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Añón JM, Giménez-Esparza C, Nanwani-Nanwani K, Úrbez MR, Bonan MV. Are post-intensive care unit consultations actually harmful? Intensive Care Med 2024; 50:1400-1401. [PMID: 38713215 DOI: 10.1007/s00134-024-07470-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Affiliation(s)
- José Manuel Añón
- Department of Intensive Care Medicine, Hospital Universitario La Paz-Carlos III-Cantoblanco, Paseo de La Castellana 264, 28046, Madrid, Spain.
- Instituto de Investigación del Hospital Universitario La Paz. IdiPAZ, Madrid, Spain.
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Kapil Nanwani-Nanwani
- Department of Intensive Care Medicine, Hospital Universitario La Paz-Carlos III-Cantoblanco, Paseo de La Castellana 264, 28046, Madrid, Spain
- Instituto de Investigación del Hospital Universitario La Paz. IdiPAZ, Madrid, Spain
| | - María Rosario Úrbez
- Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
| | - María Victoria Bonan
- Department of Psychiatry, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
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Castillejos DG, Rubio ML, Ferre C, de Los Ángeles de Gracia M, Bodí M, Sandiumenge A. Psychological symptoms in difficult-to-sedate critical care survivors. Nurs Crit Care 2023; 28:679-688. [PMID: 34549485 DOI: 10.1111/nicc.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 08/22/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Critical care survivors often experience symptoms of anxiety, depression, or post-traumatic stress disorder (PTSD). AIMS To determine the prevalence and severity of psychological symptoms during the first 6 months after discharge from the intensive care unit (ICU) and to evaluate its association with patients who are difficult to sedate during admission. DESIGN Descriptive, prospective analysis of psychological symptoms in survivors from medicosurgical ICU over a 2-year period. METHODS All ICU survivors who required mechanical ventilation (MV) for more than 24 hours were followed for 6 months after their ICU discharge. ICU outcome and complications as well as the presence of psychological symptoms, 1 to 3 to 6 months after discharge were prospectively evaluated through phone interviews comparing the incidence and intensity of patients who were difficult to sedate during their ICU stay with those who were not. Descriptive analysis and multivariate logistic regression were performed. RESULTS Data were obtained for 195 patients, of whom 30% experienced difficult sedation (DS). Difficult-to-sedate patients were younger (P = .001), less critically ill (APACHE II score P = .002), and more likely to engage in harmful use of alcohol (P = .001) and psychoactive/psychotropic drug abuse. They also spent longer times on MV and in the ICU (P = .001). Anxiety incidence at 1 to 3 to 6 months post-discharge was significantly higher in DS patients than in those who were not (87.7% vs 45.4%, 75.5% vs 29.0%, and 70.8% vs 23.7%; P < .01), respectively. Depression incidence was also significantly higher in the DS group (82.4% vs 43.1%, 66% vs 33.9%, and 60.4% vs 27.2%; [P = .001]) at 1 to 3 to 6 months, respectively. A higher percentage of patients in the DS group reported symptoms of PTSD at 1 month (28.1% vs 11.5%) (P = .007) when compared with non-DS group. CONCLUSIONS Critical care survivors who are difficult to sedate during their ICU stay are more likely to present psychological sequelae. Early identification of at-risk patients is necessary to implement appropriate preventive strategies. RELEVANCE TO CLINICAL PRACTICE Patients who are difficult to sedate in the ICU may develop psychological disorders upon discharge, which may negatively affect their recovery. The prevention of DS and the early detection of psychological disorders are essential to minimize its subsequent impact.
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Affiliation(s)
| | | | - Carmen Ferre
- Department of Nursing, Rovira i Virgili University, Tarragona, Spain
| | | | - María Bodí
- University Hospital Joan XXIII/IISPV/URV Tarragona/CIBERES, Tarragona, Spain
| | - Alberto Sandiumenge
- Medical Trasplant Coordinator, University Hospital Vall d'Hebron, Barcelona, Spain
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3
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Tejero-Aranguren J, Poyatos Aguilera E, Colmenero M, García Del Moral R. A need for post-intensive care follow-up training. Med Intensiva 2023; 47:345-347. [PMID: 36925405 PMCID: PMC10013748 DOI: 10.1016/j.medine.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/23/2023] [Accepted: 02/03/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Julia Tejero-Aranguren
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; POD Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain.
| | | | - Manuel Colmenero
- Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria. Ibs Granada, Granada, Spain
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Nanwani-Nanwani K, López-Pérez L, Giménez-Esparza C, Ruiz-Barranco I, Carrillo E, Arellano MS, Díaz-Díaz D, Hurtado B, García-Muñoz A, Relucio MÁ, Quintana-Díaz M, Úrbez MR, Saravia A, Bonan MV, García-Río F, Testillano ML, Villar J, García de Lorenzo A, Añón JM. Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19. Sci Rep 2022; 12:7977. [PMID: 35562379 PMCID: PMC9105588 DOI: 10.1038/s41598-022-11929-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/29/2022] [Indexed: 01/10/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) patients usually require long periods of mechanical ventilation and sedation, which added to steroid therapy, favours a predisposition to the development of delirium and subsequent mental health disorders, as well as physical and respiratory sequelae. The aim of this study was to determine the prevalence of post-intensive care syndrome (PICS) at 3 months after hospital discharge, in a cohort of mechanically ventilated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An ambispective, observational study was conducted in three hospitals with intensive care unit (ICU) follow-up clinics. We studied adults who survived a critical illness due to SARS-CoV-2 infection requiring invasive mechanical ventilation. A physical (muscle strength and pulmonary function), functional [12-Item Short Form Health Survey (SF-12), and Barthel score], psychological [hospital anxiety and depression (HADS) and posttraumatic stress disorder symptom severity scales], and cognitive [Montreal cognitive assessment (MoCA) test] assessment were performed. A total of 186 patients were evaluated at 88 days (IQR 68-121) after hospital discharge. Mean age was 59 ± 12 years old, 126 (68%) patients were men, and median length of mechanical ventilation was 14 days (IQR 8-31). About 3 out of 4 patients (n = 139, 75%) met PICS criteria. Symptoms of cognitive and psychiatric disorders were found in 59 (32%) and 58 (31%) patients, respectively. Ninety-one (49%) patients had muscle weakness. Pulmonary function tests in patients with no respiratory comorbidities showed a normal pattern in 93 (50%) patients, and a restrictive disorder in 62 (33%) patients. Also, 69 patients (37%) were on sick leave, while 32 (17%) had resumed work at the time of assessment. In conclusion, survivors of critical illness due to SARS-CoV-2 infection requiring mechanical ventilation have a high prevalence of PICS. Physical domain is the most frequently damaged, followed by cognitive and psychiatric disorders. ICU follow-up clinics enable the assistance of this vulnerable population.
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Affiliation(s)
- Kapil Nanwani-Nanwani
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | | | - Inés Ruiz-Barranco
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Elena Carrillo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - María Soledad Arellano
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | - Domingo Díaz-Díaz
- Intensive Care Unit, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Beatriz Hurtado
- Intensive Care Unit, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Andoni García-Muñoz
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Manuel Quintana-Díaz
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - María Rosario Úrbez
- Department of Physical Medicine and Rehabilitation, Hospital Universitario La Paz, Madrid, Spain
| | - Andrés Saravia
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
| | | | - Francisco García-Río
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Jesús Villar
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Abelardo García de Lorenzo
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - José Manuel Añón
- Intensive Care Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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AÑÓn JM, Curto J, Del Rosario Úrbez M, Burnham PM, Testillano ML, De La Cerda G, Álvare Z-Rojas E, García De Lorenzo A. Postintensive care syndrome and follow-up clinics: results after a two-year pilot. Minerva Anestesiol 2020; 86:1246-1248. [PMID: 32643362 DOI: 10.23736/s0375-9393.20.14754-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- José M AÑÓn
- Department of Intensive Care Medicine, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain - .,CIBER of Respiratory Diseases, Carlos III Health Institute, Madrid, Spain -
| | - Javier Curto
- Department of Psychiatry, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain
| | - María Del Rosario Úrbez
- Department of Physical Medicine and Rehabilitation, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain
| | - Paul M Burnham
- Department of Physical Medicine and Rehabilitation, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain
| | - María L Testillano
- Department of Pharmacy, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain
| | | | - Elena Álvare Z-Rojas
- Unit of Pediatric Intensive Care, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain
| | - Abelardo García De Lorenzo
- Department of Intensive Care Medicine, La Paz-Carlos III-Cantoblanco University Hospital (IdiPAZ), Madrid, Spain
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Gordo Vidal F, Martín Delgado MC. Perioperative Intensive Care Medicine. Contributing value to the surgical process. Med Intensiva 2020; 44:310-311. [PMID: 32093970 DOI: 10.1016/j.medin.2020.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 02/02/2023]
Affiliation(s)
- F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España; Grupo de Investigación en Patología Crítica, Universidad Francisco de Vitoria, Madrid, España.
| | - M C Martín Delgado
- Servicio Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España; Universidad Francisco de Vitoria (UFV), Madrid, España
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Abstract
Surgery represents one of the main therapeutic references in the world, affording greater survival and life expectancy for many patients. In general, the estimated postoperative mortality is low (around 1-4%). Thirteen percent of the surgical procedures have a high risk of complications, accounting for 80% of all postoperative deaths. Recently, there have been significant advances related to organizational aspects, new anesthetic and surgical techniques, prognostic scales, perioperative management and greater participation and involvement of the patient. This new series of Medicina Intensiva will address fundamental aspects of how Departments of Intensive Care Medicine can add value to the surgical process, in a coordinated manner with other services. Institutional policies are required to ensure the detection of patients at risk in hospitalization wards, with early admission to the ICU of those patients in whom admission is indicated, adapting the treatment in the ICU and optimizing the criteria for discharge. The detection and prevention of post-ICU syndrome in patients and relatives, and the follow-up of ICU discharge and hospitalization in a multidisciplinary manner can reduce the sequelae among critical surgical patients, improving the outcomes and quality of life, and restoring the patient to society. In future publications of this series directed to the surgical patient, updates will be provided on the perioperative management of some of the most complex surgeries.
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Busico M, das Neves A, Carini F, Pedace M, Villalba D, Foster C, García Urrutia J, Garbarini M, Jereb S, Sacha V, Estenssoro E. Follow-up program after intensive care unit discharge. Med Intensiva 2019; 43:243-254. [PMID: 30833016 DOI: 10.1016/j.medin.2018.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/20/2018] [Accepted: 12/12/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Patient follow-up after intensive care unit (ICU) discharge allows the early recognition of complications associated to post-intensive care syndrome (PICS). The aim of this project is to standardize outcome variables in a follow-up program for patients at risk of suffering PICS. METHODS The Rehabilitation and Patient Follow-up Committee of the Argentine Society of Intensive Care Medicine (Sociedad Argentina de Terapia Intensiva, SATI) requested the collaboration of different committees to design the present document. A thorough search of the literature on the issue, together with pre-scheduled meetings and web-based discussion encounters were carried out. After comprehensive evaluation, the recommendations according to the GRADE system included in the follow-up program were: frequency of controlled visits, appointed healthcare professionals, basic domains of assessment and recommended tools of evaluation, validated in Spanish, and entire duration of the program. CONCLUSION The measures herein suggested for patient follow-up after ICU discharge will facilitate a basic approach to diagnosis and management of the long-term complications associated to PICS.
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Affiliation(s)
- M Busico
- Clínica Olivos, SMG, Buenos Aires, Argentina; Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina.
| | - A das Neves
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital San Martín de La Plata, La Plata, Argentina
| | - F Carini
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M Pedace
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D Villalba
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Clínica Basilea, Buenos Aires, Argentina
| | - C Foster
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - J García Urrutia
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Alejandro Posadas, Buenos Aires, Argentina
| | - M Garbarini
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Jereb
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital Alejandro Posadas, Buenos Aires, Argentina
| | - V Sacha
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - E Estenssoro
- Comité de Seguimiento y Rehabilitación, Sociedad Argentina de Terapia Intensiva (SATI), Argentina; Hospital San Martín de La Plata, La Plata, Argentina
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Alonso-Ovies Á, Heras la Calle G. Tell me what you need. I hear you. Med Intensiva 2018; 43:193-194. [PMID: 30391044 DOI: 10.1016/j.medin.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Á Alonso-Ovies
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada (Madrid), España; Proyecto HUCI.
| | - G Heras la Calle
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz (Madrid), España; Proyecto HUCI
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Olaechea Astigarraga PM, Bodí Saera M, Martín Delgado MC, Holanda Peña MS, García de Lorenzo Y Mateos A, Gordo Vidal F. Document on the state of affairs of the Spanish model of Intensive Care Medicine. SEMICYUC Strategic Plan 2018-2022. Med Intensiva 2018; 43:47-51. [PMID: 29898831 DOI: 10.1016/j.medin.2018.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 04/23/2018] [Indexed: 12/27/2022]
Abstract
The role of Critical Care Medicine in Spain requires continuous revision and reflection. We have values and strengths that are evidenced in our daily work and by their important effects in routine hospital activity. Other medical specialties seeking to assume activities referred to critical patient care, as well as a number of other circumstances, may have a negative impact upon our routine duties. This article reflects the impressions of an important number of members of the Planning, Organization and Management Task Force of the Spanish Society of Critical Medicine Society (Grupo de Trabajo de Planificación, Organización y Gestión; GTPOG-SEMICYUC). The actions required to upgrade our Critical Care Medicine model are presented, evolving towards a broader view such as the 'ICU without walls' or 'Expanded ICU'. The subject is addressed from three complementary standpoints: actions involving the administrative authorities; actions required on the part of our scientific Society; and initiatives to be implemented locally in each Intensive Care Unit (led by the corresponding Unit representatives) at both hospital level and involving the regional authorities.
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Affiliation(s)
| | - M Bodí Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Tarragona, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España
| | - M S Holanda Peña
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | - F Gordo Vidal
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España
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12
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Intensive medicine services. How to add value to the surgical process? Med Intensiva 2018; 42:461-462. [PMID: 29615273 DOI: 10.1016/j.medin.2018.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
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