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Sim A, McNeilage AG, Gholamrezaei A, Rebbeck T, Ashton-James C. Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: a scoping review of systematic reviews. BMJ Open 2024; 14:e085778. [PMID: 39025825 PMCID: PMC11261706 DOI: 10.1136/bmjopen-2024-085778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Musculoskeletal injuries can cause distress, and distress is associated with delayed recovery. Numerous interventions have been developed to facilitate recovery from injury, and several systematic reviews evaluate the efficacy of these interventions for reducing psychological distress. OBJECTIVES This scoping review aims to map the synthesised evidence for the relationship between treatment interventions and distress-related outcomes following acute injury. The objectives were (1) to describe the types of interventions that have been evaluated in relation to distress-related outcomes following accidental injury, (2) to examine the scope of distress-related outcomes that have been measured in relation to these interventions and (3) to explore the range of clinical professions that deliver these interventions. DESIGN We searched nine electronic databases and grey literature (to 21 April 2022). We included any systematic review reporting on the relationship between interventions delivered in the time following injury and distress-related outcomes. Data relevant to the specific objectives of this scoping review were extracted and described using narrative synthesis. RESULTS From 8412 systematic reviews imported for screening, 8266 unique records were screened. 179 were selected for full-text review. 84 systematic reviews were included in the study. Interventional types were pharmacological, psychological, exercise based, physical/manual therapies, virtual reality based, multimodal and workplace based. Interventions were delivered digitally, face to face and using virtual reality by a variety of healthcare professionals, including doctors, nurses, psychologists and physiotherapists. The most frequently reported distress-related variables included anxiety, depression, post-traumatic stress disorder diagnosis. CONCLUSION A wide range of interventions may help to mitigate distress following acute accidental musculoskeletal or orthopaedic injury. Even interventions that were not designed to reduce distress were found to improve distress-related outcomes. In view of the important role of distress in recovery from injury, it is recommended that distress-related variables are measured as core outcomes in the evaluation of treatments for acute injuries.
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Affiliation(s)
- Alison Sim
- The University of Sydney, Sydney, Australia
| | | | - Ali Gholamrezaei
- Faculty of Medicine and Health, The University of Sydney - Camperdown and Darlington Campus, Sydney, New South Wales, Australia
| | - Trudy Rebbeck
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Claire Ashton-James
- Pain Management, The University of Sydney, Sydney, New South Wales, Australia
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Maurer C, Exl MT, Gander HP, Bertschi D, Fischbacher I, Barbezat I, Eissler C, Jeitziner MM. Consequences of a stay in the intensive care unit and outpatient follow-up care for chronic critically ill patients: A retrospective data analysis. Aust Crit Care 2024:S1036-7314(24)00098-5. [PMID: 38971649 DOI: 10.1016/j.aucc.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/22/2024] [Accepted: 05/20/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Patients with chronic critical illness (CCI) represent a particularly vulnerable patient population with significant quality-of-life consequences and a need for follow-up care. Existing research on their quality-of-life trajectory and outpatient follow-up care is limited. OBJECTIVES The aim of this study was to (i) describe a quality improvement project focussing on patients with CCI in the Swiss setting; (ii) explain the consequences of an intensive care unit (ICU) stay for patients with CCI; and (iii) evaluate outpatient follow-up care for patients with CCI. METHODS This retrospective descriptive mixed-methods longitudinal study used routine data from outpatient follow-up care between October 2018 and June 2022. The pre-ICU data were collected retrospectively for the week before ICU admission (baseline); prospectively at 3, 6, and 12 months after ICU discharge; and during an outpatient follow-up care at 6 months. Its main outcomes were health-related quality of life (HRQOL). Patients with CCI were defined as those having a ICU stay longer than 7 days. RESULTS This study enrolled 227 patients with outpatient follow-up care, but only 77 were analysed at all four timepoints. Their EuroQol five-dimension five-level questionnaire-Visual Analogue Scale scores ranged from 0 to 100, with a median of 85 (interquartile range = 0-100) and a mean of 77.2 (standard deviation ± 23.52) before their ICU stay. Their scores had almost returned to the baseline 12 months after their ICU stay. While some reported existing restrictions in the individual HRQOL dimensions before their ICU stay, patients and their families appreciated the outpatient follow-up care including an ICU visit. CONCLUSION Patients with CCI have different HRQOL trajectories over time. Patients with CCI can have a good HRQOL despite their impairments; however, the HRQOL trajectories of many patients remain unclear. The focus must be on identifying the illness trajectories and on measuring and maintaining their long-term HRQOL.
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Affiliation(s)
- Carol Maurer
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland.
| | - Matthias Thomas Exl
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Hans-Peter Gander
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Daniela Bertschi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Irene Fischbacher
- Department of Health, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland; Health Department of St.Gallen, Service for Care and Development, Oberer Graben 32, 9001 St.Gallen, Switzerland.
| | - Isabelle Barbezat
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland; Clinical Practice Development, Department of Nursing, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland.
| | - Christian Eissler
- Bern University of Applied Sciences, Department of Health Professions, Murtenstrasse 10, 3008 Bern, Switzerland.
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland.
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Zhang F, Chen Z, Xue DD, Zhang R, Cheng Y. Barriers and facilitators to offering post-intensive care follow-up services from the perspective of critical care professionals: A qualitative study. Nurs Crit Care 2024; 29:682-694. [PMID: 38146140 DOI: 10.1111/nicc.13002] [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: 05/06/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Various programmes and models for post-intensive care unit (ICU) follow-up services have been developed worldwide. In China, post-ICU follow-up remains in the exploratory stage and little is known regarding the appropriate form and challenges of implementation, which need to be further explored. AIM This study aimed to explore and describe the barriers to and facilitators of post-ICU follow-up services from the perspective of critical care professionals. DESIGN This was a descriptive qualitative study. Semi-structured interviews were conducted with 21 health care workers whose units had offered ICU survivors different forms of follow-up services; the data were analysed by qualitative content analysis during August 2022 and December 2022. SETTING The study was conducted at 14 ICUs in 11 tertiary hospitals in Shanghai, China. FINDINGS Seventeen subthemes were extracted as barriers and facilitators in the follow-up of ICU survivors. In the initiating process, the barriers included the restriction of decision-making rights and scope of practice, indifferent attitude towards survivors and repeated work. The facilitators included admitted significance, the needs of ICU survivors, the conscientiousness of professionals and the pioneers and leadership support. In the implementation process, lack of confidence, lack of cooperation in medical consortium, distrusted relationships, restrictions of medical insurance, ageing problems and insufficient human resources acted as barriers, whereas lessons learned, positive feedback and digital support served as facilitators. Furthermore, recommendations and tips were identified for offering follow-up services. CONCLUSION Medical personnel can better utilize available resources and develop strategies to overcome constraints by gaining insights into the abovementioned barriers and facilitators. The findings of this study can provide a useful reference for structured and systematic follow-ups to ameliorate post-intensive care syndrome in low- and middle-income countries. RELEVANCE TO CLINICAL PRACTICE Publicity and educational measures play a crucial role in enhancing the awareness of survivors and the consensus of health care professionals from medical consortium regarding impairments after critical care. Leadership and policy support can address numerous obstacles to guiding follow-up services.
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Affiliation(s)
- Feng Zhang
- Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Zhen Chen
- Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Dan-Dan Xue
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Rui Zhang
- Intensive Care Unit, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
- School of Nursing, Fudan University, Shanghai, People's Republic of China
| | - Yun Cheng
- Nursing Department, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
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Cox CE, Gallis JA, Olsen MK, Porter LS, Gremore TM, Iwashyna TJ, Caldwell ES, Greeson JM, Moss M, Hough CL. Mobile App-Based Mindfulness Intervention for Addressing Psychological Distress Among Survivors of Hospitalization for COVID-19 Infection. CHEST CRITICAL CARE 2024; 2:100063. [PMID: 38957856 PMCID: PMC11218743 DOI: 10.1016/j.chstcc.2024.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Psychological distress symptoms are present and persistent among many patients who survive a critical illness like COVID-19. RESEARCH QUESTION Could a self-directed mobile app-delivered mindfulness intervention be feasibly and rapidly implemented within a clinical trials network to reduce distress symptoms? STUDY DESIGN AND METHODS A randomized clinical trial was conducted between January 2021 and May 2022 at 29 US sites and included survivors of hospitalization due to COVID-19-related illness with elevated symptoms of depression at discharge. Participants were randomized to intervention or usual care control. The intervention consisted of four themed weeks of daily audio, video, and text content. All study procedures were virtual. The primary outcome was depression symptoms assessed with the Patient Health Questionnaire 9 at 3 months. Secondary outcomes included anxiety (Generalized Anxiety Disorder 7-item scale), quality of life (EQ-5D), and adherence. We used general linear models to estimate treatment arm differences in outcomes over time. RESULTS Among 56 randomized participants (mean age ± SD, 51.0 ± 13.2 years; 38 female [67.9%]; 14 Black participants [25%]), 45 (intervention: n = 23 [79%]; control: n = 22 [81%]) were retained at 6 months. There was no difference in mean improvement between intervention and control participants at 3 months in Patient Health Questionnaire 9 (-0.5 vs 0.1), Generalized Anxiety Disorder 7-item scale (-0.3 vs 0.1), or EQ-5D (-0.03 vs 0.02) scores, respectively; 6-month results were similar. Only 15 participants (51.7%) initiated the intervention, whereas the mean number ± SD of the 56 prescribed intervention activities completed was 12.0 ± 15.2. Regulatory approvals delayed trial initiation by nearly a year. INTERPRETATION Among survivors of COVID-19 hospitalization with elevated psychological distress symptoms, a self-directed mobile app-based mindfulness intervention had poor adherence. Future psychological distress interventions mobilized at broad scale should focus efforts on patient engagement and regulatory simplification to enhance success. TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT04581200; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Christopher E Cox
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - John A Gallis
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Maren K Olsen
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Laura S Porter
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Tina M Gremore
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Ellen S Caldwell
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Jeffrey M Greeson
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Marc Moss
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine (C. E. C.), the Program to Support People and Enhance Recovery (ProSPER) (C. E. C.), and the Department of Biostatistics and Bioinformatics (J. A. G. and M. K. O.), Duke University, Durham, NC; the Center of Innovation (M. K. O.), Durham Veterans Affairs Medical Center, Veterans Administration, Durham, NC; the Department of Psychology (L. S. P. and T. M. G.), Duke University, Durham, NC; the Department of Medicine (T. J. I.), Johns Hopkins University, Baltimore, MD; the Department of Medicine (E. S. C. and C. L. H.), Oregon Health & Science University, Portland, OR; the Department of Psychology (J. M. G.), Rowan University, Glassboro, NJ; and the Department of Medicine (M. M.), University of Colorado, Denver, CO
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Su LJ, Chen MJ, Yang R, Zou H, Chen TT, Li SL, Xin HN, Hu RF. Investigating the correlation of delirium after cardiac surgery with memories and posttraumatic stress disorder consequences of intensive care unit: A prospective cohort study. Intensive Crit Care Nurs 2024; 82:103632. [PMID: 38290221 DOI: 10.1016/j.iccn.2024.103632] [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: 01/11/2024] [Accepted: 01/20/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To explore the differences in post-intensive care unit memory and posttraumatic stress disorder symptoms between patients with and without delirium, and assess the correlations between the two. DESIGN Prospective cohort observation study. SETTING A cardiac intensive care unit of a tertiary hospital in China. We enrolled 318 consecutive patients after cardiac surgery between December 2017 and March 2019. MAIN OUTCOME MEASURES Delirium was assessed using the Confusion Assessment Method for the ICU from intensive care unit admission to discharge. Intensive care unit memory was assessed using the ICU-Memory Tool through face-to-face interviews one week after discharge. Posttraumatic stress disorder was measured telephonically using the Impact of Events Scale-revised questionnaire at three months post-discharge. RESULTS Eighty patients each in the delirium and non-delirium groups were enrolled for follow-up interviews. Patients with delirium had vaguer memories of pre-intensive care unit admission and of their stay, and recollected more memories of feelings (vs. without delirium). Posttraumatic stress disorder was diagnosed in 14 patients with and in seven without delirium, with non-significant differences between groups. Delirium did not influence post-intensive care unit factual, feeling, and delusional memories, nor posttraumatic stress disorder and hyperarousal, intrusion, and avoidance. The memories of feelings were positively correlated with the last three (r = 0.285, r = 0.390 and r = 0.373, respectively). CONCLUSION Patients with delirium had vague intensive care unit memories. Memories of feelings were positively correlated with symptoms of hyperarousal, intrusion, and avoidance. Delirium did not influence factual, feeling, or delusional memories nor posttraumatic stress disorder incidence and symptoms. IMPLICATIONS FOR CLINICAL PRACTICE Interventions are needed to reduce the impact of vague memory in patients with post-intensive care unit delirium. Memories of feelings should be focused on because of their correlation with hyperarousal, intrusion, and avoidance. Delirium prevention and early recognition measures are suggested.
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Affiliation(s)
- Li-Jing Su
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Mei-Jing Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Rong Yang
- Follow-Up Center, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Ting-Ting Chen
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China
| | - Sai-Lan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Hui-Ning Xin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province 350001, China.
| | - Rong-Fang Hu
- School of Nursing, Fujian Medical University, Fuzhou, Fujian Province 350122, China.
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Friberg K, Hofsø K, Rustøen T, Ræder J, Hagen M, Puntillo K, Olsen BF. Patient characteristics associated with posttraumatic stress symptoms in intensive care unit survivors during a one-year follow-up: A multicenter study. Heart Lung 2024; 66:1-8. [PMID: 38492243 DOI: 10.1016/j.hrtlng.2024.02.011] [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: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival. OBJECTIVES To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission. METHODS Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures. RESULTS High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times. CONCLUSIONS The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health professionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these.
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Affiliation(s)
- Klara Friberg
- Østfold Hospital Trust, Intensive and post operative unit, Postbox 300, 1714 Grålum, Norway; University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316 Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University Collage, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway; Oslo University Hospital, Department of Postoperative and Critical Care Nursing, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Tone Rustøen
- University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316 Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Johan Ræder
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Postbox 0316 Oslo, Norway
| | - Milada Hagen
- Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway; Oslo Metropolitan University, Department of Public Health, Faculty of Health Sciences, Postbox 4, St Olavs plass, 0130 Oslo, Norway
| | - Kathleen Puntillo
- University of California, Department of Physiological Nursing, School of Nursing, 2 Koret Way, San Francisco, 94143 California, USA
| | - Brita Fosser Olsen
- Østfold Hospital Trust, Intensive and post operative unit, Postbox 300, 1714 Grålum, Norway; Østfold University College, Faculty of Health and Welfare, Postbox 700, 1757 Halden, Norway
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Haines KJ, Hibbert E, Skinner EH, Leggett N, Holdsworth C, Ali Abdelhamid Y, Bates S, Bicknell E, Booth S, Carmody J, Deane AM, Emery K, Farley KJ, French C, Krol L, MacLeod-Smith B, Maher L, Paykel M, Iwashyna TJ. In-person peer support for critical care survivors: The ICU REcovery Solutions cO-Led through surVivor Engagement (ICURESOLVE) pilot randomised controlled trial. Aust Crit Care 2024:S1036-7314(24)00022-5. [PMID: 38360469 DOI: 10.1016/j.aucc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies. OBJECTIVES The objective of this study was to establish feasibility of an in-person, co-designed, peer-support model. METHODS Prospective, randomised, adaptive, single-centre pilot trial with blinded outcome assessment, conducted at a university-affiliated hospital in Melbourne, Australia. Intensive care unit survivors (and their nominated caregiver, where survivor and caregiver are referred to as a dyad), >18 years of age, able to speak and understand English and participate in phone surveys, were eligible. Participants were randomised to the peer-support model (six sessions, fortnightly) or usual care (no follow-up or targeted information). Two sequential models were piloted: 1. Early (2-3 weeks post hospital discharge) 2. Later (4-6 weeks post hospital discharge). Primary outcome was feasibility of implementation measured by recruitment, intervention attendance, and outcome completion. Secondary outcomes included post-traumatic stress and social support. RESULTS Of the 231 eligible patients, 80 participants were recruited. In the early model we recruited 38 participants (28 patients, 10 carers; 18 singles, 10 dyads), with an average (standard deviation) age of 60 (18) years; 55 % were female. Twenty-two participants (58 %) were randomised to intervention. Participants in the early intervention model attended a median (interquartile range) of 0 (0-1) sessions (total 24 sessions), with 53% (n = 20) completing the main secondary outcome of interest (Impact of Event Scale) at the baseline and 37 % (n = 14) at the follow-up. For the later model we recruited 42 participants (32 patients, 10 carers; 22 singles, 10 dyads), with an average (standard deviation) age of 60.4 (15.4) years; 50 % were female. Twenty-one participants (50 %) were randomised to intervention. The later intervention model attended a median (interquartile range) of 1 (0-5) sessions (total: 44 sessions), with the main secondary outcome impact of events scale (IES-R) completed by 41 (98 %) participants at baseline and 29 (69 %) at follow-up. CONCLUSIONS In this pilot trial, a peer-support model that required in-person attendance delivered in a later posthospital phase of recovery appeared more feasible than an early model. Further research should investigate alternative modes of intervention delivery to improve feasibility (ACTRN12621000737831).
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia.
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Erin Bicknell
- Department of Physiotherapy, Melbourne Health, Melbourne, Australia
| | - Sarah Booth
- Department of Social Work, Western Health, Melbourne, Australia
| | - Jacki Carmody
- Department of Psychology, Western Health, Melbourne, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - K J Farley
- Department of Intensive Care, Western Health, Melbourne, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Lauren Krol
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Lynne Maher
- Ko Awatea, Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand
| | - Melanie Paykel
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Theodore J Iwashyna
- Pulmonary and Critical Care Medicine, School of Medicine, John Hopkins University, Baltimore, MD, United States
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McNicholas B, Akcan Arikan A, Ostermann M. Quality of life after acute kidney injury. Curr Opin Crit Care 2023; 29:566-579. [PMID: 37861184 DOI: 10.1097/mcc.0000000000001090] [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: 10/21/2023]
Abstract
PURPOSE OF REVIEW Deciphering the effect of acute kidney injury (AKI) during critical illness on long-term quality of life versus the impact of conditions that brought on critical illness is difficult. RECENT FINDINGS Reports on patient-centred outcomes such as health-related quality of life (HRQOL) have provided insight into the long-lasting impact of critical illness complicated by AKI. However, these data stem from observational studies and randomized controlled trials, which have been heterogeneous in their patient population, timing, instruments used for assessment and reporting. Recent studies have corroborated these findings including lack of effect of renal replacement therapy compared to severe AKI on outcomes and worse physical compared to cognitive dysfunction. SUMMARY In adults, more deficits in physical than mental health domains are found in survivors of AKI in critical care, whereas memory deficits and learning impairments have been noted in children. Further study is needed to understand and develop interventions that preserve or enhance the quality of life for individual patients who survive AKI following critical illness, across all ages.
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Affiliation(s)
- Bairbre McNicholas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital
- School of Medicine, University of Galway, Galway, Ireland
| | - Ayse Akcan Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, Westminster Bridge Road, London, UK
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Shi W, Jiang D, Rando H, Khanduja S, Lin Z, Hazel K, Pottanat G, Jones E, Xu C, Lin D, Yasar S, Cho SM, Lu H. Blood-brain barrier breakdown in COVID-19 ICU survivors: an MRI pilot study. NEUROIMMUNE PHARMACOLOGY AND THERAPEUTICS 2023; 2:333-338. [PMID: 38058998 PMCID: PMC10696574 DOI: 10.1515/nipt-2023-0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
Objectives Coronavirus disease 2019 (COVID-19) results in severe inflammation at the acute stage. Chronic neuroinflammation and abnormal immunological response have been suggested to be the contributors to neuro-long-COVID, but direct evidence has been scarce. This study aims to determine the integrity of the blood-brain barrier (BBB) in COVID-19 intensive care unit (ICU) survivors using a novel MRI technique. Methods COVID-19 ICU survivors (n=7) and age and sex-matched control participants (n=17) were recruited from June 2021 to March 2023. None of the control participants were hospitalized due to COVID-19 infection. The COVID-19 ICU survivors were studied at 98.6 ± 14.9 days after their discharge from ICU. A non-invasive MRI technique was used to assess the BBB permeability to water molecules, in terms of permeability surface area-product (PS) in the units of mL/100 g/min. Results PS was significantly higher in COVID-19 ICU survivors (p=0.038) when compared to the controls, with values of 153.1 ± 20.9 mL/100 g/min and 132.5 ± 20.7 mL/100 g/min, respectively. In contrast, there were no significant differences in whole-brain cerebral blood flow (p=0.649) or brain volume (p=0.471) between the groups. Conclusions There is preliminary evidence of a chronic BBB breakdown in COVID-19 survivors who had a severe acute infection, suggesting a plausible contributor to neurological long-COVID symptoms.
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Affiliation(s)
- Wen Shi
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hannah Rando
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivalika Khanduja
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zixuan Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kaisha Hazel
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - George Pottanat
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ebony Jones
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cuimei Xu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Doris Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sevil Yasar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sung-Min Cho
- Department of Neurology, Neurosurgery, Surgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
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10
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Drewitz KP, Hasenpusch C, Bernardi C, Brandstetter S, Fisser C, Pielmeier K, Rohr M, Brunnthaler V, Schmidt K, Malfertheiner MV, Apfelbacher CJ. Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): feasibility of a pragmatic randomised controlled trial. BMC Anesthesiol 2023; 23:344. [PMID: 37838669 PMCID: PMC10576359 DOI: 10.1186/s12871-023-02255-1] [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: 11/21/2022] [Accepted: 08/24/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND ICU survivors often suffer from prolonged physical and mental impairments resulting in the so called "Post-Intensive Care Syndrome" (PICS). The aftercare of former ICU patients affected by PICS in particular has not been addressed sufficiently in Germany so far. The aim of this study was to evaluate the feasibility of a pragmatic randomised trial (RCT) comparing an intensive care unit (ICU) follow-up clinic intervention to usual care. METHODS This pilot study in a German university hospital evaluated the feasibility of a pragmatic RCT. Patients were assigned in a 1:1 ratio to an ICU follow-up clinic intervention or to usual care. The concept of this follow-up clinic was previously developed in a participatory process with patients, next of kin, health care professionals and researchers. We performed a process evaluation and determined acceptability, fidelity, completeness of measurement instruments and practicality as feasibility outcomes. The RCT's primary outcome (health-related quality of life) was assessed six months after ICU discharge by means of the physical component scale of the Short-Form-12 self-report questionnaire. RESULTS The pilot study was conducted from June 2020 to May 2021 with 21 and 20 participants in the intervention and control group. Principal findings related to feasibility were 85% consent rate (N = 48), 62% fidelity rate, 34% attrition rate (N = 41) and 77% completeness of outcome measurements. The primary effectiveness outcome (health-related quality of life) could be measured in 93% of participants who completed the study (N = 27). The majority of participants (85%) needed assistance with follow-up questionnaires (practicality). Median length of ICU stay was 13 days and 85% (N = 41) received mechanical ventilation, median Sequential Organ Failure Assessment Score was nine. Six-month follow-up assessment was planned for all study participants and performed for 66% (N = 41) of the participants after 197 days (median). CONCLUSION The participatory developed intervention of an ICU follow-up clinic and the pragmatic pilot RCT both seem to be feasible. We recommend to start a pragmatic RCT on the effectiveness of the ICU follow-up clinic. TRIAL REGISTRATION ClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468.
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Affiliation(s)
- Karl Philipp Drewitz
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Claudia Hasenpusch
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Bernardi
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Katharina Pielmeier
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Magdalena Rohr
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Vreni Brunnthaler
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Maximilian V Malfertheiner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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She SJ, Xu YY. Effect of CICARE communication nursing model combined with motivational psychological intervention in patients with post-intensive care unit syndrome. World J Psychiatry 2023; 13:707-713. [PMID: 37771643 PMCID: PMC10523197 DOI: 10.5498/wjp.v13.i9.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is a term used to describe a constellation of new or worsened dysfunctions in the physical, cognitive, or mental health status of critically ill patients after their discharge from the intensive care unit (ICU). These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family. Connect, Introduce, Communicate, Ask, Respond, Exit (CICARE) communication advocates that patients should be respected and accepted when receiving medical services. Clinicians should attach importance to the communication mode of feelings, including connection, introduction, communication, ask, response, and exit 6 steps. AIM To assess the impact of CICARE communication on the reduction of anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms in patients transitioning from the ICU to other care settings. METHODS This prospective, randomized, controlled study was performed between October 2021 and March 2023. Intensive Care Unit Memory Tool was used to evaluate patients' ICU memory. The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms. Impact of Event Scale-Revised was utilized to assess the presence of PTSD. All data were processed and analyzed using R language software version 4.1.0. The measurement data were expressed as mean ± SD, and the t test was used. The count data were analyzed by the χ2 test and expressed as [n (%)]. RESULTS In total, 248 subjects were included in this study. Among them, 206 were successfully followed up for three months after transfer from the ICU, and 42 cases were lost to follow-up. There was no significant difference in the composition of ICU memory between the two groups. The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model, as well as the adoption of only the motivational psychological intervention nursing model, demonstrated favorable effects on PICS. Both groups of patients showed a reduction in anxiety scores, depression scores, and PTSD scores following the implementation of these two nursing models. However, it is noteworthy that the experimental group exhibited greater improvements compared to the control group. CONCLUSION Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.
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Affiliation(s)
- Sun-Ju She
- Department of Neurosurgery, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Ying-Ying Xu
- Emergency Intensive Care Unit, Dushu Lake Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu Province, China
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12
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Suganuma S, Idei M, Nakano H, Koyama Y, Hashimoto H, Yokoyama N, Takaki S, Nakamura K. Impact of Persistent Inflammation, Immunosuppression, and Catabolism Syndrome during Intensive Care Admission on Each Post-Intensive Care Syndrome Component in a PICS Clinic. J Clin Med 2023; 12:5427. [PMID: 37629468 PMCID: PMC10455637 DOI: 10.3390/jcm12165427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is known as a prolonged immunodeficiency that occurs after severe infection. Few studies have demonstrated a direct relationship between PIICS and physical dysfunction in post-intensive care syndrome (PICS). We herein investigated how each component of PICS was affected by the diagnosis of PIICS during hospitalization and examined the relationship between PIICS and PICS using PICS assessments performed at the Hitachi General Hospital PICS Clinic. METHODS The 273 patients who visited the PICS clinic at one month after discharge from the ICU at Hitachi General Hospital were included in the study. We used the diagnostic criteria for PIICS described in previous studies. At least two of the following blood test values on day 14 of hospitalization had to be met for a diagnosis of PIICS: C-reactive protein (CRP) > 2.0 mg/dL, albumin (Alb) < 3.0 g/dL, and lymphocytes (Lym) < 800/μL. Blood test values closest to day 14 out of 11-17 days of hospitalization were used. The primary outcome was a Barthel Index (BI) < 90, while secondary outcomes were the results of various PICS assessments, including mental and cognitive impairments, performed at the PICS clinic. We supplemented missing data with multiple imputations by chained equations. We performed a nominal logistic regression analysis with age, sex, BMI, SOFA, and the presence of PIICS as variables for BI < 90. RESULTS Forty-three out of two hundred seventy-three PICS outpatients met the diagnostic criteria for PIICS during hospitalization. In comparisons with non-PIICS patients, significantly higher severity scores for APACHE II and SOFA and a longer hospital stay were observed in PIICS patients, suggesting a higher clinical severity. The primary outcome, BI, was lower in the PIICS group (97.5 (58.5, 100) vs. 100 (95, 100), p = 0.008), as were the secondary outcomes (FSS-ICU: 35 (31, 35) vs. 35 (35, 35), MRC score: 55 (50.25, 58) vs. 58 (53, 60), grip strength: 16.45 (9.2, 25.47) vs. 20.4 (15.3, 27.7)). No significant differences were noted in mental or cognitive function assessments, such as HADS, IES-R, and SMQ. A multivariable analysis supplemented with missing data revealed that PIICS (odds ratio: 1.23 (1.08-1.40 p = 0.001) and age (odds ratio: 1.007 (1.004-1.01), p < 0.001) correlated with BI < 90, independent of clinical severity such as sequential organ failure assessment (SOFA). Similar results were obtained in the sensitivity analysis excluding missing data. CONCLUSIONS The present study revealed a strong relationship between PIICS and post-discharge PICS physical dysfunction in patients requiring intensive care.
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Affiliation(s)
- Shinya Suganuma
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (S.S.); (M.I.); (N.Y.); (S.T.)
| | - Masafumi Idei
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (S.S.); (M.I.); (N.Y.); (S.T.)
| | - Hidehiko Nakano
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi 317-0077, Japan; (H.N.); (Y.K.); (H.H.)
| | - Yasuaki Koyama
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi 317-0077, Japan; (H.N.); (Y.K.); (H.H.)
| | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi 317-0077, Japan; (H.N.); (Y.K.); (H.H.)
| | - Nobuyuki Yokoyama
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (S.S.); (M.I.); (N.Y.); (S.T.)
| | - Shunsuke Takaki
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (S.S.); (M.I.); (N.Y.); (S.T.)
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan; (S.S.); (M.I.); (N.Y.); (S.T.)
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi 317-0077, Japan; (H.N.); (Y.K.); (H.H.)
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Mathey L, Jacquier M, Meunier-Beillard N, Andreu P, Roudaut JB, Labruyère M, Rigaud JP, Quenot JP, Ecarnot F. ICU stays that are judged to be non-beneficial: A qualitative study of the perception of nursing staff. PLoS One 2023; 18:e0289954. [PMID: 37561766 PMCID: PMC10414562 DOI: 10.1371/journal.pone.0289954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Non-beneficial stays in the intensive care unit (ICU) may have repercussions for patients and their families, but can also cause suffering among the nursing staff. We aimed explore the perceptions of nursing staff in the ICU about patient stays that are deemed to be "non-beneficial" for the patient, to identify areas amenable to intervention, with a view to improving how the nursing staff perceive the patient pathway before, during and after intensive care. METHODS Multicentre, qualitative study using individual, semi-structured interviews. All qualified nurses and nurses' aides who were full-time employees in the ICU of three participating centres were invited to participate. Interviews were recorded, transcribed and analyzed using textual content analysis. RESULTS A total of 21 interviews were performed from February 2020 to October 2021, at which point saturation was reached in the data. Average age of participants was 38.5±7.5 years, and they had an average of 10.7±7.4 years of experience working in the ICU. Four major themes emerged from the interviews, namely: (1) the work is oriented towards life-threatening emergencies, technical procedures and burdensome care; (2) a range of specific criteria and circumstances influence the decisions to admit patients to ICU; (3) there are significant organisational, physical and psychological repercussions associated with a non-beneficial stay in the ICU; (4) respondents made some proposals for improvements to the patient care pathway. CONCLUSION Nursing staff have a similar perception to physicians regarding admission decisions and non-beneficial ICU stays. The possibility of future ICU admission needs to be anticipated, discussed systematically with patients and integrated into healthcare goals that are consistent with the patient's wishes and preferences, in multi-professional collaboration including nursing and medical staff.
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Affiliation(s)
- Lucas Mathey
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
| | - Marine Jacquier
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
| | - Nicolas Meunier-Beillard
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, Dijon, France
| | - Pascal Andreu
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
| | | | - Marie Labruyère
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, Dieppe, France
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, Caen, France
| | - Jean-Pierre Quenot
- Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Dijon, France
- Equipe Lipness, Centre de Recherche INSERM UMR1231 et LabEx LipSTIC, Université de Bourgogne-Franche Comté, Dijon, France
- INSERM, CIC 1432, Module Épidémiologie Clinique, Université de Bourgogne-Franche Comté, Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), Dijon, France
| | - Fiona Ecarnot
- EA3920, Department of Cardiology, University Hospital Besancon, Besancon, France
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Cox CE, Kelleher SA, Parish A, Olsen MK, Bermejo S, Dempsey K, Jaggers J, Hough CL, Moss M, Porter LS. Feasibility of Mobile App-based Coping Skills Training for Cardiorespiratory Failure Survivors: The Blueprint Pilot Randomized Controlled Trial. Ann Am Thorac Soc 2023; 20:861-871. [PMID: 36603136 PMCID: PMC10257028 DOI: 10.1513/annalsats.202210-890oc] [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: 10/25/2022] [Accepted: 01/05/2023] [Indexed: 01/07/2023] Open
Abstract
Rationale: Psychological distress symptoms are common among patients recently hospitalized with cardiorespiratory failure, yet there are few effective postdischarge therapies that are relevant to their experiences. Objectives: To determine the feasibility and clinical impact of two different versions of a month-long self-guided mobile app-based coping skills program called Blueprint in comparison to usual care (UC) control. Methods: Patients hospitalized with a serious cardiopulmonary diagnoses were recruited from adult intensive care units and stepdown units at a large academic medical center. Participants with elevated psychological distress symptoms just after discharge were randomized in a 1:1:1 ratio to Blueprint with a therapist (BP/therapist), Blueprint without a therapist (BP/no therapist), or UC control. All study procedures were conducted remotely. Blueprint is a self-guided, symptom-responsive, mobile app-based adaptive coping skills program with 4 themed weeks with different daily audio, video, and text content. Participants completed surveys via the app platform at baseline and 1 and 3 months later. The primary outcome was feasibility. Additional outcomes included the HADS (Hospital Anxiety and Depression Scale) total score, the PTSS (Post-Traumatic Stress Scale), and a 100-point quality of life visual analog scale. Results: Of 63 patients who consented, 45 (71%) with elevated distress were randomized to BP/therapist (n = 16 [36%]), BP/no therapist (n = 14 [31%]), and UC (n = 15 [33%]). Observed rates were similar to target feasibility benchmarks, including consented patients who were randomized (71.4%), retention (75.6%), and intervention adherence (97% with weekly use). Estimated mean differences (95% confidence intervals) at 1 month compared with baseline included: HADS total (BP/therapist, -3.8 [-6.7 to -0.6]; BP/no therapist, -4.2 [-7.6 to -0.0]; UC, -3.4 [-6.6 to 0.2]); PTSS (BP/therapist, -6.7 [-11.3 to -2.1]; BP/no therapist, -9.1 [-14.4 to -3.9]; UC, -4.2 [-10.8 to 2.3]); and quality of life (BP/therapist, -4.5 [-14.3 to 4.6]; BP/no therapist, 14.0 [-0.9 to 29.0]; UC, 8.7 [-3.5 to 20.9]). Conclusions: Among survivors of cardiorespiratory failure, a mobile app-based postdischarge coping skills training intervention demonstrated evidence of feasibility and clinical impact compared with UC control. A larger trial is warranted to test the efficacy of this approach. Clinical trial registered with ClinicalTrials.gov (NCT04329702).
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Affiliation(s)
- Christopher E. Cox
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | | | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Maren K. Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Santos Bermejo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | - Katelyn Dempsey
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | - Jennie Jaggers
- Department of Medicine, Division of Pulmonary and Critical Care Medicine
- Program to Support People and Enhance Recovery (ProSPER)
| | - Catherine L. Hough
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health & Sciences University, Portland, Oregon; and
| | - Marc Moss
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Colorado, Denver, Colorado
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Liang S, Pak Chun Chau J, Hoi Shan Lo S, Chow Choi K, Bai L, Cai W. The effects of a sensory stimulation intervention on psychosocial and clinical outcomes of critically ill patients and their families: A randomised controlled trial. Intensive Crit Care Nurs 2023; 75:103369. [PMID: 36528458 DOI: 10.1016/j.iccn.2022.103369] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore the effectiveness of a sensory stimulation intervention on intensive care unit patients' psychosocial, clinical, and family outcomes. DESIGN A prospective, assessor-blind, parallel-group randomised controlled trial. SETTING A surgical intensive care unit of one tertiary hospital in Guangzhou, mainland China. INTERVENTION Participants in the intervention group received a daily 30-minute auditory and visual stimulation session starting from recruitment and for a maximum of seven days while in the intensive care unit. MEASUREMENT AND MAIN RESULTS One hundred fifty-two patients and family caregiver dyads were recruited. Patients in the intervention group showed lower total scores of post-traumatic stress disorder (21.92 ± 6.34 vs 27.62 ± 10.35,p = 0.001), depressive symptoms (3.76 ± 3.99 vs 6.78 ± 4.75,p = 0.001) and delusional memories (0.47 ± 0.92 vs 0.82 ± 1.23,p = 0.001) collected immediately post-intervention than those in the control group, while not on depressive symptoms at one-month post-intervention (3.32 ± 4.03 vs 3.28 ± 3.77,p = 0.800). Sensory stimulation did not significantly impact patients' unit length of stay and 30-day mortality (allp > 0.05). For family outcomes, family caregivers in the intervention group had greater satisfaction with care (127.12 ± 14.14 vs 114.38 ± 21.97,p = 0.001) and a lower level of anxiety (28.49 ± 6.48 vs 34.64 ± 7.68,p = 0.001) than family caregivers in the control group. CONCLUSIONS Sensory stimulation may benefit patients' and family caregivers' psychological well-being, and further well-designed multi-centre clustered randomized controlled trials could be considered to strengthen the evidence.
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Affiliation(s)
- Surui Liang
- Nursing Department, Shenzhen Hospital of Southern Medical University, Administrative Building, Xinhu Road, Shenzhen 518101, China
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Liping Bai
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou 510080, China
| | - Wenzhi Cai
- Nursing Department, Shenzhen Hospital of Southern Medical University, Administrative Building, Xinhu Road, Shenzhen 518101, China.
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Kovaleva MA, Jones AC, Kimpel CC, Lauderdale J, Sevin CM, Stollings JL, Jackson JC, Boehm LM. Patient and caregiver experiences with a telemedicine intensive care unit recovery clinic. Heart Lung 2023; 58:47-53. [PMID: 36399862 PMCID: PMC9992018 DOI: 10.1016/j.hrtlng.2022.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/20/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intensive Care Unit Recovery Clinics (ICU-RCs) were founded to address post-intensive care syndrome among ICU survivors. Telemedicine ICU-RCs may facilitate access for more ICU survivors, however, patient and caregiver experiences with telemedicine ICU-RCs have not been explored qualitatively. OBJECTIVE To explore patient and informal caregiver experiences with a telemedicine ICU-RC. METHODS Our qualitative exploratory cross-sectional study was guided by qualitative description methodology. Telemedicine ICU-RC visits were conducted at 3- and 12-weeks post-discharge following critical illness. Patients, and caregivers when available, met with an ICU pharmacist, ICU physician, and a neuropsychologist via Zoom. Thereafter, we conducted qualitative (1:1) telephone interviews with 14 patients and 12 caregivers recruited purposefully. Data were analyzed using conventional content analysis. RESULTS Five themes were identified: (1) general impressions of the intervention; (2) intervention organization and delivery; (3) intervention substance; (4) caregiver participation; and (5) ways to improve the intervention. Participants found the telemedicine delivery acceptable, convenient, time-saving, and conducive to thorough discussions. Participants appreciated the information, reassurance, and validation. Attention to mental health during the visits was strongly endorsed. Caregiver involvement depended on patient self-management and technical ability. Suggestions included scheduling a 1-week post-discharge visit, more follow-up visits, and individualizing content for in-depth discussions, including mental health evaluation. CONCLUSIONS The study results enhance the understanding of patient and caregiver experiences with a telemedicine ICU-RC. Participants' narratives helped to formulate recommendations to improve telemedicine ICU-RC delivery and content. Acceptability of this intervention indicates the potential for wider implementation of telemedicine ICU-RCs to reach more ICU survivors.
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Affiliation(s)
- Mariya A Kovaleva
- University of Nebraska Medical Center College of Nursing, Omaha, NE.
| | - Abigail C Jones
- Yale University School of Nursing, Orange, CT; Vanderbilt University School of Nursing, Nashville, TN
| | - Christine Cleary Kimpel
- Vanderbilt University School of Nursing, Nashville, TN; Tennessee Valley Health Care System, Nashville, TN, USA
| | | | | | - Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN
| | - James C Jackson
- Vanderbilt University Medical Center, Nashville, TN; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN; Department of Medicine, Division of Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN; Geriatrics Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN
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Teixeira JP, Mayer KP, Griffin BR, George N, Jenkins N, Pal CA, González-Seguel F, Neyra JA. Intensive Care Unit-Acquired Weakness in Patients With Acute Kidney Injury: A Contemporary Review. Am J Kidney Dis 2023; 81:336-351. [PMID: 36332719 PMCID: PMC9974577 DOI: 10.1053/j.ajkd.2022.08.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/31/2022] [Indexed: 11/06/2022]
Abstract
Acute kidney injury (AKI) and intensive care unit-acquired weakness (ICU-AW) are 2 frequent complications of critical illness that, until recently, have been considered unrelated processes. The adverse impact of AKI on ICU mortality is clear, but its relationship with muscle weakness-a major source of ICU morbidity-has not been fully elucidated. Furthermore, improving ICU survival rates have refocused the field of intensive care toward improving long-term functional outcomes of ICU survivors. We begin our review with the epidemiology of AKI in the ICU and of ICU-AW, highlighting emerging data suggesting that AKI and AKI treated with kidney replacement therapy (AKI-KRT) may independently contribute to the development of ICU-AW. We then delve into human and animal data exploring the pathophysiologic mechanisms linking AKI and acute KRT to muscle wasting, including altered amino acid and protein metabolism, inflammatory signaling, and deleterious removal of micronutrients by KRT. We next discuss the currently available interventions that may mitigate the risk of ICU-AW in patients with AKI and AKI-KRT. We conclude that additional studies are needed to better characterize the epidemiologic and pathophysiologic relationship between AKI, AKI-KRT, and ICU-AW and to prospectively test interventions to improve the long-term functional status and quality of life of AKI survivors.
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Affiliation(s)
- J Pedro Teixeira
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico; Center for Adult Critical Care, University of New Mexico, Albuquerque, New Mexico.
| | - Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky
| | - Benjamin R Griffin
- Division of Nephrology, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Naomi George
- Center for Adult Critical Care, University of New Mexico, Albuquerque, New Mexico; Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Nathaniel Jenkins
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa
| | - C Anil Pal
- Division of Nephrology, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Javier A Neyra
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
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Vanderhaeghen SFM, Decruyenaere JM, Benoit DD, Oeyen SG. Organization, feasibility and patient appreciation of a follow-up consultation in surgical critically ill patients with favorable baseline quality of life and prolonged ICU-stay: a pilot study. Acta Clin Belg 2023; 78:25-35. [PMID: 35261330 DOI: 10.1080/17843286.2022.2050003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Intensive care unit (ICU) survivors are often left with impairments in physical, mental and cognitive functioning (Post-Intensive Care Syndrome (PICS)). We evaluated the organization, the feasibility for caregivers and patients and the patients' appreciation of a post-ICU consultation aiming to detect these PICS-symptoms. METHODS A single-center prospective observational pilot study was conducted during an 18 month-period in the surgical ICU of a tertiary care hospital. Consecutive adult patients with an ICU-stay of ≥8 days and a favorable baseline quality of life (utility index ≥0.6 on EQ-5D-3 L) were eligible for inclusion. A post-ICU follow-up consultation consisting of a structured interview was scheduled 3 months after hospital discharge. Characteristics of the consultation (CG) and no consultation group (NCG) were compared. P-values <0.05 were considered significant. RESULTS Of 133 eligible patients, 85 (64%) consented for the study and 42 (49%) attended the consultation. A total of 148 phone calls were made to schedule the consultations. Consultations took a median of 68 (61-74) minutes. Compared to CG-patients, NCG-patients were more often discharged to a care facility (P = 0.003) and had more problems with mobility (P = 0.014), self-care (P < 0.001) and usual activities (P = 0.005) after 3 months. At least one PICS-related problem was documented in all patients in the CG and NCG. Thirty-four CG-patients (81%) appreciated the initiative. CONCLUSION Organizing an ICU-follow-up consultation was difficult and feasibility was low, but most attending patients appreciated the initiative. Better developed structures for ICU-follow-up are needed in view of the high number of PICS-related problems documented.
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Affiliation(s)
| | | | | | - Sandra G Oeyen
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
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19
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Narváez-Martínez MA, Gómez Tovar LO, Henao-Castaño ÁM. Scales to measure post intensive care syndrome, a scoping review. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:440-450. [PMID: 36049644 DOI: 10.1016/j.enfcle.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/28/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Post Intensive Care Syndrome is a recently studied syndrome that affects between 50% and 70% of patients admitted to the ICU, its detection is complex due to the great variety of affected components. OBJECTIVE To determine the most widely used assessment instruments for the detection of post-intensive care syndrome, according to the evidence in the last 5 years. METHODOLOGY A scoping review was carried out in the databases: Academic Search, ScienceDirect, Scielo, Biblioteca Virtual en Salud, Medline, and Springer Link, with terms «Postintensive care syndrome» and «Post-intensive care syndrome». This review included 22 articles that met the criteria of: research or review typology, English, Spanish or Portuguese language, with access to the full text and published between 2015 and 2020. CONCLUSIONS Most of the instruments used to measure post-intensive care syndrome are divided according to the components of physical affectation (the Medical Research Council scale, the Katz index and the Barthel index); cognitive (Repeatable Battery for the Assessment of Neuropsychological Status, and the Montreal Cognitive Assessment test); and mental (Hospital Anxiety and Depression Scale, Beck's anxiety test, Depression Inventory Second Edition scale and Post Traumatic Stress Syndrome-14 scale). In addition, two tools were found that measure the event in its entirety with its three components, such as the Healthy Aging Brain Care Monitor and the Post-Intensive Care Syndrome Questionnaire.
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20
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Effectiveness of Nurse-Led Interventions for the Prevention of Mental Health Issues in Patients Leaving Intensive Care: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10091716. [PMID: 36141328 PMCID: PMC9498853 DOI: 10.3390/healthcare10091716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to evaluate the effectiveness of nurse-led interventions for the prevention of mental health disorders after intensive care unit discharge through a systematic review of the literature. The searches were conducted in the MEDLINE (via PubMed), CINAHL, PsycINFO, and Cochrane Library databases for studies pertaining to such interventions. Two independent reviewers analyzed the studies, extracted data, and assessed the quality of the evidence. Six eligible articles were identified, all of which were regarding post-traumatic stress disorder after intensive care unit discharge. Some of the interventions were conducted during the admission and some after the discharge. One study found that multimedia education during admission improved anxiety and depression one week after discharge. The remaining five studies concluded that nurse-led interventions did not prevent mental health disorders three months to one year after intensive care unit discharge. Our review revealed a paucity of research into the effectiveness of nurse-led interventions for the prevention of mental health disorders after intensive care unit discharge. The timing and the content of these interventions, and the adequate training of nurses, appear to be key factors. Therefore, multidisciplinary interventions are likely to be more effective than those led by nurses alone.
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21
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Jaquet P, Legouy C, Le Fevre L, Grinea A, Sinnah F, Franchineau G, Patrier J, Marzouk M, Wicky PH, Alexis Geoffroy P, Arnoult F, Vledouts S, de Montmollin E, Bouadma L, Timsit JF, Sharshar T, Sonneville R. Neurologic Outcomes of Survivors of COVID-19-Associated Acute Respiratory Distress Syndrome Requiring Intubation. Crit Care Med 2022; 50:e674-e682. [PMID: 35132020 PMCID: PMC9275804 DOI: 10.1097/ccm.0000000000005500] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe 3-6-month neurologic outcomes of survivors of COVID-19-associated acute respiratory distress syndrome, invasively ventilated in the ICU. DESIGN A bicentric prospective study during the two first waves of the pandemic (March to May and September to December, 2020). SETTING Two academic hospital ICUs, Paris, France. PATIENTS Adult COVID-19-associated acute respiratory distress syndrome survivors, invasively ventilated in the ICU, were eligible for a neurologic consultation between 3 and 6 months post ICU discharge. INTERVENTIONS Follow-up by face-to-face neurologic consultation. MEASURES AND MAIN RESULTS The primary endpoint was favorable functional outcome defined by a modified Rankin scale score less than 2, indicating survival with no significant disability. Secondary endpoints included mild cognitive impairment (Montreal Cognitive Assessment score < 26), ICU-acquired weakness (Medical Research Council score < 48), anxiety and depression (Hospital Anxiety and Depression score > 7), and posttraumatic stress disorder (posttraumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders 5 score > 30). Of 54 eligible survivors, four non-French-speaking patients were excluded, eight patients were lost-to-follow-up, and one died during follow-up. Forty-one patients were included. Time between ICU discharge and neurologic consultation was 3.8 months (3.6-5.9 mo). A favorable functional outcome was observed in 16 patients (39%) and mild cognitive impairment in 17 of 33 patients tested (52%). ICU-acquired weakness, depression or anxiety, and posttraumatic stress disorder were reported in six of 37 cases (16%), eight of 31 cases (26%), and two of 27 cases (7%), respectively. Twenty-nine patients (74%) required rehabilitation (motor, cognitive, or psychologic). ICU and hospital lengths of stay, tracheostomy, and corticosteroids were negatively associated with favorable outcome. By contrast, use of alpha-2 agonists during ICU stay was associated with favorable outcome. CONCLUSIONS COVID-19-associated acute respiratory distress syndrome requiring intubation led to slight-to-severe functional disability in about 60% of survivors 4 months after ICU discharge. Cognitive impairment, muscle weakness, and psychologic symptoms were frequent. A large multicenter study is warranted to allow identification of modifiable factors for improving long-term outcome.
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Affiliation(s)
- Pierre Jaquet
- UFR de médecine, Université de Paris, Paris, France
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Camille Legouy
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Lucie Le Fevre
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Alexandra Grinea
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Fabrice Sinnah
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Guillaume Franchineau
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Juliette Patrier
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Mehdi Marzouk
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Paul-Henri Wicky
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
| | - Pierre Alexis Geoffroy
- Department of Psychiatry and Addictive Medicine, AP-HP, Hospital Bichat - Claude Bernard, 75018 Paris, France
- Université de Paris, NeuroDiderot, Inserm, F-75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Florence Arnoult
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, DMU DREAM, AP-HP Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Serafima Vledouts
- Neurophysiologie clinique, service de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France
| | - Etienne de Montmollin
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Lila Bouadma
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Jean-François Timsit
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1137, Team 5, F-75018 Paris, France
| | - Tarek Sharshar
- Médecine intensive-réanimation, CH Saint Anne, F-75014 Paris, France
| | - Romain Sonneville
- Médecine intensive - réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Bichat - Claude Bernard, F-75018 Paris, France
- Université de Paris, INSERM UMR1148, Team 6, F-75018 Paris, France
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Narváez-Martínez MA, Gómez Tovar LO, Henao-Castaño ÁM. Instrumentos para valorar el síndrome pos cuidado intensivo, revisión de alcance. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kovaleva MA, Jones A, Kimpel CC, Lauderdale J, Sevin C, Boehm L. Patients' and Caregivers' Perceptions of Intensive Care Unit Hospitalization and Recovery. Am J Crit Care 2022; 31:319-323. [PMID: 35773198 PMCID: PMC9275380 DOI: 10.4037/ajcc2022945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Telehealth-based intensive care unit recovery clinics (ICU-RCs) can increase access to post-ICU recovery care for patients and their families. It is crucial to understand patients' and caregivers' experience of illness and recovery to build patient- and family-centered ICU-RCs. OBJECTIVE To explore patients' and caregivers' perceptions of ICU hospitalization and recovery. METHODS Individual semistructured telephone interviews were conducted with 14 patients and 12 caregivers who participated in a telehealth ICU-RC. This study was guided by qualitative description methodology. Conventional content analysis was used to analyze the data. RESULTS Patients described their ICU hospitalization as scary, traumatic, and lonely. Participants' feedback on hospitalization ranged from praise to criticism. Patients wanted more realistic and detailed prognostication about post-ICU recovery and more physical therapy after discharge. Patients strongly valued the mental health component of ICU-RC visits, which contrasted with the scant attention paid to mental health in other postdischarge health care settings. Their knowledge about post-ICU recovery and connectedness to a primary care provider varied. CONCLUSIONS Examining patients' and caregivers' perceptions of ICU hospitalization and recovery highlights ICU-RC components that can be strengthened to support patient- and family-centered recovery. The ICU-RC staff should invite patients to share feedback about their ICU stay; give a timely, realistic prognosis for recovery; offer mental health consultations; provide physical therapy; and partner with patients and their caregivers to develop and deliver post-ICU care.
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Affiliation(s)
| | - Abigail Jones
- Vanderbilt University School of Nursing, Nashville, TN
| | | | | | - Carla Sevin
- Vanderbilt University Medical Center, Nashville, TN
| | - Leanne Boehm
- Vanderbilt University School of Nursing, Nashville, TN
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van Gelder TG, Lalmohamed A, van Diem-Zaal IJ, Egberts TCG, Slooter AJC. Systemic glucocorticoid use during ICU admission and symptoms of posttraumatic stress disorder in intensive care unit survivors. Intensive Care Med 2022; 48:762-764. [PMID: 35552789 DOI: 10.1007/s00134-022-06725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Thomas G van Gelder
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Arief Lalmohamed
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Irene J van Diem-Zaal
- Department of Intensive Care Medicine and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.,Department of Intensive Care Medicine, Radboud Institute of Health Science, Radboud University Medical Center Nijmegen, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Toine C G Egberts
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO Box 80082, 3508 TB, Utrecht, The Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine and UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, The Netherlands.,Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels, Belgium
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25
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Scheunemann L, White JS, Prinjha S, Eaton TL, Hamm M, Girard TD, Reynolds C, Leland N, Skidmore ER. Barriers and facilitators to resuming meaningful daily activities among critical illness survivors in the UK: a qualitative content analysis. BMJ Open 2022; 12:e050592. [PMID: 35473739 PMCID: PMC9045053 DOI: 10.1136/bmjopen-2021-050592] [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: 11/23/2022] Open
Abstract
OBJECTIVE To identify critical illness survivors' perceived barriers and facilitators to resuming performance of meaningful activities when transitioning from hospital to home. DESIGN Secondary content analysis of semistructured interviews about patients' experiences of intensive care (primary analysis disseminated on the patient-facing website www.healthtalk.org). Two coders characterised patient-perceived barriers and facilitators to resuming meaningful activities. To facilitate clinical application, we mapped the codes onto the Person-Task-Environment model of performance, a patient-centred rehabilitation model that characterises complex interactions among the person, task and environment when performing activities. SETTING United Kingdom, 2005-2006. PARTICIPANTS 39 adult critical illness survivors, sampled for variation among demographics and illness experiences. RESULTS Person-related barriers included negative mood or affect, perceived setbacks; weakness or limited endurance; pain or discomfort; inadequate nutrition or hydration; poor concentration/confusion; disordered sleep/hallucinations/nightmares; mistrust of people or information; and altered appearance. Task-related barriers included miscommunication and managing conflicting priorities. Environment-related barriers included non-supportive health services and policies; challenging social attitudes; incompatible patient-family coping (emotional trauma and physical disability); equipment problems; overstimulation; understimulation; and environmental inaccessibility. Person-related facilitators included motivation or attitude; experiencing progress; and religion or spirituality. Task-related facilitators included communication. Environment-related facilitators included support from family, friends or healthcare providers; supportive health services and policies; equipment; community resources; medications; and accessible housing. Barriers decreased and facilitators increased over time. Six barrier-facilitator domains dominated based on frequency and emphasis across all performance goals: mood/motivation, setbacks/progress, fatiguability/strength; mis/communication; lack/community support; lack/health services and policies. CONCLUSIONS Critical illness survivors described a comprehensive inventory of 18 barriers and 11 facilitators that align with the Person-Task-Environment model of performance. Six dominant barrier-facilitator domains seem strong targets for impactful interventions. These results verify previous knowledge and offer novel opportunities for optimising patient-centred care and reducing disability after critical illness.
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Affiliation(s)
- Leslie Scheunemann
- Division of Geriatric Medicine and Gerontology in the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine in the Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jennifer S White
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Tammy L Eaton
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Critical Illness Recovery Center (CIRC), UPMC Mercy, Pittsburgh, Pennsylvania, USA
| | - Megan Hamm
- Division of General Medicine in the Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy D Girard
- Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Charles Reynolds
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Natalie Leland
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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26
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Williams CN, Hall TA, Francoeur C, Kurz J, Rasmussen L, Hartman ME, O'meara AI, Ferguson NM, Fink EL, Walker T, Drury K, Carpenter JL, Erklauer J, Press C, Wainwright MS, Lovett M, Dapul H, Murphy S, Risen S, Guerriero RM, Woodruff A, Guilliams KP. Continuing Care For Critically Ill Children Beyond Hospital Discharge: Current State of Follow-up. Hosp Pediatr 2022; 12:359-393. [PMID: 35314865 PMCID: PMC9182716 DOI: 10.1542/hpeds.2021-006464] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Survivors of the PICU face long-term morbidities across health domains. In this study, we detail active PICU follow-up programs (PFUPs) and identify perceptions and barriers about development and maintenance of PFUPs. METHODS A web link to an adaptive survey was distributed through organizational listservs. Descriptive statistics characterized the sample and details of existing PFUPs. Likert responses regarding benefits and barriers were summarized. RESULTS One hundred eleven respondents represented 60 institutions located in the United States (n = 55), Canada (n = 3), Australia (n = 1), and the United Kingdom (n = 1). Details for 17 active programs were provided. Five programs included broad PICU populations, while the majority were neurocritical care (53%) focused. Despite strong agreement on the need to assess and treat morbidity across multiple health domains, 29% were physician only programs, and considerable variation existed in services provided by programs across settings. More than 80% of all respondents agreed PFUPs provide direct benefits and are essential to advancing knowledge on long-term PICU outcomes. Respondents identified "lack of support" as the most important barrier, particularly funding for providers and staff, and lack of clinical space, though successful programs overcome this challenge using a variety of funding resources. CONCLUSIONS Few systematic multidisciplinary PFUPs exist despite strong agreement about importance of this care and direct benefit to patients and families. We recommend stakeholders use our description of successful programs as a framework to develop multidisciplinary models to elevate continuity across inpatient and outpatient settings, improve patient care, and foster collaboration to advance knowledge.
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Affiliation(s)
- Cydni N Williams
- Divisions of Pediatric Critical Care.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Trevor A Hall
- Pediatric Psychology.,Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Conall Francoeur
- Department of Pediatrics, CHU de Québec - Université Laval Research Center, Quebec, QC, Canada
| | - Jonathan Kurz
- Translational Pharmacology, Merck & Co., Inc., North Wales, Pennsylvania
| | - Lindsey Rasmussen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Mary E Hartman
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Am Iqbal O'meara
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Nikki Miller Ferguson
- Division of Pediatric Critical Care, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Ericka L Fink
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tracie Walker
- Division of Pediatric Critical Care, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | | | - Jessica L Carpenter
- Division of Pediatric Neurology, Departments of Pediatrics and Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Erklauer
- Sections of Critical Care Medicine and Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Craig Press
- Section of Child Neurology, Department of Pediatrics, University of Colorado, Boulder, Colorado
| | - Mark S Wainwright
- Division of Pediatric Neurology, Department of Neurology, University of Washington, Seattle, Washington
| | - Marlina Lovett
- Division of Critical Care Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Heda Dapul
- Division of Pediatric Critical Care, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Sarah Murphy
- Division of Pediatric Critical Care, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sarah Risen
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rejean M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Alan Woodruff
- Section of Pediatric Critical Care, Department of Anesthesiology.,Critical Illness, Injury and Recovery Research Center, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kristin P Guilliams
- Division of Pediatric Critical Care, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.,Section of Pediatric Critical Care, Department of Anesthesiology.,Washington University School of Medicine, Mallinckrodt Institute of Radiology, Division of Neuroradiology, St. Louis, Missouri
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27
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Geen O, Rochwerg B, Wang XM. Optimisation des soins chez les personnes âgées gravement malades. CMAJ 2021; 193:E1850-1859. [PMID: 34872961 PMCID: PMC8648358 DOI: 10.1503/cmaj.210652-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Olivia Geen
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont.
| | - Bram Rochwerg
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
| | - Xuyi Mimi Wang
- Division de médecine gériatrique (Geen, Wang) et de médecine de soins intensifs (Rochwerg), Départements de médecine et des méthodes, impacts et données probantes de la recherche en santé (Rochwerg), Université McMaster, Hamilton, Ont
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28
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Affiliation(s)
- Olivia Geen
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont.
| | - Bram Rochwerg
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
| | - Xuyi Mimi Wang
- Divisions of Geriatric Medicine (Geen, Wang) and Critical Care Medicine (Rochwerg), Department of Medicine, and Department of Health Research Methods, Impact and Evidence (Rochwerg), McMaster University, Hamilton, Ont
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29
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Rosa RG, Dietrich C, Valle ELTD, Souza D, Tagliari L, Mattioni M, Tonietto TF, Rosa RD, Barbosa MG, Lovatel GA, Lago PD, Oliveira ES, Sganzerla D, Andrade JMS, Berto P, Cardoso PR, Sanchez EC, Falavigna M, Maccari JG, Rech G, Robinson C, Schneider D, Leon PD, Biason L, Teixeira C. The 6-Minute Walk Test predicts long-term physical improvement among intensive care unit survivors: a prospective cohort study. Rev Bras Ter Intensiva 2021; 33:374-383. [PMID: 35107548 PMCID: PMC8555392 DOI: 10.5935/0103-507x.20210056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022] Open
Abstract
Objetivo Avaliar a capacidade do Teste de Caminhada de 6 Minutos para predizer a
melhora do estado funcional físico em longo prazo de pacientes
sobreviventes à unidade de terapia intensiva. Métodos Foram avaliados, de forma prospectiva, entre fevereiro de 2017 e agosto de
2018, em um ambulatório pós-unidade de terapia intensiva, 32
sobreviventes à unidade de terapia intensiva. Foram inscritos
consecutivamente os pacientes com permanência na unidade de terapia
intensiva acima de 72 horas (para admissões emergenciais) ou acima de
120 horas (para admissões eletivas) que compareceram ao
ambulatório pós-unidade de terapia intensiva 4 meses
após receberem alta da unidade de terapia intensiva. A
associação entre a distância percorrida no Teste de
Caminhada de 6 Minutos realizado na avaliação inicial e a
evolução do estado funcional físico foi avaliada
durante 8 meses, com utilização do Índice de Barthel. Resultados A distância média percorrida no Teste de Caminhada de 6 Minutos
foi significantemente mais baixa nos sobreviventes à unidade de
terapia intensiva do que na população geral (405m
versus 557m; p < 0,001). A idade (β = -4,0; p
< 0,001) e a fraqueza muscular (β = -99,7; p = 0,02) se associaram
com a distância percorrida no Teste de Caminhada de 6 Minutos. A
distância percorrida no Teste de Caminhada de 6 Minutos se associou
com melhora do estado funcional físico no período de 8 meses
de acompanhamento desses pacientes (razão de chance para cada 10m:
1,07; IC95% 1,01 - 1,16; p = 0,03). A área sob a curva
Característica de Operação do Receptor para
predição da melhora funcional física pelo Teste de
Caminhada de 6 Minutos foi de 0,72 (IC95% 0,53 - 0,88). Conclusão O Teste de Caminhada de 6 Minutos, realizado 4 meses após a alta da
unidade de terapia intensiva, predisse com precisão moderada a
melhora do estado funcional físico de sobreviventes à unidade
de terapia intensiva.
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Affiliation(s)
| | - Camila Dietrich
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Denise Souza
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | - Rosa da Rosa
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | - Pedro Dal Lago
- Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | | | | | | | - Paula Berto
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Paulo Ricardo Cardoso
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | | | | | | | - Gabriela Rech
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | | | | | | | - Lívia Biason
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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30
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Cholack G, Garfein J, Errickson J, Krallman R, Montgomery D, Kline-Rogers E, Eagle K, Rubenfire M, Bumpus S, Barnes GD. Early (0-7 day) and late (8-30 day) readmission predictors in acute coronary syndrome, atrial fibrillation, and congestive heart failure patients. Hosp Pract (1995) 2021; 49:364-370. [PMID: 34474638 DOI: 10.1080/21548331.2021.1976558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Thirty-day readmission following hospitalization for acute coronary syndrome (ACS), atrial fibrillation (AF), or congestive heart failure (CHF) is common, and many occur within one week of discharge. Using a cohort of patients hospitalized for ACS, AF, or CHF, we sought to identify predictors of 30-day, early (0-7 day), and late (8-30 day) all-cause readmission. METHODS We identified 3531 hospitalizations for ACS, AF, or CHF at a large academic medical center between 2008 and 2018. Multivariable logistic regression models were created to identify predictors of 30-day, early, and late unplanned, all-cause readmission, adjusting for discharge diagnosis and other demographics and comorbidities. RESULTS Of 3531 patients hospitalized for ACS, AF, or CHF, 700 (19.8%) were readmitted within 30 days, and 205 (29.3%) readmissions were early. Of all 30-day readmissions, 34.8% of ACS, 16.8% of AF, and 26.0% of the CHF cohorts' readmissions occurred early. Higher hemoglobin was associated with lower 30-day readmission [adjusted (adj) OR 0.92, 95% CI 0.88-0.97] while patients requiring intensive care unit (ICU) admission were more likely readmitted within 30 days (adj OR 1.31, 95% CI 1.03-1.67). Among patients with a 30-day readmission, females (adj OR 1.73, 95% CI 1.22, 2.47) and patients requiring ICU admission (adj OR 2.03, 95% CI 1.27, 3.26) were more likely readmitted early than late. Readmission predictors did not vary substantively by discharge diagnosis. CONCLUSION Patients admitted to the ICU were more likely readmitted in the early and 30-day periods. Other predictors varied between readmission groups. Since outpatient follow-up often occurs beyond 1 week of discharge, early readmission predictors can help healthcare providers identify patients who may benefit from particular post-discharge services.
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Affiliation(s)
- George Cholack
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.,Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Joshua Garfein
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Josh Errickson
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Krallman
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Daniel Montgomery
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Eva Kline-Rogers
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Kim Eagle
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Melvyn Rubenfire
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Sherry Bumpus
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.,College of Health and Human Services, School of Nursing, Eastern Michigan University, Ypsilanti, MI, USA
| | - Geoffrey D Barnes
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
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31
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Glimelius Petersson C, Jakobsson L, Westergren A, Bergbom I. Factors and health-related quality of life associated with participation in a post-ICU follow-up. A register study. Acta Anaesthesiol Scand 2021; 65:902-911. [PMID: 33650105 DOI: 10.1111/aas.13811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/09/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Follow-up for heterogeneous intensive care patients presents challenges for rehabilitation interventions and outcome measurements. The aim was to describe and explore characteristics and determinants for visiting/not visiting a nurse-led clinic (NLC) at different time-points, and to describe physical and mental health (HRQoL) over time. METHODS Patients with a length of stay (LOS) of ≥72 hours, discharged from a general intensive care unit 2004-2014, who participated in a 6-month follow-up programme offering visits to NLC at 2 and 6 months were included. The register study includes information regarding patients' participation in NLC, clinical and demographic data from the Patient Administrative System within Intensive care, and data on 2-, 6- and 12-month HRQoL by using SF-36 from the Swedish Intensive Care Registry. RESULTS Of 656 patients, 57% visited the NLC on some occasion. These patients were younger (P = .000), had lower Simplified Acute Physiology scores (P = .001) and higher SF-36 physical health domain scores at 2 months (P < .05) compared to those not visiting at all. Visitors at 2 months only were younger, had shorter LOS and higher physical and mental domain scores than patients visiting at 6 months only. Patients visiting the NLC scored significantly higher in all domains from 2 to 12 months, whereas non-visiting-patients' did this in four out of eight domains during the same time frame. CONCLUSION Individual patient's characteristics and current health conditions seem to influence visits to NLC or not. The findings may contribute to the development of existing routines to match the diversity of patients' needs and life situations.
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Affiliation(s)
| | | | - Albert Westergren
- Faculty of Health Sciences Kristianstad University Kristianstad Sweden
| | - Ingegerd Bergbom
- Institute of Health and Care Sciences Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
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32
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Millward K, McGraw C, Aitken LM. The expressed support needs of families of adults who have survived critical illness: A thematic synthesis. Int J Nurs Stud 2021; 122:104048. [PMID: 34392173 DOI: 10.1016/j.ijnurstu.2021.104048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surviving critical illness can result in ongoing psychological, physical and cognitive impairments for both survivors and families. During the time from the critical illness through to the period of adaptation back to community living, families, alongside survivors, have support needs. OBJECTIVES This systematic review aimed to provide an in-depth insight into the expressed support needs of families of adults who survived an admission to an intensive care unit and returned to a home environment. It also aimed to explore how these needs change over time, and what support provisions families perceived to be helpful. METHODS This was a systematic review using thematic synthesis methodology. Predefined searches were conducted in CINAHL, Medline, PsychINFO, SocIndex, EMbase, Academic Search Complete, EThOS and OpenGrey to locate studies published in English from 2000. Two reviewers screened each study against the inclusion criteria. Quality appraisal was undertaken using Joanna Briggs Institute tools. Extracted data were managed in Nvivo12® and analysed to identify descriptive and analytical themes. The Timing it Right Framework was used to frame changes in need across the recovery continuum. RESULTS Thirty-nine studies were included, 30 qualitative, eight quantitative and one mixed methods. Five key family needs were identified across the recovery continuum: for security; to make sense of the situation; finding a balance; holding everything together; and for trust. DISCUSSION Families found the following interventions helpful: written information; care coordination and navigation; input from intensive care staff after discharge to support continuity; and provision of family support groups. Although there are similarities between the needs of families and survivors, there are sufficient differences to warrant the development of processes to identify and address family need throughout the recovery continuum. CONCLUSION More research is required to develop a tool to better identify the needs of families across the recovery continuum, identify gaps in current service provision, and design interventions to meet these needs. STUDY REGISTRATION CRD42019136883 (PROSPERO).
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Affiliation(s)
- Kat Millward
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
| | - Caroline McGraw
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, 10 Northampton Square, London EC1V 0HB, United Kingdom.
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33
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Rohr M, Weiß A, Bein T, Bernardi C, Brandstetter S, Drewitz KP, Fisser C, Loss J, Malfertheiner M, Apfelbacher C. Experiences, opinions and expectations of health care providers towards an intensive care unit follow-up clinic: Qualitative study and online survey. Intensive Crit Care Nurs 2021; 67:103084. [PMID: 34304978 DOI: 10.1016/j.iccn.2021.103084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Independent of the underlying disease, intensive care unit survivors often suffer from cognitive, physical and mental impairments, also known as post-intensive care syndrome (PICS). Specific follow-up services are recommended for these patients. This study aims to capture the perspectives of health care providers on the development of the first intensive care unit follow-up-clinic in Germany. RESEARCH METHODOLOGY A qualitative study with six focus groups (n = 41) and six expert interviews, followed by a quantitative survey was conducted, involving nine different professions. Qualitative and quantitative data were analysed using thematic analysis and descriptive statistics, respectively. FINDINGS Participants described aftercare of former intensive care unit patients as complex and appreciated the idea of an intensive care unit follow-up clinic to improve continuity of care and multidisciplinary collaboration. The favoured model combined diagnostics and targeted referral of patients to specialists and therapists with the provision of information. In the survey, participants disagreed on how to implement this referral system but agreed that assessments should be multidimensional. CONCLUSION The necessity of and important criteria for the design of an intensive care unit follow-up clinic were identified. We will integrate these data with further evidence to develop a concept for a complex intervention.
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Affiliation(s)
- Magdalena Rohr
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Annette Weiß
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Bavarian Care and Nursing Authority, Amberg, Germany.
| | - Thomas Bein
- Department of Anesthesia & Operative Intensive Care, University Hospital Regensburg, Regensburg, Germany.
| | - Christine Bernardi
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Susanne Brandstetter
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; University Children's Hospital Regensburg (KUNO-Clinics), University of Regensburg, Regensburg, Germany.
| | - Karl Philipp Drewitz
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany.
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
| | - Julika Loss
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | | | - Christian Apfelbacher
- Medical Sociology, Institute for Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdeburg, Germany; Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
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34
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Kosilek RP, Schmidt K, Baumeister SE, Gensichen J. Frequency and risk factors of post-intensive care syndrome components in a multicenter randomized controlled trial of German sepsis survivors. J Crit Care 2021; 65:268-273. [PMID: 34280656 DOI: 10.1016/j.jcrc.2021.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is a combination of cognitive, psychiatric and physical impairments in survivors of critical illness and intensive care. There is little data on long-term co-occurrence of associated impairments. METHODS Analysis of data from 289 sepsis survivors from a German multicenter RCT. Impairments associated with PICS (depression, PTSD, cognitive impairment, chronic pain, neuropathic symptoms, dysphagia) during 24 months follow-up are used to explore the frequency and risk factors of PICS components in three classification models. RESULTS The majority of participants showed impairments in 2-3 of 6 domains during follow-up. The overall frequency of PICS according to the classification models ranged from 32.9% to 98.6%. In regression analyses, there were no significant effects in selected ICU-related exposures or covariates for PICS classification models. Regarding individual components, only higher age and longer duration of ICU treatment and mechanical ventilation showed significant positive associations with the occurrence of cognitive impairment during follow-up, as did male gender and higher age for dysphagia. CONCLUSIONS Almost all study participants showed impairments associated with PICS in at least one domain. The proposed classification models for PICS appear to be too broad to identify specific risk factors beyond its individual components.
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Affiliation(s)
- R P Kosilek
- Institute of General Practice and Family Medicine, LMU Klinikum, Munich, Germany.
| | - K Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - S E Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany; Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - J Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Munich, Germany
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Grip Strength Correlates with Mental Health and Quality of Life after Critical Care: A Retrospective Study in a Post-Intensive Care Syndrome Clinic. J Clin Med 2021; 10:jcm10143044. [PMID: 34300209 PMCID: PMC8304889 DOI: 10.3390/jcm10143044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Abstract
Post-intensive care syndrome (PICS) is characterized by several prolonged symptoms after critical care, including physical and cognitive dysfunctions as well as mental illness. In clinical practice, the long-term follow-up of PICS is initiated after patients have been discharged from the intensive care unit, and one of the approaches used is a PICS clinic. Although physical dysfunction and mental illness often present in combination, they have not yet been examined in detail in PICS patients. Grip strength is a useful physical examination for PICS, and is reported to be associated with mental status in the elderly. We herein investigated the relationship between grip strength and the mental status using data from our PICS clinic. We primarily aimed to analyze the correlation between grip strength and the Hospital Anxiety and Depression Scale (HADS) score. We also analyzed the association between grip strength and the EuroQol 5 Dimension (EQ5D) score as quality of life (QOL). Subjects comprised 133 patients who visited the PICS clinic at one month after hospital discharge between August 2019 and December 2020. Total HADS scores were 7 (4, 13) and 10 (6, 16) (p = 0.029) and EQ5D scores were 0.96 (0.84, 1) and 0.77 (0.62, 0.89) (p ≤ 0.0001) in the no walking disability group and walking disability group, respectively. Grip strength negatively correlated with HADS and EQ5D scores. Correlation coefficients were r = -0.25 (p = 0.011) and r = -0.47 (p < 0.0001) for HADS and EQ5D scores, respectively. Grip strength was a useful evaluation that also reflected the mental status and QOL.
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Johanna Josepha Op't Hoog SA, Eskes AM, Johanna van Mersbergen-de Bruin MP, Pelgrim T, van der Hoeven H, Vermeulen H, Maria Vloet LC. The effects of intensive care unit-initiated transitional care interventions on elements of post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care 2021; 35:309-320. [PMID: 34120805 DOI: 10.1016/j.aucc.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the effectiveness of intensive care unit (ICU)-initiated transitional care interventions for patients and families on elements of post-intensive care syndrome (PICS) and/or PICS-family (PICS--F). REVIEW METHOD USED This is a systematic review and meta-analysis SOURCES: The authors searched in biomedical bibliographic databases including PubMed, Embase (OVID), CINAHL Plus (EBSCO), Web of Science, and the Cochrane Library and included studies written in English conducted up to October 8, 2020. REVIEW METHODS We included (non)randomised controlled trials focussing on ICU-initiated transitional care interventions for patients and families. Two authors conducted selection, quality assessment, and data extraction and synthesis independently. Outcomes were described using the three elements of PICS, which were categorised into (i) physical impairments (pulmonary, neuromuscular, and physical function), (ii) cognitive impairments (executive function, memory, attention, visuo-spatial and mental processing speed), and (iii) psychological health (anxiety, depression, acute stress disorder, post-traumatic stress disorder, and depression). RESULTS From the initially identified 5052 articles, five studies were included (i.e., two randomised controlled trials and three nonrandomised controlled trials) with varied transitional care interventions. Quality among the studies differs from moderate to high risk of bias. Evidence from the studies shows no significant differences in favour of transitional care interventions on physical or psychological aspects of PICS-(F). One study with a nurse-led structured follow-up program showed a significant difference in physical function at 3 months. CONCLUSIONS Our review revealed that there is a paucity of research about the effectiveness of transitional care interventions for ICU patients with PICS. All, except one of the identified studies, failed to show a significant effect on the elements of PICS. However, these results should be interpreted with caution owing to variety and scarcity of data. PROSPERO REGISTRATION CRD42020136589 (available via https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020136589).
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Affiliation(s)
- Sabine Adriana Johanna Josepha Op't Hoog
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands; Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands.
| | - Anne Maria Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | | | - Thomas Pelgrim
- Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands
| | | | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, the Netherlands; Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands
| | - Lilian Christina Maria Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands; Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, the Netherlands; Foundation Family and Patient Centered Intensive Care, Alkmaar, the Netherlands
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37
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A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project. Crit Care Med 2021; 48:e1164-e1170. [PMID: 33003081 DOI: 10.1097/ccm.0000000000004579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care. DESIGN Population health quality improvement comparative study with retrospective data analysis. SETTING A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs. PATIENTS ICU survivors. INTERVENTIONS Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process. MEASUREMENTS AND MAIN RESULTS Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed. CONCLUSIONS Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.
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Fernando SM, Qureshi D, Sood MM, Pugliese M, Talarico R, Myran DT, Herridge MS, Needham DM, Rochwerg B, Cook DJ, Wunsch H, Fowler RA, Scales DC, Bienvenu OJ, Rowan KM, Kisilewicz M, Thompson LH, Tanuseputro P, Kyeremanteng K. Suicide and self-harm in adult survivors of critical illness: population based cohort study. BMJ 2021; 373:n973. [PMID: 33952509 PMCID: PMC8097311 DOI: 10.1136/bmj.n973] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To analyse the association between survival from critical illness and suicide or self-harm after hospital discharge. DESIGN Population based cohort study using linked and validated provincial databases. SETTING Ontario, Canada between January 2009 and December 2017 (inclusive). PARTICIPANTS Consecutive adult intensive care unit (ICU) survivors (≥18 years) were included. Linked administrative databases were used to compare ICU hospital survivors with hospital survivors who never required ICU admission (non-ICU hospital survivors). Patients were categorised based on their index hospital admission (ICU or non-ICU) during the study period. MAIN OUTCOME MEASURES The primary outcome was the composite of death by suicide (as noted in provincial death records) and deliberate self-harm events after discharge. Each outcome was also assessed independently. Incidence of suicide was evaluated while accounting for competing risk of death from other causes. Analyses were conducted by using overlap propensity score weighted, cause specific Cox proportional hazard models. RESULTS 423 060 consecutive ICU survivors (mean age 61.7 years, 39% women) were identified. During the study period, the crude incidence (per 100 000 person years) of suicide, self-harm, and the composite of suicide or self-harm among ICU survivors was 41.4, 327.9, and 361.0, respectively, compared with 16.8, 177.3, and 191.6 in non-ICU hospital survivors. Analysis using weighted models showed that ICU survivors (v non-ICU hospital survivors) had a higher risk of suicide (adjusted hazards ratio 1.22, 95% confidence interval 1.11 to 1.33) and self-harm (1.15, 1.12 to 1.19). Among ICU survivors, several factors were associated with suicide or self-harm: previous depression or anxiety (5.69, 5.38 to 6.02), previous post-traumatic stress disorder (1.87, 1.64 to 2.13), invasive mechanical ventilation (1.45, 1.38 to 1.54), and renal replacement therapy (1.35, 1.17 to 1.56). CONCLUSIONS Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support. Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem.
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Affiliation(s)
- Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Danial Qureshi
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Manish M Sood
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Michael Pugliese
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Talarico
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel T Myran
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dale M Needham
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Deborah J Cook
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Hannah Wunsch
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Robert A Fowler
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Damon C Scales
- ICES, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - O Joseph Bienvenu
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, Napier House, London, UK
| | | | - Laura H Thompson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kwadwo Kyeremanteng
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
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Boede M, Gensichen JS, Jackson JC, Eißler F, Lehmann T, Schulz S, Petersen JJ, Wolf FP, Dreischulte T, Schmidt KFR. Trajectories of depression in sepsis survivors: an observational cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:161. [PMID: 33926493 PMCID: PMC8082919 DOI: 10.1186/s13054-021-03577-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Advances in critical care medicine have led to a growing number of critical illness survivors. A considerable part of them suffers from long-term sequelae, also known as post-intensive care syndrome. Among these, depressive symptoms are frequently observed. Depressive symptom trajectories and associated factors of critical illness survivors have rarely been investigated. Study objective was to explore and compare different trajectories of depressive symptoms in sepsis survivors over 1 year after discharge from ICU. METHODS Data of a randomized controlled trial on long-term post-sepsis care were analyzed post hoc. Depressive symptoms were collected at 1, 6 and 12 months post-ICU discharge using the Major Depression Inventory (MDI), among others. Statistical analyses comprised descriptive analysis, univariate and multivariate, linear and logistic regression models and Growth Mixture Modeling. RESULTS A total of 224 patients were included into this analysis. We identified three latent classes of depressive symptom trajectories: Over the course of 1 year, 152 patients recovered from mild symptoms, 27 patients showed severe persistent symptoms, and 45 patients recovered from severe symptoms. MDI sum scores significantly differed between the three classes of depressive symptom trajectories at 1 and 6 months after ICU discharge (p < 0.024 and p < 0.001, respectively). Compared with other classes, patients with the mild recovered trajectory showed lower levels of chronic pain (median sum score of 43.3 vs. 60.0/53.3 on the Graded Chronic Pain Scale, p < 0.010) and posttraumatic stress (4.6% with a sum score of ≥ 35 on the Posttraumatic Stress Scale 10 vs. 48.1%/33.3%, p < 0.003); and higher levels of health-related quality of life (HRQOL) using the Short Form-36 scale within 1 month after ICU discharge (p < 0.035). CONCLUSIONS In the first year after discharge from ICU, sepsis survivors showed three different trajectories of depressive symptoms. Course and severity of depressive symptoms were associated with chronic pain, posttraumatic stress and reduced HRQOL at discharge from ICU. Regular screening of sepsis survivors on symptoms of depression, chronic pain and posttraumatic stress within 1 year after ICU may be considered. Trial registration ISRCTN, ISRCTN 61744782. Registered April 19, 2011-Retrospectively registered, http://www.isrctn.com/ISRCTN61744782 .
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Affiliation(s)
- Monique Boede
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.
| | - Jochen S Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 10, 80336, Munich, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - James C Jackson
- Department of Medicine, Pulmonary and Critical Care, Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University, Suite 450, 4th Floor 2525 West End Avenue, Nashville, TN, 37203, USA
| | - Fiene Eißler
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Paediatrics and Adolescent Medicine, Sanaklinikum Lichtenberg, Fanningerstraße 32, 10365, Berlin, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany
| | - Sven Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Juliana J Petersen
- Institute of General Practice, Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt a. Main, Germany
| | - Florian P Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Tobias Dreischulte
- Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Pettenkoferstr. 10, 80336, Munich, Germany
| | - Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Institute of General Practice, Charité University Medicine, Charitéplatz 1, 10117, Berlin, Germany
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40
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Su H, Hopkins RO, Kamdar BB, May S, Dinglas VD, Johnson KL, Hosey M, Hough CL, Needham DM, Thompson HJ. Association of imbalance between job workload and functional ability with return to work in ARDS survivors. Thorax 2021; 77:123-128. [PMID: 33927021 DOI: 10.1136/thoraxjnl-2020-216586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/01/2021] [Accepted: 04/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Inability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS). Mismatch in an individual's job workload and his or her functional ability, termed work ability imbalance, is negatively associated with RTW, but has not been evaluated in ARDS survivors. OBJECT We examine associations between work ability imbalance at 6 months and RTW at 6 months and 12 months, as well as the ability to sustain employment in ARDS survivors. METHODS Previously employed participants from the ARDS Network Long-Term Outcomes Study (N=341) were evaluated. Pre-ARDS workload was determined based on the US Occupational Information Network classification. Post-ARDS functional ability was assessed using self-reported 36-Item Short Form Health Survey (SF-36) physical functioning, social functioning and mental health subscales, and Mini-Mental State Examination. ARDS survivors were categorised into four work ability imbalance categories: none, psychosocial, physical, and both psychosocial and physical. RESULTS Almost 90% of ARDS survivors had a physical and/or psychosocial work ability imbalance at both 6-month and 12-month follow-up. Compared with survivors with no imbalance at 6 months, those with both physical and psychosocial imbalance had lower odds of RTW (6 months: OR=0.33, 95% CI=0.13 to 0.82; 12 months: OR=0.22, 95% CI=0.07 to 0.65). Thirty-eight (19%) of those who ever RTW were subsequently jobless at 12 months. CONCLUSION Interventions aimed at rebalancing ARDS survivors' work ability by addressing physical and psychosocial aspects of their functional ability and workload should be explored as part of efforts to improve RTW, maintain employment and reduce the financial impact of joblessness.
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Affiliation(s)
- Han Su
- School of Nursing, University of Washington Seattle Campus, Seattle, Washington, USA
| | - Ramona O Hopkins
- Psychology Department, Brigham Young University, Provo, Utah, USA.,Neuroscience Center, Brigham Young University, Provo, Utah, USA.,Pulmonary and Critical Care, Intermountain Medical Center, Murray, Utah, USA.,Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah, USA
| | - Biren B Kamdar
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California, San Diego, California, USA
| | - Susanne May
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kurt L Johnson
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Megan Hosey
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hilaire J Thompson
- School of Nursing, University of Washington Seattle Campus, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
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Gehrke-Beck S, Gensichen J, Turner KM, Heintze C, Schmidt KF. General practitioners' views and experiences in caring for patients after sepsis: a qualitative interview study. BMJ Open 2021; 11:e040533. [PMID: 33568366 PMCID: PMC7878160 DOI: 10.1136/bmjopen-2020-040533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied. OBJECTIVES The aim of this study is to describe GPs' views and experiences of caring for postsepsis patients and of participating a specific outreach training. DESIGN Semistructured qualitative interviews. SETTING 14 primary care practices in the metropolitan area of Berlin, Germany. PARTICIPANTS 14 GPs who had participated in a structured sepsis aftercare programme in primary care. RESULTS Themes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP's experiences during their patient's critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice. CONCLUSIONS GPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit-GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare. TRIAL REGISTRATION NUMBER ISRCTN61744782.
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Affiliation(s)
- Sabine Gehrke-Beck
- Institute of General Practice and Family Medicine, Charite University Medicine Berlin, Berlin, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital Munich, Munchen, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
- Center of Sepsis Care and Control, Jena University Hospital, Jena, Germany
| | | | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charite University Medicine Berlin, Berlin, Germany
| | - Konrad Fr Schmidt
- Institute of General Practice and Family Medicine, Charite University Medicine Berlin, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
- Center of Sepsis Care and Control, Jena University Hospital, Jena, Germany
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Post-Intensive Care Unit Care. A Qualitative Analysis of Patient Priorities and Implications for Redesign. Ann Am Thorac Soc 2021; 17:221-228. [PMID: 31726016 DOI: 10.1513/annalsats.201904-332oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Rationale: Although survival during critical illness is improving, little evidence exists to guide post-intensive care unit (ICU) care. Understanding patients' needs and priorities is fundamental to improving care quality.Objectives: To describe the evolution of patients' priorities for recovery across the spectrum of post-ICU care.Methods: This was a secondary analysis of 39 semistructured interviews conducted from 2005 to 2006 in participants' homes 19 days to 11 years after hospital discharge after critical illness. Adult critical illness survivors (N = 39) aged 20 years or older from multiple ICUs across the United Kingdom were purposively selected to maximize diversity with respect to time since diagnosis, disease severity, sex, age, ethnicity, socioeconomic group/status, region. age, ICU admitting diagnoses, and length of stay. We used the method of qualitative description to characterize patients' priorities for recovery and their evolution within and between individual patients across three post-ICU periods: ICU transition to wards, early period (approximately the first 2 mo) after discharge to home, and late period (>2 mo) after discharge to home.Results: The analysis revealed 12 core patient priorities during recovery: feeling safe, being comfortable, engaging in mobility, participating in self-care, asserting personhood, connecting with people, ensuring family well-being, going home, restoring psychological health, restoring physical health, resuming previous roles and routines, and seeking new life experiences. In general, priorities evolved from those pertaining to basic survival during the stay on wards to being broader and more aspirational by the late postdischarge period.Conclusions: Understanding patients' priorities for post-ICU care is critical for developing stakeholder-driven clinical guidelines. Engaging other stakeholders (e.g., family members, healthcare providers, and institutionalized and frail older adults) to inform the development of clinical guidelines for post-ICU care, together with the barriers and facilitators faced in achieving patient- and family-centered care, is an important next step.
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Ali Abdelhamid Y, Phillips LK, White MG, Presneill J, Horowitz M, Deane AM. Survivors of Intensive Care With Type 2 Diabetes and the Effect of Shared-Care Follow-Up Clinics: The SWEET-AS Randomized Controlled Pilot Study. Chest 2021; 159:174-185. [PMID: 32800818 DOI: 10.1016/j.chest.2020.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Follow-up clinics after ICU admission have demonstrated limited benefit. However, existing trials have evaluated heterogeneous cohorts and used physicians who had limited training in outpatient care. RESEARCH QUESTION What are the effects of a "shared-care" intensivist-endocrinologist clinic for ICU survivors with type 2 diabetes on process measures and clinical outcomes 6 months after hospital discharge, and is it feasible to conduct a larger trial? STUDY DESIGN AND METHODS This was a prospective, randomized, single-center pilot study with blinded outcome assessment. Patients with type 2 diabetes, who required ≥ 5 days of ICU care (mixed medical-surgical ICU) and survived to ICU discharge, were eligible. Participants were randomized to attendance at the shared-care clinic 1 month after hospital discharge or usual care. Six months after hospital discharge, participants were assessed for outcomes including glycated hemoglobin, neuropathy, nephropathy, quality of life, return to employment, frailty, and health-care use. The primary outcome was participant recruitment and retention. RESULTS During an 18-month period, 42 of 82 eligible patients (51%) were recruited. Four participants (10%) withdrew before assessment at 6 months and 11 (26%) died. At 6 months, only 18 of 38 participants who did not withdraw (47%) were living independently without support, and 24 (63%) required at least one subsequent hospital admission. In the intervention group (n = 21), 16 (76%) attended the clinic. Point estimates did not indicate that the intervention improved glycated hemoglobin (+5.6 mmol/mol; 95% CI, -6.3 to 17; P = .36) or quality of life (36-Item Short Form Survey physical summary score, 32 [9] vs. 32 [7]; P = 1.0). INTERPRETATION Outcomes for ICU survivors with type 2 diabetes are poor. Because of low participation and high mortality, a larger trial of a shared-care follow-up clinic in this cohort, using the present design, does not appear feasible. TRIAL REGISTRY Australian New Zealand Clinical Trials Registry (ANZCTR); No.: ACTRN12616000206426; URL: www.anzctr.org.au.
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Affiliation(s)
- Yasmine Ali Abdelhamid
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; ICU, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia.
| | - Liza K Phillips
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Service, Royal Adelaide Hospital, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence (CRE) in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, Australia
| | - Mary G White
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; ICU, Royal Adelaide Hospital, Adelaide, Australia
| | - Jeffrey Presneill
- ICU, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Service, Royal Adelaide Hospital, Adelaide, Australia; National Health and Medical Research Council Centre of Research Excellence (CRE) in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, Australia
| | - Adam M Deane
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; ICU, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
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Escher M, Nendaz M, Scherer F, Cullati S, Perneger T. Physicians' predictions of long-term survival and functional outcomes do not influence the decision to admit patients with advanced disease to intensive care: A prospective study. Palliat Med 2021; 35:161-168. [PMID: 33063607 DOI: 10.1177/0269216320963931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term survival and functional outcomes should influence admission decisions to intensive care, especially for patients with advanced disease. AIM To determine whether physicians' predictions of long-term prognosis influenced admission decisions for patients with and without advanced disease. DESIGN A prospective study was conducted. Physicians estimated patient survival with intensive care and with care on the ward, and the probability of 4 long-term outcomes: leaving hospital alive, survival at 6 months, recovery of functional status, and recovery of cognitive status. Patient mortality at 28 days was recorded. We built multivariate logistic regression models using admission to the intensive care unit (ICU) as the dependent variable. SETTING/PARTICIPANTS ICU consultations for medical inpatients at a Swiss tertiary care hospital were included. RESULTS Of 201 evaluated patients, 105 (52.2%) had an advanced disease and 140 (69.7%) were admitted to the ICU. The probability of admission was strongly associated with the expected short-term survival benefit for patients with or without advanced disease. In contrast, the predicted likelihood that the patient would leave the hospital alive, would be alive 6 months later, would recover functional status, and would recover initial cognitive capacity was not associated with the decision to admit a patient to the ICU. Even for patients with advanced disease, none of these estimated outcomes influenced the admission decision. CONCLUSIONS ICU admissions of patients with advanced disease were determined by short-term survival benefit, and not by long-term prognosis. Advance care planning and developing decision-aid tools for triage could help limit potentially inappropriate admissions to intensive care.
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Affiliation(s)
- Monica Escher
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland.,Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fabienne Scherer
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphane Cullati
- Division of Palliative Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
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Nordness MF, Bipin Patel M, Erickson CR, Kiehl A, Jackson JC, Raman R, Pandharipande PP, Ely EW, Wilson JE. Depression predicts long-term cognitive impairment in survivors of critical illness. J Trauma Acute Care Surg 2021; 90:79-86. [PMID: 33017354 DOI: 10.1097/ta.0000000000002955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intensive care unit (ICU) survivorship is associated with long-term cognitive impairment (LTCI). Our work has found post-ICU depression in up to 30% and posttraumatic stress disorder (PTSD) in up to 10% of ICU survivors. We hypothesized that post-ICU depression and PTSD are independently associated with LTCI in ICU survivors. METHODS This is a five-center nested prospective cohort of critically ill patients admitted to medical and surgical ICUs who underwent neuropsychological assessments at 3 and 12 months posthospital discharge. Our primary outcome was global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail Making Test, Part B, a test of executive functioning, at 3- and 12-month follow-up. Our independent variables were Beck Depression Inventory II and the PTSD Checklist-Specific Version measured at 3 and 12 months. We performed multivariable linear regression models controlling for covariates such as age, years of education, preexisting cognitive impairment, comorbidities, ventilator days, hypoxemia episodes, and days of delirium or coma. RESULTS Of 1,047 patients in the combined cohort, 679 were alive and available for follow-up at 3 months. A total of 590 (87%) ICU survivors completed at least one 3-month assessment, and of the 554 who survived to 12 months, 519 (94%) completed both a 3- and 12-month assessment with a median age of 61 years (52-70 years) and mean daily Sequential Organ Failure Assessment score of 6 (4-8), 520 (88%) were mechanically ventilated, and 420 (71%) were with delirium. Of these, 113 (19%) had PTSD and 187 (32%) had depression at 3 months with similar rates at 12 months. Depression at 3 months was associated with lower 3-month RBANS (coefficient, -2.25; -3.10 to -1.39) and lower Trails B scores at both 3 months (odds ratio, 0.69; 0.56-0.85) and 12 months (odds ratio, 0.66; 0.52-0.84). Posttraumatic stress disorder at 3 months had no association with RBANS or Trails B scores at 3 or 12 months. CONCLUSION Early post-ICU depression, but not PTSD, is independently associated with coexisting LTCI, even when controlling for past ICU delirium. Treatment for early depression represents a novel intervention area for LTCI prevention in ICU survivors. LEVEL OF EVIDENCE Prognostic/epidemiological, level III.
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Affiliation(s)
- Mina Faye Nordness
- From the Critical Illness, Brain Dysfunction and Survivorship Center, Center for Health Services Research (M.F.N., M.B.P., C.R.E., A.K., J.C.J., P.P.P., E.W.E., J.E.W.), Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, (M.F.N., M.B.P.), Department of Hearing and Speech Sciences (M.B.P), Department of Neurosurgery (M.B.P) Department of Psychiatry (J.E.W.), Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine (J.C.J., E.W.E.), Division of Anesthesiology Critical Care, Department of Anesthesiology (P.P.P.), and Department of Biostatistics (R.R.), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research Education and Clinical Center (M.B.P., J.C.J., P.P.P., E.W.E., J.E.W.), Tennessee Valley Healthcare System, Nashville TN; and Vanderbilt University School of Medicine (M.B.P., C.R.E., P.P.P., E.W.E., J.E.W.)
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Ling CG, Casida J. Primary and Acute Care Nurse Practitioner Networking: The Case for a Cup of Coffee. AACN Adv Crit Care 2020; 31:75-79. [PMID: 32168520 DOI: 10.4037/aacnacc2020611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Catherine G Ling
- Catherine G. Ling is FNP Track Coordinator, Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD 21205
| | - Jesus Casida
- Jesus Casida is Associate Professor and MSN in Health Systems Management Track Coordinator, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Liang S, Chau JPC, Lo SHS, Zhao J, Choi KC. Effects of nonpharmacological delirium-prevention interventions on critically ill patients' clinical, psychological, and family outcomes: A systematic review and meta-analysis. Aust Crit Care 2020; 34:378-387. [PMID: 33250403 DOI: 10.1016/j.aucc.2020.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/24/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Delirium is common in critically ill patients and may lead to severe complications, such as falls and injuries. Nonpharmacological interventions have been widely suggested to prevent delirium, yet the effects remain uncertain. OBJECTIVES The aim of the study was to determine the effects of nonpharmacological interventions on preventing delirium and improving critically ill patients' clinical, psychological, and family outcomes. METHODS Ten databases were searched from their inception to September 2020. Two reviewers assessed the methodological quality and extracted details of the included studies. The data were narratively or statistically pooled where appropriate. Dichotomous variables are presented as odds ratio (OR), and continuous variables are presented as mean difference (MD). The Grading of Recommendations Assessment, Development, and Evaluation criteria were used to assess the quality of evidence for each review outcome. RESULTS Thirty-four studies (10 randomised controlled trials, eight controlled clinical trials, and 16 before-and-after studies) were included in the analysis. Low-certainty evidence indicated that nonpharmacological interventions reduced delirium incidence (OR = 0.43, 95% confidence interval [CI] [0.33, 0.55]), delirium duration (MD = -1.43 days, 95% CI [-1.94, 0.92]), and length of stay in the intensive care unit (MD = -1.24 days, 95% CI [-2.05, -0.43]). Moderate-certainty evidence demonstrated no effect on mortality. Narrative synthesis further implied improvements in patients' psychological recovery (two studies, very low-certainty evidence) and families' satisfaction with care (two studies, very low-certainty evidence) through nonpharmacological interventions. As for effective intervention types, moderate-certainty evidence demonstrates that early mobilisation (OR = 0.33, 95% CI [0.24, 0.46], five studies, 859 participants, I2 = 24%), family participation (OR = 0.25, 95% CI [0.18, 0.34], four studies, 997 participants, I2 = 21%), and use of multicomponent interventions (OR = 0.48, 95% CI [0.34, 0.69], 13 studies, 3172 participants, I2 = 77%) are associated with reduced incidence of delirium. CONCLUSIONS Healthcare professionals are recommended to apply early mobilisation, family participation, or multicomponent interventions in clinical practice to prevent delirium. Further studies investigating the effects of nonpharmacological interventions on patients' psychological and family outcomes are warranted.
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Affiliation(s)
- Surui Liang
- The Nethersole School of Nursing, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region
| | - Janita Pak Chun Chau
- The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region.
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, 8/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region
| | - Jie Zhao
- The Nethersole School of Nursing, 6/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region
| | - Kai Chow Choi
- The Nethersole School of Nursing, 7/F, Esther Lee Building, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region
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The effect of postintensive care syndrome on the quality of life of intensive care unit survivors: A secondary analysis. Aust Crit Care 2020; 34:246-253. [PMID: 33214026 DOI: 10.1016/j.aucc.2020.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Despite increasing interest in postintensive care syndrome and the quality of life of intensive care unit survivors, the empirical literature on the relationship between these two variables is limited. OBJECTIVES This study aimed to examine whether postintensive care syndrome predicts the quality of life of intensive care unit survivors. METHODS We analysed secondary data, which were collected as part of a larger cross-sectional study. The participants were recruited from six health institutions in Korea. The data of 496 survivors who had been admitted to an intensive care unit for at least 48 h during the past year were analysed. They responded to measures of postintensive care syndrome and quality of life. RESULTS The participants' mean physical and mental component summary scores (quality of life) were 40.08 ± 8.99 and 40.24 ± 11.19, respectively. Physical impairment (β = -0.48, p < 0.001), unemployment (β = -0.19, p < 0.001), low income (β = -0.11, p = 0.004), older age (β = -0.08, p = 0.039), and cognitive impairment (β = -0.11, p = 0.045) predicted lower physical component summary scores. Mental (β = -0.49, p < 0.001) and cognitive impairment (β = -0.14, p = 0.005) and low income (β = -0.09, p = 0.014) predicted mental component summary scores. CONCLUSIONS The participants reported poor physical and mental health-related quality of life. Postintensive care syndrome, unemployment, low income, and older age were the main predictors of poor quality of life. In addition, postintensive care syndrome was a stronger risk factor for poor quality of life than demographic characteristics and intensive care unit treatment factors.
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Prevedello D, Fiore M, Creteur J, Preiser JC. Intensive care units follow-up: a scoping review protocol. BMJ Open 2020; 10:e037725. [PMID: 33148730 PMCID: PMC7643502 DOI: 10.1136/bmjopen-2020-037725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/30/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Increasing numbers of patients are surviving critical illness, leading to growing concern about the potential impact of the long-term consequences of intensive care on patients, families and society as a whole. These long-term effects are together known as postintensive care syndrome and their presence can be evaluated at intensive care unit (ICU) follow-up consultations. However, the services provided by these consultations vary across hospitals and units, in part because there is no validated standard model to evaluate patients and their quality of life after ICU discharge. We describe a protocol for a scoping review focusing on models of ICU follow-up and the impact of such strategies on improving patient quality of life. METHODS AND ANALYSIS In this scoping review, we will search the literature systematically using electronic databases (MEDLINE - from database inception to June 15th 2020) and a grey literature search. We will involve stakeholders as recommended by the Joanna Briggs Institute approach developed by Peters et al. The research will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION This study does not require ethics approval, because data will be obtained through a review of published primary studies. The results of our evaluation will be published in a peer-reviewed journal and will also be disseminated through presentations at national and international conferences.
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Affiliation(s)
- Danielle Prevedello
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Marco Fiore
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - J C Preiser
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
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Klitzman RL. Needs to Prepare for "Post-COVID-19 Syndrome". THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:4-6. [PMID: 33103966 DOI: 10.1080/15265161.2020.1820755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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