patients in three risk probability groups - low (0 to 29%), moderate (30 to 59%) high risk (60 to 100%), the actual prevalence of adverse psychological outcome in respective groups was 12%, 50% and 63%. Conclusion The screening instrument developed in this study may aid ICU clinicians in identifying patients at risk for adverse psychological outcome two months after critical illness. Prior to wider clinical use, external validation is needed.
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Abstract
AIMS AND OBJECTIVES To illustrate the potential physical and psychological problems faced by patients after an episode of critical illness, highlight some of the interventions that have been tested and identify areas for future research. BACKGROUND Recovery from critical illness is an international problem and as an issue is likely to increase. For some, recovery from critical illness is prolonged, subject to physical and psychological problems that may negatively impact upon health-related quality of life. METHODS The literature accessed for this review includes the work of a number of key researchers in the field of critical care research. These were identified from a number of sources include (1) personal knowledge of the research field accumulated over the last decade and (2) using the search engine 'The Knowledge Network Scotland'. RESULTS Fatigue and weakness are significant problems for critical care survivors and are common in patients who have been in ICU for more than one week. Psychological problems include anxiety, depression, post-traumatic stress, delirium and cognitive impairment. Prevalence of these problems is difficult to establish for a number of methodological reasons that include the use of self-report questionnaires, the number of different questionnaires used and the variation in administration and timing. Certain subgroups of ICU survivors especially those at the more severe end of the illness severity spectrum are more at risk and this has been demonstrated for both physical and psychological problems. Findings from international studies of a range of potential interventions are presented. However, establishing effectiveness for most of these still has to be empirically demonstrated. CONCLUSION What seems clear is the need for a co-ordinated, multidisciplinary, designated recovery and rehabilitation pathway that begins as soon as the patient is admitted into an intensive care unit.
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Affiliation(s)
- Janice Rattray
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
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Adam N, Kandelman S, Mantz J, Chrétien F, Sharshar T. Sepsis-induced brain dysfunction. Expert Rev Anti Infect Ther 2013; 11:211-21. [PMID: 23409826 DOI: 10.1586/eri.12.159] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Systemic infection is often revealed by or associated with brain dysfunction, which is characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. Its pathophysiology involves an ischemic process, secondary to impairment of cerebral perfusion and its determinants and a neuroinflammatory process that includes endothelial activation, alteration of the blood-brain barrier and passage of neurotoxic mediators. Microcirculatory dysfunction is common to these two processes. This brain dysfunction is associated with increased mortality, morbidity and long-term cognitive disability. Its diagnosis relies essentially on neurological examination that can lead to specific investigations, including electrophysiological testing or neuroimaging. In practice, cerebrospinal fluid analysis is indisputably required when meningitis is suspected. Hepatic, uremic or respiratory encephalopathy, metabolic disturbances, drug overdose, sedative or opioid withdrawal, alcohol withdrawal delirium or Wernicke's encephalopathy are the main differential diagnoses. Currently, treatment consists mainly of controlling sepsis. The effects of insulin therapy and steroids need to be assessed. Various drugs acting on sepsis-induced blood-brain barrier dysfunction, brain oxidative stress and inflammation have been tested in septic animals but not yet in patients.
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Affiliation(s)
- Nicolas Adam
- General Intensive Care Unit, Raymond Poincaré Teaching Hospital, University of Versailles Saint-Quentin en Yvelines, 104 Boulevard Raymond Poincaré, 92380 Garches, France
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Psychological wellbeing and posttraumatic stress associated with implantable cardioverter defibrillator therapy in young adults with genetic heart disease. Int J Cardiol 2013; 168:3779-84. [PMID: 23835269 DOI: 10.1016/j.ijcard.2013.06.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/26/2013] [Accepted: 06/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sudden cardiac death is a tragic complication of a number of genetic heart diseases. Implantable cardioverter defibrillator (ICD) therapy plays an important role in prevention of sudden death. The psychological consequences of ICD therapy in young people with genetic heart disease are poorly understood. This study sought to better understand psychological wellbeing and identify symptoms of posttraumatic stress in young people who had experienced an ICD shock. METHODS Eligible patients (ICD implanted over 12 months prior) with an inherited cardiomyopathy or primary arrhythmogenic disorder, enrolled in the Australian Genetic Heart Disease Registry were included. Ninety patients completed the Hospital Anxiety and Depression Scale (HADS). Those patients who had an ICD shock (n=31) also completed the Impact of Events Scale-Revised (IES-R). RESULTS While the mean HADS-Anxiety and IES-R scores were within the normal range in the total group (n=90), a significant subgroup reported symptoms of anxiety (38%), depression (17%) and posttraumatic stress (31%) indicative of the potential need for referral to clinical care. Overall, greater psychological distress in ICD patients was associated with female gender, a history of syncope, other comorbid medical conditions, and reporting of other distressing events (i.e., ICD complications). In those with an ICD shock, higher posttraumatic stress scores were associated with female gender and longer time to first shock. CONCLUSIONS Patients with genetic heart diseases can experience psychological difficulties, including anxiety, depression and posttraumatic stress, related to ICD implantation and subsequent shocks. This signals the importance of offering patients access to targeted interventions, including psychological care and support.
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Lombardo V, Vinatier I, Baillot ML, Franja V, Bourgeon-Ghittori I, Dray S, Jeune S, Mossadegh C, Reignier J, Souweine B, Roch A. How caregivers view patient comfort and what they do to improve it: a French survey. Ann Intensive Care 2013; 3:19. [PMID: 23815804 PMCID: PMC3700816 DOI: 10.1186/2110-5820-3-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/11/2013] [Indexed: 11/29/2022] Open
Abstract
Background Intensive care unit (ICU) patients are exposed to many sources of discomfort. Most of these are related to the patient’s condition, but ICU design or how care is organized also can contribute. The present survey was designed to describe the opinions of ICU caregivers on sources of patient discomfort and to determine how they were dealt with in practice. The architectural and organizational characteristics of ICUs also were analyzed in relation to patient comfort. Methods An online, closed-ended questionnaire was developed. ICU caregivers registered at the French society of intensive care were invited to complete this questionnaire. Results A total of 915 staff members (55% nurses) from 264 adult and 28 pediatric ICUs completed the questionnaire. Analysis of the answers reveals that: 68% of ICUs had only single-occupancy rooms, and 66% had natural light in each room; ICU patients had access to television in 59% of ICUs; a clock was present in each room in 68% of ICUs. Visiting times were <4 h in 49% of adult ICUs, whereas 64% of respondents considered a 24-h policy to be very useful or essential to patients’ well-being. A nurse-driven analgesia protocol was available in 42% of units. For caregivers, the main sources of patient discomfort were anxiety, feelings of restraint, noise, and sleep disturbances. Paramedics generally considered discomfort related to thirst, lack of privacy, and the lack of space and time references, whereas almost 50% of doctors ignored these sources of discomfort. Half of caregivers indicated they assessed sleep quality. A minority of caregivers declared regular use of noise-reduction strategies. Twenty percent of respondents admitted to having non-work-related conversations during patient care, and only 40% indicated that care often was or always was provided without closing doors. Family participation in care was planned in very few adult ICUs. Conclusions Results of this survey showed that ICUs are poorly equipped to ensure patient privacy and rest. Access by loved ones and their participation in care also is limited. The data also highlighted that some sources of discomfort are less often taken into account by caregivers, despite being considered to contribute significantly.
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Affiliation(s)
- Véronique Lombardo
- The Nurses' board of the Société de Réanimation de Langue Française (SRLF), Paris, France.
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Abstract
Sepsis often is characterized by an acute brain dysfunction, which is associated with increased morbidity and mortality. Its pathophysiology is highly complex, resulting from both inflammatory and noninflammatory processes, which may induce significant alterations in vulnerable areas of the brain. Important mechanisms include excessive microglial activation, impaired cerebral perfusion, blood-brain-barrier dysfunction, and altered neurotransmission. Systemic insults, such as prolonged inflammation, severe hypoxemia, and persistent hyperglycemia also may contribute to aggravate sepsis-induced brain dysfunction or injury. The diagnosis of brain dysfunction in sepsis relies essentially on neurological examination and neurological tests, such as EEG and neuroimaging. A brain MRI should be considered in case of persistent brain dysfunction after control of sepsis and exclusion of major confounding factors. Recent MRI studies suggest that septic shock can be associated with acute cerebrovascular lesions and white matter abnormalities. Currently, the management of brain dysfunction mainly consists of control of sepsis and prevention of all aggravating factors, including metabolic disturbances, drug overdoses, anticholinergic medications, withdrawal syndromes, and Wernicke's encephalopathy. Modulation of microglial activation, prevention of blood-brain-barrier alterations, and use of antioxidants represent relevant therapeutic targets that may impact significantly on neurologic outcomes. In the future, investigations in patients with sepsis should be undertaken to reduce the duration of brain dysfunction and to study the impact of this reduction on important health outcomes, including functional and cognitive status in survivors.
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État de stress post-traumatique après ventilation prolongée. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gul S, Gul EU, Yesilyurt M, Ozturk B, Kuscu F, Ergonul O. Health-Related Quality of Life and the Prevalence of Post-Traumatic Stress Disorder among Crimean-Congo Hemorrhagic Fever Survivors. Jpn J Infect Dis 2012; 65:392-5. [DOI: 10.7883/yoken.65.392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Relationship of a common polymorphism of the glucocorticoid receptor gene to traumatic memories and posttraumatic stress disorder in patients after intensive care therapy. Crit Care Med 2011; 39:643-50. [PMID: 21169818 DOI: 10.1097/ccm.0b013e318206bae6] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Glucocorticoids play a major role in the consolidation and retrieval of traumatic information. They act through the glucocorticoid receptor, for which, in humans, several polymorphisms have been described. In particular, the BclI single-nucleotide polymorphism is associated with hypersensitivity to glucocorticoids and with susceptibility to development of major depression. Furthermore, in patients with posttraumatic stress disorder carrying the BclI GG genotype, cortisol levels were lower and showed an inverse relationship to posttraumatic stress disorder symptom intensity. Here, we studied the association of the BclI polymorphism with plasma cortisol levels, traumatic memories, posttraumatic stress disorder symptoms, and health-related quality of life outcomes in 126 patients undergoing cardiac surgery and intensive care unit therapy. DESIGN Prospective observational study. SETTING Cardiovascular intensive care unit in a university hospital. PATIENTS A total of 126 patients undergoing cardiac surgery and intensive care unit treatment. INTERVENTIONS No interventions were performed. MEASUREMENTS AND MAIN RESULTS Validated questionnaires were used to quantify end points. Measurements were taken 1 day before and 1 wk and 6 months after cardiac surgery. Homozygous carriers of the BclI G allele (n = 21) had significantly lower preoperative plasma cortisol levels and more long-term traumatic memories from intensive care unit therapy at 6 months after cardiac surgery than heterozygous carriers or noncarriers (1.9 ± 1.4 vs. 1.0 ± 1.2, p = .01). Anxiety was significantly more common as a long-term traumatic memory in homozygous BclI G allele carriers than in heterozygous carriers or noncarriers (57% vs. 35%, p = .03). Posttraumatic stress disorder symptom scores were significantly higher at discharge from the intensive care unit in homozygous BclI G allele carriers than in heterozygous carriers or noncarriers. Only heterozygous carriers or BclI G allele noncarriers had a significant gain in health-related quality of life physical function at 6 months after cardiac surgery (p < .01). Baseline values were not statistically different between carriers of the different BclI alleles. CONCLUSION Homozygous BclI G allele carriers are at risk for traumatic memories, posttraumatic stress disorder symptoms, and lower health-related quality of life after cardiac surgery and intensive care unit therapy. The BclI single-nucleotide polymorphism may help to identify individuals at need for tailored medical care.
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Roffey P, Thangathurai D. Delayed Endotracheal Extubation and PTSD in ICU Patients. PSYCHOSOMATICS 2011; 52:194. [DOI: 10.1016/j.psym.2010.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Peris A, Bonizzoli M, Iozzelli D, Migliaccio ML, Zagli G, Bacchereti A, Debolini M, Vannini E, Solaro M, Balzi I, Bendoni E, Bacchi I, Trevisan M, Giovannini V, Belloni L. Early intra-intensive care unit psychological intervention promotes recovery from post traumatic stress disorders, anxiety and depression symptoms in critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R41. [PMID: 21272307 PMCID: PMC3221970 DOI: 10.1186/cc10003] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/18/2010] [Accepted: 01/27/2011] [Indexed: 11/10/2022]
Abstract
Introduction Critically ill patients who require intensive care unit (ICU) treatment may experience psychological distress with increasing development of psychological disorders and related morbidity. Our aim was to determine whether intra-ICU clinical psychologist interventions decrease the prevalence of anxiety, depression and posttraumatic stress disorder (PTSD) after 12 months from ICU discharge. Methods Our observational study included critical patients admitted before clinical psychologist intervention (control group) and patients who were involved in a clinical psychologist program (intervention group). The Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised questionnaires were used to assess the level of posttraumatic stress, anxiety and depression symptoms. Results The control and intervention groups showed similar demographic and clinical characteristics. Patients in the intervention group showed lower rates of anxiety (8.9% vs. 17.4%) and depression (6.5% vs. 12.8%) than the control group on the basis of HADS scores, even if the differences were not statistically significant. High risk for PTSD was significantly lower in patients receiving early clinical psychologist support than in the control group (21.1% vs. 57%; P < 0.0001). The percentage of patients who needed psychiatric medications at 12 months was significantly higher in the control group than in the patient group (41.7% vs. 8.1%; P < 0.0001). Conclusions Our results suggest that that early intra-ICU clinical psychologist intervention may help critically ill trauma patients recover from this stressful experience.
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Affiliation(s)
- Adriano Peris
- Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, I-50139 Florence, Italy
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