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Gravante F, Trotta F, Latina S, Simeone S, Alvaro R, Vellone E, Pucciarelli G. Quality of life in ICU survivors and their relatives with post-intensive care syndrome: A systematic review. Nurs Crit Care 2024; 29:807-823. [PMID: 38622971 DOI: 10.1111/nicc.13077] [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: 06/02/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status. AIM This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post-intensive care syndrome (PICS-F) and to report anxiety, depression and Post-Traumatic Stress Disorders (PTSD) in studies investigating PICS. STUDY DESIGN A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123). RESULTS We included 19 studies of PICS and PICS-F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post-traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain-related symptoms and sleep disorders were problems encountered by ICU relatives with PICS-F. CONCLUSION PICS and PICS-F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS-F on QoL. RELEVANCE TO CLINICAL PRACTICE PICS and PICS-F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission.
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Affiliation(s)
- Francesco Gravante
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Trotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Salvatore Latina
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Silvio Simeone
- Department of Clinical and Experimental Medicine, University of Catanzaro Magna Graecia, Catanzaro, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Lau WK, Hwang DY. ICU Family Bereavement: Demonstrating Predictors and a Call to Improve Outcomes. Crit Care Med 2024; 52:982-984. [PMID: 38752816 DOI: 10.1097/ccm.0000000000006280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Affiliation(s)
- Winnie K Lau
- Both authors: Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC
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Wen FH, Prigerson HG, Hu TH, Huang CC, Chou WC, Chuang LP, Chiang MC, Tang ST. Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents. Crit Care Med 2024; 52:900-909. [PMID: 38299933 PMCID: PMC11093430 DOI: 10.1097/ccm.0000000000006199] [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] [Indexed: 02/02/2024]
Abstract
OBJECTIVES To examine associations between family surrogates' bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst). DESIGN Prospective, longitudinal, observational study. SETTING Medical ICUs at two academically affiliated medical centers in Taiwan. PATIENTS/PARTICIPANTS Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates' distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144-2.772], -2.245 [-3.961 to -0.529]), poor-to-uncertain (2.224 [1.438-3.010], -7.026 [-8.683 to -5.369]), and worst (2.081 [1.215-2.964], -4.268 [-6.096 to -2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392-2.798]) and poor-to-uncertain (0.801 [0.123-1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005-4.774]) than those in the high QODD class. CONCLUSIONS The four distinct QODD latent classes were significantly associated with ICU family surrogates' bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | | | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
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He X, Song Y, Cao Y, Miao L, Zhu B. Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention. Heliyon 2024; 10:e31278. [PMID: 38803859 PMCID: PMC11128526 DOI: 10.1016/j.heliyon.2024.e31278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
Post intensive care syndrome (PICS) is a typical complication of critically ill patients during or after their stay in intensive care unit (ICU), characterized by a high incidence and impairment rate. It significantly impacts the quality of life of patients and their families, as well as consumes a substantial amount of medical resources. Therefore, early intervention and assessment of PICS is crucial. This paper aims to provide clinical professionals with a reference base by focusing on the clinical symptoms, diagnostic assessment, and preventative measures of PICS.
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Affiliation(s)
- Xiaofang He
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuwei Song
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Yuchun Cao
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
| | - Liying Miao
- Department of Nephrology, the Third Affiliated Hospital of Soochow University, Changzhou, 213000, Jiangsu, China
| | - Bin Zhu
- Department of Critical Care Medicine, the Third Affiliated Hospital of Soochow University, Changzhou 213000, Jiangsu, China
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Li Y, Wang M, Wang L, Cao Y, Liu Y, Zhao Y, Yuan R, Yang M, Lu S, Sun Z, Zhou F, Qian Z, Kang H. Advances in the Application of AI Robots in Critical Care: Scoping Review. J Med Internet Res 2024; 26:e54095. [PMID: 38801765 PMCID: PMC11165292 DOI: 10.2196/54095] [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: 10/29/2023] [Revised: 03/07/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND In recent epochs, the field of critical medicine has experienced significant advancements due to the integration of artificial intelligence (AI). Specifically, AI robots have evolved from theoretical concepts to being actively implemented in clinical trials and applications. The intensive care unit (ICU), known for its reliance on a vast amount of medical information, presents a promising avenue for the deployment of robotic AI, anticipated to bring substantial improvements to patient care. OBJECTIVE This review aims to comprehensively summarize the current state of AI robots in the field of critical care by searching for previous studies, developments, and applications of AI robots related to ICU wards. In addition, it seeks to address the ethical challenges arising from their use, including concerns related to safety, patient privacy, responsibility delineation, and cost-benefit analysis. METHODS Following the scoping review framework proposed by Arksey and O'Malley and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a scoping review to delineate the breadth of research in this field of AI robots in ICU and reported the findings. The literature search was carried out on May 1, 2023, across 3 databases: PubMed, Embase, and the IEEE Xplore Digital Library. Eligible publications were initially screened based on their titles and abstracts. Publications that passed the preliminary screening underwent a comprehensive review. Various research characteristics were extracted, summarized, and analyzed from the final publications. RESULTS Of the 5908 publications screened, 77 (1.3%) underwent a full review. These studies collectively spanned 21 ICU robotics projects, encompassing their system development and testing, clinical trials, and approval processes. Upon an expert-reviewed classification framework, these were categorized into 5 main types: therapeutic assistance robots, nursing assistance robots, rehabilitation assistance robots, telepresence robots, and logistics and disinfection robots. Most of these are already widely deployed and commercialized in ICUs, although a select few remain under testing. All robotic systems and tools are engineered to deliver more personalized, convenient, and intelligent medical services to patients in the ICU, concurrently aiming to reduce the substantial workload on ICU medical staff and promote therapeutic and care procedures. This review further explored the prevailing challenges, particularly focusing on ethical and safety concerns, proposing viable solutions or methodologies, and illustrating the prospective capabilities and potential of AI-driven robotic technologies in the ICU environment. Ultimately, we foresee a pivotal role for robots in a future scenario of a fully automated continuum from admission to discharge within the ICU. CONCLUSIONS This review highlights the potential of AI robots to transform ICU care by improving patient treatment, support, and rehabilitation processes. However, it also recognizes the ethical complexities and operational challenges that come with their implementation, offering possible solutions for future development and optimization.
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Affiliation(s)
- Yun Li
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Min Wang
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Lu Wang
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yuan Cao
- The Second Hospital, Hebei Medical University, Hebei, China
| | - Yuyan Liu
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yan Zhao
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Rui Yuan
- Medical School of Chinese PLA, Beijing, China
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Mengmeng Yang
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Siqian Lu
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
| | - Zhichao Sun
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
| | - Feihu Zhou
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhirong Qian
- Beidou Academic & Research Center, Beidou Life Science, Guangzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fujian, China
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hongjun Kang
- The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Avgeri K, Mantzarlis K, Gerovasileiou E, Deskata K, Chatzi M, Fotakopoulos G, Sgantzos M, Tsolaki V, Zakynthinos E, Makris D. Quality of Life, Family Support, Spirometry, and 6-Minute Walking Distance Differences between COVID-19 and Non-COVID-19 Intensive Care Unit Patients in One Year Following Hospital Discharge. Healthcare (Basel) 2024; 12:996. [PMID: 38786407 PMCID: PMC11121675 DOI: 10.3390/healthcare12100996] [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: 04/02/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Critically ill patients after Intensive Care Unit (ICU) discharge may present disability in their cognitive and physical functions. OBJECTIVES To investigate the quality of life (QoL) of both COVID-19 and non-COVID-19 patients following ICU discharge, lung function, and physical performance of participants. METHODS This study was prospective and conducted between 2020 and 2021 in the "X" hospital. If patients were Mechanically-Ventilated (MV) > 48 h, they were included. RESULTS Fifty COVID-19 and seventy-two non-COVID-19 participants were included in this study. The mean (SD) of the total SF-36 scores at COVID-19 patients at hospital discharge and 3 and 12 months were 46.5 (14.5), 68.6 (17.8), and 82.3 (8.9) (p < 0.05), while non-COVID-19 participants were 48.5 (12.1), 72.2 (9.9), and 82.7 (5.4) (p < 0.05). The forced expiratory volume in one second (FEV1) and 6-minute walking distance (6MWD) were assessed at 3 and 12 months and significantly improved over 12 months. CONCLUSION The QoL of COVID-19 patients improved significantly over time as FEV1 and 6MWD.
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Affiliation(s)
| | - Konstantinos Mantzarlis
- Medical Deparment, University of Thessaly, 41336 Larissa, Greece; (K.A.); (E.G.); (K.D.); (M.C.); (G.F.); (M.S.); (V.T.); (E.Z.); (D.M.)
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7
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Lehmkuhl L, Munck MS, Rothmann MJ, Sorknaes AD. Exploring critically ill patients' and their relatives' experiences of intensive care unit during COVID-19: A qualitative study. Nurs Crit Care 2024; 29:427-437. [PMID: 38183390 DOI: 10.1111/nicc.13011] [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: 01/10/2023] [Revised: 10/19/2023] [Accepted: 10/31/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Admission to an intensive care unit has physiological and psychological consequences for patients and families, including the family's fear that the patient might die. The COVID-19 pandemic underlined this and furthermore involved visiting restrictions separating patients and families. AIM To explore how patients with confirmed COVID-19 and their relatives experienced an intensive care unit stay and its significance for family dynamics. STUDY DESIGN A qualitative study was performed during the spring of 2020. Five dyadic interviews were conducted with COVID-19 patients admitted to an intensive care unit and their relatives. The analysis was inspired by Hochman's dyadic analysis. FINDINGS The analysis revealed three themes: (1) From ill to critically ill: The trauma of separation and fear of losing loved ones; (2) The relatives' significant role in creating a shared coherent understanding of the admission in ICU due to COVID-19; (3) The nurses' roles as a go-between in maintenance of the family dynamic. CONCLUSION Separation challenged family function and destabilized family dynamics. Nurses provided emotional support, information about and contact with the patient and relatives. The patients' distorted perception of reality and lack of memory were reconstructed in new family narratives, which offered relief and stabilization of family dynamics. The nurses entered into a triad with the patient and relatives, which also contributed to maintaining a relational dynamic in the family. RELEVANCE TO CLINICAL PRACTICE Maintaining communication between health professionals, relatives and patients, and usage of virtual visits during intensive care unit stay can support the family relationship. Nurse therapeutic conversations might help families' in redefining their family dynamics after ICU admission.
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Affiliation(s)
- Lene Lehmkuhl
- Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Maja Stensdal Munck
- Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital, Svendborg, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense C, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense C, Denmark
| | - Anne Dichmann Sorknaes
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
- Internal Medicine & Emergency Department M/FAM, OUH Svendborg Hospital, Svendborg, Denmark
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Denke C, Voigt B, Krampe H, Spies C, Rose M. [Psychosocial Care in the Intensive Care Unit]. Anasthesiol Intensivmed Notfallmed Schmerzther 2023; 58:666-674. [PMID: 38056446 DOI: 10.1055/a-2081-3521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The improvement of intensive care treatment options leads to an increasing number of patients being treated in this setting. For the majority of those affected and their relatives, this treatment is associated with tremendous stress, but also subsequent physical, psychological and cognitive impairments, the post-intensive care syndrome. The aim of psychosocial support in the intensive care unit is to stabilise and minimise the acute stress. This is done through care services oriented towards trauma therapy interventions and emergency psychology. Equally central are the needs of the patient's relatives and ways to stabilise and relieve them. The third pillar of psychosocial work in the intensive care unit is the support of the treatment team. Finally, an outlook is given for the specialised aftercare of these complex patients in PICS outpatient clinics.
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Liu T, Zhao Z, Wu C, Lu C, Liu M, An X, Sha Z, Wang X, Luo Z, Chen L, Liu C, Cao P, Zhang D, Jiang R. Impact of COVID-19 infection experience on mental health status of intensive care unit patients' family members: a real-world study. QJM 2023; 116:903-910. [PMID: 37498557 DOI: 10.1093/qjmed/hcad184] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/05/2023] [Indexed: 07/28/2023] Open
Abstract
PURPOSE Family members of patients hospitalized in intensive care unit (ICU) are susceptible to adverse psychological outcomes. However, there is a paucity of studies specifically examining the mental health symptoms in ICU patients' family members with a prior history of coronavirus disease 2019 (COVID-19) infection. AIM This study aimed to investigate mental health status and its influencing factors of ICU patients' family members with previous COVID-19 infection experience in China. DESIGN Nationwide, cross-sectional cohort of consecutive participants of family members of ICU patients from 10 provinces randomly selected in mainland China conducted between October 2022 and May 2023. METHODS The basic information scale, Self-rating depression scale, Self-rating Anxiety Scale, Impact of Event Scale-Revised, Pittsburgh sleep quality index, Perceived Stress Scale, Connor-Davidson resilience scale, Simplified Coping Style Questionnaire were employed to explore mental health status among participants. RESULTS A total of 463 participants, comprising 156 individuals in Covid-19 family member cohort (infection group) and 307 individuals in control family member cohort (control group), met inclusion criteria. The infection group exhibited significantly higher incidence of composite mental health symptoms compared to control group (P = 0.017). Multivariable logistic regression analysis revealed that being female, engaging in physical/mental labor, residing in rural areas, and having children were identified as risk factors for the development of depression, anxiety, and post-traumatic stress disorder symptoms, while medical history of surgery was protective factor. A predictive model demonstrated a favorable discriminative ability and excellent calibration. CONCLUSION COVID-19 infection experience regarded as new traumatic stressors worsen mental health status of ICU patients' family members.
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Affiliation(s)
- T Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Z Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - C Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - C Lu
- Department of Psychiatry, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, China
| | - M Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - X An
- Department of Intensive Care Unit, Beijing Tiantan Hospital, Beijing, China
| | - Z Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - X Wang
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Z Luo
- Department of Neurosurgery, Shandong Provincial Third Hospital, Shandong, China
| | - L Chen
- Department of Intensive Care Unit, Shaoxing People's Hospital, Shaoxing, Zhejiang, China
| | - C Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Anhui, China
| | - P Cao
- Department of Intensive Care Unit, The First Affiliated Hospital of Bengbu Medical College, Anhui, China
| | - D Zhang
- Tianjin Neurological Institute, Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China
| | - R Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
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Petrinec AB, Wilk C, Hughes JW, Zullo MD, George RL. Self-Care Mental Health App Intervention for Post-Intensive Care Syndrome-Family: A Randomized Pilot Study. Am J Crit Care 2023; 32:440-448. [PMID: 37907376 DOI: 10.4037/ajcc2023800] [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: 11/02/2023]
Abstract
BACKGROUND Post-intensive care syndrome-family (PICS-F) is a constellation of adverse psychological symptoms experienced by family members of critically ill patients during and after acute illness. Cognitive behavioral therapy delivered using smartphone technology is a novel approach for PICS-F symptom self-management. OBJECTIVE To determine the efficacy of smartphone delivery of cognitive behavioral therapy in reducing the prevalence and severity of PICS-F symptoms in family members of critically ill patients. METHODS The study had a randomized controlled longitudinal design with control and intervention groups composed of family members of patients admitted to 2 adult intensive care units. The intervention consisted of a mental health app loaded on participants' personal smartphones. The study time points were upon enrollment (within 5 days of intensive care unit admission; time 1), 30 days after enrollment (time 2), and 60 days after enrollment (time 3). Study measures included demographic data, PICS-F symptoms, mental health self-efficacy, health-related quality of life, and app use. RESULTS The study sample consisted of 60 predominantly White (72%) and female (78%) family members (30 intervention, 30 control). Anxiety and depression symptom severity decreased significantly over time in the intervention group but not in the control group. Family members logged in to the app a mean of 11.4 times (range, 1-53 times) and spent a mean of 50.16 minutes (range, 1.87-245.92 minutes) using the app. CONCLUSIONS Delivery of cognitive behavioral therapy to family members of critically ill patients via a smartphone app shows some efficacy in reducing PICS-F symptoms.
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Affiliation(s)
- Amy B Petrinec
- Amy B. Petrinec is an associate professor, College of Nursing, Kent State University, Kent, Ohio
| | - Cindy Wilk
- Cindy Wilk is an associate professor, College of Nursing, Kent State University, Kent, Ohio
| | - Joel W Hughes
- Joel W. Hughes is a professor, Department of Psychological Sciences, Kent State University
| | - Melissa D Zullo
- Melissa D. Zullo is a professor, College of Public Health, Kent State University
| | - Richard L George
- Richard L. George is a physician, Summa Health System, Akron, Ohio
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Vogel G, Joelsson-Alm E, Forinder U, Svensen C, Sandgren A. Shifting focus: A grounded theory of how family members to critically ill patients manage their situation. Intensive Crit Care Nurs 2023; 78:103478. [PMID: 37384978 DOI: 10.1016/j.iccn.2023.103478] [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: 10/28/2022] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES Critical illness is a life-threatening condition for the patient, which affects their family members as a traumatic experience. Well-known long-term consequences include impact on mental health and health-related quality of life. This study aims to develop a grounded theory to explain pattern of behaviours in family members of critically ill patients cared for in an intensive care unit, addressing the period from when the patient becomes critically ill until recovery at home. RESEARCH METHODOLOGY/DESIGN We used a classic grounded theory to explore the main concern for family members of intensive care patients. Fourteen interviews and seven observations with a total of 21 participants were analysed. Data were collected from February 2019 to June 2021. SETTING Three general intensive care units in Sweden, consisting of a university hospital and two county hospitals. FINDINGS The theory Shifting focus explains how family members' main concern, living on hold, is managed. This theory involves different strategies: decoding, sheltering and emotional processing. The theory has three different outcomes: adjusting focus, emotional resigning or remaining in focus. CONCLUSION Family members could stand in the shadow of the patients' critical illness and needs. This emotional adversity is processed through shifting focus from one's own needs and well-being to the patient's survival, needs and well-being. This theory can raise awareness of how family members of critically ill patients manage the process from critical illness until return to everyday life at home. Future research focusing on family members' need for support and information, to reduce stress in everyday life, is needed. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals should support family members in shifting focus by interaction, clear and honest communication, and through mediating hope.
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Affiliation(s)
- Gisela Vogel
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Ulla Forinder
- Faculty of Health and Occupational Studies, University of Gävle, Kungsbäcksvägen 47, SE-801 76 Gävle, Sweden.
| | - Christer Svensen
- Department of Clinical Science and Education, Karolinska Institutet, Unit of Anaesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken 10, SE-118 83 Stockholm, Sweden.
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Universitetsplatsen 1, SE-352 52 Växjö, Sweden.
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Lobato CT, Camões J, Carvalho D, Vales C, Dias CC, Gomes E, Araújo R. Risk factors associated with post-intensive care syndrome in family members (PICS-F): A prospective observational study. J Intensive Care Soc 2023; 24:247-257. [PMID: 37744068 PMCID: PMC10515326 DOI: 10.1177/17511437221108904] [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: 09/26/2023] Open
Abstract
Background The family members of intensive care unit (ICU) patients play a crucial role in modern ICUs. These individuals are predisposed to the development of post-intensive care syndrome in family members (PICS-F), a syndrome experienced by family members of ICU patients in response to critical illness and characterised by new or worsening psychological symptoms. This study sought to evaluate the levels of anxiety and depression exhibited by the family members of patients hospitalised in the ICU. It also aimed to identify the risk factors associated with the experience of PICS-F, which should assist with its prevention in the future. Methods The study sample comprised 164 ICU patients and their family members. Sociodemographic data were gathered at the time of ICU admission and 3 months after discharge, and the family members were screened for emotional distress using the Hospital Anxiety and Depression Scale (HADS). Comparison tests were used to test for an association between family/patient characteristics and a positive HADS score. In addition, a multivariable logistic regression model was constructed to identify the independent factors associated with a positive HADS score. Results Emotional distress was identified in 24% of the family members 3 months after their relatives had been discharged from the ICU. A number of personal traits were found to be associated with emotional distress in the family members, namely unemployment (p = .008), smoking/drinking habits (p = .036) and personal history of psychopathology (p = .045). In the multiple logistic regression analyses, only unemployment was found to be an independent factor associated with both anxiety and depression in the family members (OR = 2.74, CI 95%: 1.09-6.93). No association was found between the patients' characteristics and emotional distress in the family members. Conclusions The findings of this study indicate an association between emotional distress in the family members of ICU patients and their personal traits, thereby building on the prior literature by suggesting that patient characteristics are less pertinent to the experience of PICS-F. Unemployment may represent a meaningful risk factor for emotional distress in family members (a potential marker of PICS-F), given its relationship with family members' positive HADS scores post-ICU discharge. These findings should influence preventative strategies concerning PICS-F by illustrating the need to assess family characteristics and demographics early in a patient's ICU stay and, consequently, allowing for the early identification of at-risk individuals and the prompt implementation of adequate support services.
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Affiliation(s)
- Carolina Tintim Lobato
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - João Camões
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Daniela Carvalho
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Cláudia Vales
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- RISE- Health Research Network- From the Lab to the Community, Porto, Portugal
| | - Ernestina Gomes
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
| | - Rui Araújo
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Portugal
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Liu X, Long J, Chang Y, Gao H, Zhang X, Chen J, Hu R. Application of the whole-course care model (IWF/C Care) for postintensive care syndrome based on an early warning system in critically ill patients: a randomised controlled trial study protocol. BMJ Open 2023; 13:e073035. [PMID: 37479509 PMCID: PMC10364161 DOI: 10.1136/bmjopen-2023-073035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Critically ill patients are at risk of developing postintensive care syndrome (PICS), which is manifested by physical, psychological and cognitive impairment. Currently, there are no programmes that combine early warning systems with interventions for PICS. We hypothesise that a comprehensive care model for PICS based on an early warning system would reduce medical costs and the incidence of PICS. METHODS AND ANALYSIS The Intensive Care Unit (ICU) -Ward-Family/Community whole-course care (IWF/C Care) trial will be a unicentric, randomised, controlled trial. A total of 138 ICU patients from two ICUs at a university hospital in Guizhou province, China, will be enrolled in February 2023. The inclusion criteria are an age of 18 years or older, an ICU stay of more than 48 hours, provide informed consent and the ability to communicate normally. Patients will be followed for 12 months and randomised in a 1:1:1 ratio to three groups. INTERVENTIONS Patients in intervention group 1 will be assessed by the PICS early warning system within 24 hours of ICU discharge, and precise interventions will be carried out according to the results; that is, high-risk patients will receive care based on the IWF/C Care model and low-risk patients will receive routine care. All patients in intervention group 2 will receive care based on the IWF/C Care model. The control group will receive routine care. The primary endpoints are the incidence of PICS and quality of life. The secondary endpoints include the incidence of adverse events: the unplanned readmission rate, cost-effectiveness, and the experiences and feelings of patients receiving care based on the IWF/C Care model. The incidence of PICS will be measured at ICU discharge, general ward discharge, the home/community stage and 1 month and 3, 6, 9, and 12 months after discharge. ETHICS AND DISSEMINATION Ethics approval was obtained from Biomedical Research Ethics Committee of the Affiliated Hospital of Zunyi Medical University (approval number: KLL-2022-780). The results of this study will be distributed through peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2300068135.
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Affiliation(s)
- Xiaohui Liu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Jianmei Long
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Yonghu Chang
- School of Information Engineering, Zunyi Medical University, Zunyi, Guizhou, China
| | - Huiming Gao
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xia Zhang
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Junxi Chen
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Rujun Hu
- Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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14
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Wen FH, Juang YY, Prigerson HG, Chou WC, Huang CC, Hu TH, Chiang MC, Chuang LP, Tang ST. Temporal reciprocal relationships among anxiety, depression, and posttraumatic stress disorder for family surrogates from intensive care units over their first two bereavement years. BMC Psychiatry 2023; 23:412. [PMID: 37291535 PMCID: PMC10248341 DOI: 10.1186/s12888-023-04916-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND/OBJECTIVE Bereaved family surrogates from intensive care units (ICU) are at risk of comorbid anxiety, depression, and post-traumatic stress disorder (PTSD), but the temporal reciprocal relationships among them have only been examined once among veterans. This study aimed to longitudinally investigate these never-before-examined temporal reciprocal relationships for ICU family members over their first two bereavement years. METHODS In this prospective, longitudinal, observational study, symptoms of anxiety, depression, and PTSD were assessed among 321 family surrogates of ICU decedents from 2 academically affiliated hospitals in Taiwan by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale, and the Impact of Event Scale-Revised, respectively at 1, 3, 6, 13, 18, and 24 months postloss. Cross-lagged panel modeling was conducted to longitudinally examine the temporal reciprocal relationships among anxiety, depression, and PTSD. RESULTS Examined psychological-distress levels were markedly stable over the first 2 bereavement years: autoregressive coefficients for symptoms of anxiety, depression, and PTSD were 0.585-0.770, 0.546-0.780, and 0.440-0.780, respectively. Cross-lag coefficients showed depressive symptoms predicted PTSD symptoms in the first bereavement year, whereas PTSD symptoms predicted depressive symptoms in the second bereavement year. Anxiety symptoms predicted symptoms of depression and PTSD at 13 and 24 months postloss, whereas depressive symptoms predicted anxiety symptoms at 3 and 6 months postloss while PTSD symptoms predicted anxiety symptoms during the second bereavement year. CONCLUSIONS Different patterns of temporal relationships among symptoms of anxiety, depression, and PTSD over the first 2 bereavement years present important opportunities to target symptoms of specific psychological distress at different points during bereavement to prevent the onset, exacerbation, or maintenance of subsequent psychological distress.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Jiangsu, Taiwan, R. O. C
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, R. O. C
| | - Holly G Prigerson
- Department of Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R. O. C
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, R. O. C
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R. O. C
- Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, R. O. C
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R. O. C
| | - Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R. O. C
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R. O. C
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, R. O. C..
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, R. O. C..
- School of Nursing, Medical College, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, 333, Tao-Yuan, Taiwan, R. O. C..
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R. O. C..
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Avgeri K, Zakynthinos E, Tsolaki V, Sgantzos M, Fotakopoulos G, Makris D. Quality of Life and Family Support in Critically Ill Patients following ICU Discharge. Healthcare (Basel) 2023; 11:healthcare11081106. [PMID: 37107940 PMCID: PMC10138299 DOI: 10.3390/healthcare11081106] [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: 02/23/2023] [Revised: 03/27/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Following discharge from the intensive care unit (ICU), critically ill patients may present cognitive dysfunction and physical disability. OBJECTIVES To investigate the quality of life (QoL) of patients following discharge from ICU, physical performance and lung function and to assess the role of support by family members and friends. METHODS This prospective study was conducted in the University Hospital of Larissa Greece between 2020 and 2021. Patients hospitalized at the ICU for at least 48 h were included and assessed at hospital discharge, at 3 and at 12 months later. The research implements of the study were a dedicated questionnaire and the SF-36 health questionnaire for the appraisal of the QoL. Lung function changes were assessed by spirometry and physical performance by the 6-min walking test (6MWT). RESULTS One hundred and forty-three participants were included in the study. The mean (SD) of the physical and mental health SF-36 scores at hospital discharge, 3 and 12 months were 27.32 (19.59), 40.97 (26.34) and 50.78 (28.26) (p < 0.0001) and 42.93 (17.00), 55.19 (23.04) and 62.24 (23.66), (p < 0.0001), respectively. The forced expiratory volume in one second and 6MWT significantly improved over 12 months. Patients who were supported by two or more family members or patients who were visited by their friends >3 times/week presented better scores in the physical and mental SF36 domains at 12 months. CONCLUSION This study shows that the quality of life of Greek patients who were discharged from the ICU can be positively affected both by the support they receive from their family environment and friends.
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Affiliation(s)
- Konstantina Avgeri
- Department of Medical School, University of Thessaly, 41110 Larissa, Greece
| | | | - Vasiliki Tsolaki
- Department of Medical School, University of Thessaly, 41110 Larissa, Greece
| | - Markos Sgantzos
- Department of Medical School, University of Thessaly, 41110 Larissa, Greece
| | | | - Demosthenes Makris
- Department of Medical School, University of Thessaly, 41110 Larissa, Greece
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Onrust M, Visser A, van Veenendaal N, Dieperink W, Luttik ML, Derksen MHG, van der Voort PHJ, van der Meulen IC. Physical, social, mental and spiritual functioning of COVID-19 intensive care unit-survivors and their family members one year after intensive care unit-discharge: A prospective cohort study. Intensive Crit Care Nurs 2023; 75:103366. [PMID: 36528460 PMCID: PMC9726690 DOI: 10.1016/j.iccn.2022.103366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/14/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the long-term functioning of patients who survived a COVID-19-related admission to the intensive care unit and their family members, in the physical, social, mental and spiritual domain. DESIGN A single-centre, prospective cohort study with a mixed-methods design. SETTING The intensive care unit of the University Medical Center Groningen in the Netherlands. MAIN OUTCOME MEASURES To study functioning 12 months after intensive care discharge several measurements were used, including a standardised list of physical problems, the Clinical Frailty Scale, the Medical Outcomes Study Short-Form General Health Survey, the McMaster Family Assessment Device, the Hospital Anxiety and Depression Scale, and the Spiritual Needs Questionnaire, as well as open questions and interviews with survivors and their family members. RESULTS A total of 56 survivors (77%) returned the 12-month questionnaire, whose median age was 62 (inter-quartile range [IQR]: 55.0-68.0). Moreover, 67 family members (66%) returned the 12-month questionnaire, whose median age was 58 (IQR: 43-66). At least one physical problem was reported by 93% of the survivors, with 22% reporting changes in their work-status. Both survivors (84%) and their family members (85%) reported at least one spiritual need. The need to feel connected with family was the strongest. The main theme was 'returning to normal' in the interviews with survivors and 'if the patient is well, I am well' in the interviews with family members. CONCLUSIONS One year after discharge, both COVID-19 intensive care survivors and their family members positively evaluate their health-status. Survivors experience physical impairments, and their family members' well-being is strongly impacted by the health of the survivor.
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Affiliation(s)
- Marisa Onrust
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands.
| | - Anja Visser
- University of Groningen, Faculty of Theology and Religious Studies, Department of Comparative Study of Religion, the Netherlands.
| | - Nadine van Veenendaal
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, the Netherlands.
| | - Willem Dieperink
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, the Netherlands.
| | - Marie Louise Luttik
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, the Netherlands.
| | | | - Peter H J van der Voort
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands.
| | - Ingeborg C van der Meulen
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, the Netherlands.
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17
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Ramnarain D, Pouwels S, Fernández-Gonzalo S, Navarra-Ventura G, Balanzá-Martínez V. Delirium-related psychiatric and neurocognitive impairment and the association with post-intensive care syndrome-A narrative review. Acta Psychiatr Scand 2023; 147:460-474. [PMID: 36744298 DOI: 10.1111/acps.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Delirium is common among patients admitted to the intensive care unit (ICU) and its impact on the neurocognitive and psychiatric state of survivors is of great interest. These new-onset or worsening conditions, together with physical alterations, are called post-intensive care syndrome (PICS). Our aim is to update on the latest screening and follow-up options for psychological and cognitive sequelae of PICS. METHOD This narrative review discusses the occurrence of delirium in ICU settings and the relatively new concept of PICS. Psychiatric and neurocognitive morbidities that may occur in survivors of critical illness following delirium are addressed. Future perspectives for practice and research are discussed. RESULTS There is no "gold standard" for diagnosing delirium in the ICU, but two extensively validated tools, the confusion assessment method for the ICU and the intensive care delirium screening checklist, are often used. PICS complaints are frequent in ICU survivors who have suffered delirium and have been recognized as an important public health and socio-economic problem worldwide. Depression, anxiety, post-traumatic stress disorder, and long-term cognitive impairment are recurrently exhibited. Screening tools for these deficits are discussed, as well as the suggestion of early assessment after discharge and at 3 and 12 months. CONCLUSIONS Delirium is a complex but common phenomenon in the ICU and a risk factor for PICS. Its diagnosis is challenging with potential long-term adverse outcomes, including psychiatric and cognitive difficulties. The implementation of screening and follow-up protocols for PICS sequelae is warranted to ensure early detection and appropriate management.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburgh Medical Center, Hardenberg, The Netherlands.,Departmentof Medical and Clinical Psychology, Center of Research on Psychological and Somatic disease (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of General, Abdominal and Minimally Invasive Surgery, Helios Klinikum, Krefeld, Germany
| | - Sol Fernández-Gonzalo
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Guillem Navarra-Ventura
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Vicent Balanzá-Martínez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, Valencia, Spain
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18
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Gregory AJ, Noss CD, Chun R, Gysel M, Prusinkiewicz C, Webb N, Raymond M, Cogan J, Rousseau-Saine N, Lam W, van Rensburg G, Alli A, de Vasconcelos Papa F. Perioperative Optimization of the Cardiac Surgical Patient. Can J Cardiol 2023; 39:497-514. [PMID: 36746372 DOI: 10.1016/j.cjca.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 02/06/2023] Open
Abstract
Perioperative optimization of cardiac surgical patients is imperative to reduce complications, utilize health care resources efficiently, and improve patient recovery and quality of life. Standardized application of evidence-based best practices can lead to better outcomes. Although many practices should be applied universally to all patients, there are also opportunities along the surgical journey to identify patients who will benefit from additional interventions that will further ameliorate their recovery. Enhanced recovery programs aim to bundle several process elements in a standardized fashion to optimize outcomes after cardiac surgery. A foundational concept of enhanced recovery is attaining a better postsurgical end point for patients, in less time, through achievement and maintenance in their greatest possible physiologic, functional, and psychological state. Perioperative optimization is a broad topic, spanning multiple phases of care and involving a variety of medical specialties and nonphysician health care providers. In this review we highlight a variety of perioperative care topics, in which a comprehensive approach to patient care can lead to improved results for patients, providers, and the health care system. A particular focus on patient-centred care is included. Although existing evidence supports all of the elements reviewed, most require further improvements in implementation, as well as additional research, before their full potential and usefulness can be determined.
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Affiliation(s)
- Alexander J Gregory
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Christopher D Noss
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Rosaleen Chun
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Michael Gysel
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Prusinkiewicz
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Webb
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Meggie Raymond
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | | | - Wing Lam
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Gerry van Rensburg
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Ahmad Alli
- Department of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Best A, Harvey C, Minton C. Experiences of families of prolonged critical illness survivors that are discharged home: An integrative review of the literature. Nurs Crit Care 2023. [DOI: 10.1111/nicc.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Amy Best
- School of Nursing Massey University Wellington New Zealand
- Intensive Care Unit Wellington Regional Hospital Wellington New Zealand
| | - Clare Harvey
- School of Nursing Massey University Wellington New Zealand
| | - Claire Minton
- School of Nursing Massey University Palmerston North New Zealand
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20
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Cuzco C, Castro P, Marín Pérez R, Ruiz García S, Núñez Delgado AI, Romero García M, Martínez Momblan MA, Benito Aracil L, Carmona Delgado I, Canalias Reverter M, Nicolás JM, Martínez Estalella G, Delgado-Hito P. Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial. Crit Care Med 2022; 50:1757-1767. [PMID: 36178294 DOI: 10.1097/ccm.0000000000005676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN A prospective, multicenter, randomized clinical trial. SETTING Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge. INTERVENTION The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. MEASUREMENTS AND RESULTS Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. CONCLUSIONS We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials. TRIAL REGISTRATION NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).
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Affiliation(s)
- Cecilia Cuzco
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Pedro Castro
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Raquel Marín Pérez
- Department of Cardiologic. Hospital Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Samuel Ruiz García
- Department of Cardiologic. Hospital Bellvitge. L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana I Núñez Delgado
- Department of lntensive Care Unit, Hospital Valle d'Hebron, Barcelona, Spain
| | - Marta Romero García
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Antonia Martínez Momblan
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Llucia Benito Aracil
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - José M Nicolás
- Medical lntensive Care Unit, Hospital Clinic of Barcelona, Barcelona, Spain
- Department of Biomedical Research Institute August Pi Sunyer (IDIBAPS), Hospital Clínic of Barcelona, Barcelona, Spain
- Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
| | - Gemma Martínez Estalella
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Nursing Head, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Pilar Delgado-Hito
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences University of Barcelona, Barcelona, Spain
- Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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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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Psychological Attachment Orientation and Long-Term Posttraumatic Stress Symptoms Among Family Members of ICU Patients. Crit Care Explor 2022; 4:e0753. [PMID: 36050994 PMCID: PMC9426807 DOI: 10.1097/cce.0000000000000753] [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] [Indexed: 11/26/2022] Open
Abstract
To determine the degree to which an ICU patient’s family member having an “anxious” psychologic attachment orientation is a risk factor for developing long-term posttraumatic stress disorder (PTSD) symptoms following patient ICU discharge or death.
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The lived experience by patients and family members of extracorporeal membrane oxygenation: A qualitative study. Intensive Crit Care Nurs 2022; 73:103307. [PMID: 35933249 DOI: 10.1016/j.iccn.2022.103307] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/17/2022] [Accepted: 07/25/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the lived experience of extracorporeal membrane oxygenation (ECMO) by patients and their families, and their relationship with intensive care clinicians. RESEARCH METHODOLOGY Semi-structured interviews were conducted with six patients who had received ECMO and with four of their family members. The data were analysed narratively using a constant comparative method. SETTING Patients were treated at a major acute care hospital in British Columbia between 2014 and 2021. ECMO was used either as a bridge to recovery or to organ transplant. Four had family members bedside throughout, while two had virtual visits due to COVID-19 infection control measures. FINDINGS ECMO was experienced through a triad of relationships between the patient, key family members and key clinicians. The strength, directionality and focus of these relationships shifted during therapy and realigned once ECMO was removed. The largest shift involved family members. Post-ECMO, patients relied almost entirely on spouses, adult children and clinical team members to reconstruct their experience. The connection between families and clinical team members was limited and changed little. CONCLUSIONS The lived experience of ECMO was complex in ways yet to be comprehensively reported in the literature. This technology had particular impact on family members when ECMO was used as a bridge to transplant and where run times extended to multiple weeks. COVID-19 infection control restrictions further complicated how this technology was experienced. Findings from this study highlight the importance of intensive care nurses recognising the critical role family members play as witnesses whose experiences later allow patients to make sense of their journey post-discharge.
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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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ICU bereaved surrogates' comorbid psychological-distress states and their associations with prolonged grief disorder. Crit Care 2022; 26:102. [PMID: 35410374 PMCID: PMC8996508 DOI: 10.1186/s13054-022-03981-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background/objective Bereaved ICU family surrogates’ psychological distress, e.g., anxiety, depression, and post-traumatic stress disorder (PTSD), is usually examined independently, despite the well-recognized comorbidity of these symptoms. Furthermore, the few studies exploring impact of psychological distress on development of prolonged grief disorder (PGD) did not consider the dynamic impact of symptom evolution. We identified surrogates’ distinct patterns/states of comorbid psychological distress and their evolution over the first 3 months of bereavement and evaluated their associations with PGD at 6-month postloss. Methods A longitudinal observational study was conducted on 319 bereaved surrogates. Symptoms of anxiety, depression, PTSD, and PGD were measured by the anxiety and depression subscales of the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised scale, and the PGD-13, respectively. Distinct psychological-distress states and their evolution were examined by latent transition analysis. Association between psychological-distress states and PGD symptoms was examined by logistic regression.
Results Three distinct comorbid psychological-distress states (prevalence) were initially identified: no distress (56.3%), severe-depressive/borderline-anxiety distress (30.5%), and severe-anxiety/depressive/PTSD distress (13.3%). Except for those in the stable no-distress state, surrogates tended to regress to states of less psychological distress at the subsequent assessment. The proportion of participants in each psychological-distress state changed to no distress (76.8%), severe-depressive/borderline-anxiety distress (18.6%), and severe-anxiety/depressive/PTSD distress (4.6%) at 3-month postloss. Surrogates in the severe-depressive/borderline-anxiety distress and severe-anxiety/depressive/PTSD-distress state at 3-month postloss were more likely to develop PGD at 6-month postloss (OR [95%] = 14.58 [1.48, 143.54] and 104.50 [10.45, 1044.66], respectively).
Conclusions A minority of family surrogates of ICU decedents suffered comorbid severe-depressive/borderline-anxiety distress and severe-anxiety/depressive/PTSD symptoms during early bereavement, but they were more likely to progress into PGD at 6-month postloss.
Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03981-7.
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Badke CM, Krogh-Jespersen S, Flynn RM, Shukla A, Essner BS, Malakooti MR. Virtual Reality in the Pediatric Intensive Care Unit: Patient Emotional and Physiologic Responses. Front Digit Health 2022; 4:867961. [PMID: 35419557 PMCID: PMC8995472 DOI: 10.3389/fdgth.2022.867961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Context Patients in the Pediatric Intensive Care Unit (PICU) are limited in their ability to engage in developmentally typical activity. Long-term hospitalization, especially with minimal interpersonal engagement, is associated with risk for delirium and delayed recovery. Virtual reality (VR) has growing evidence as a safe, efficacious, and acceptable intervention for pain and distress management in the context of uncomfortable healthcare procedures, and for enhancing engagement in, and improving outcomes of rehabilitation therapy. Hypothesis Critically ill children may experience high levels of engagement and physiologic effects while engaging with VR. Methods and Models This cross-sectional study of 3–17-year-old children admitted to a PICU used a VR headset to deliver 360-degree immersive experiences. This study had a mixed-method approach, including standardized behavioral coding, participant and parent surveys, and participant physiologic responses. Investigators noted comments the child made about VR, observed emotional responses, and documented an engagement score. To determine physiologic response to VR, integer heart rate variability (HRVi) was collected 30 min before, during, and 30 min after VR. Results One hundred fifteen participants were enrolled from 6/18 to 10/19, and they interacted with VR for a median of 10 min (interquartile range 7–17). Most children enjoyed the experience; 83% of participants smiled and 36% laughed while using VR. Seventy-two percent made positive comments while using VR. The strongest age-related pattern regarding comments was that the youngest children were more likely to share the experience with others. Seventy-nine percent of participants were highly engaged with VR. Ninety-two percent of parents reported that VR calmed their child, and 78% of participants felt that VR was calming. HRVi Minimum scores were significantly higher during VR than pre- (p < 0.001) or post-VR (p < 0.001). There was no significant difference between pre-and post-VR (p = 0.387); therefore, children returned to their pre-intervention state following VR. Interpretations and Conclusions Children admitted to the PICU are highly engaged with and consistently enjoyed using VR. Both participants and parents found VR to be calming, consistent with intra-intervention physiologic improvements in HRVi. VR is an immersive tool that can augment the hospital environment for children.
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Affiliation(s)
- Colleen M. Badke
- Division of Critical Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Pediatric Intensive Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- IGNITE Innovation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- *Correspondence: Colleen M. Badke
| | - Sheila Krogh-Jespersen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Rachel M. Flynn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Avani Shukla
- Pediatric Intensive Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Bonnie S. Essner
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Marcelo R. Malakooti
- Division of Critical Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Pediatric Intensive Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- IGNITE Innovation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
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Onrust M, Lansink-Hartgring AO, van der Meulen I, Luttik ML, de Jong J, Dieperink W. Coping strategies, anxiety and depressive symptoms in family members of patients treated with extracorporeal membrane oxygenation: A prospective cohort study. Heart Lung 2022; 52:146-151. [DOI: 10.1016/j.hrtlng.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
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Gibney RN, Blackman C, Gauthier M, Fan E, Fowler R, Johnston C, Jeremy Katulka R, Marcushamer S, Menon K, Miller T, Paunovic B, Tanguay T. COVID-19 pandemic: the impact on Canada’s intensive care units. Facets (Ott) 2022. [DOI: 10.1139/facets-2022-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity. The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces. Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions. This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.
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Affiliation(s)
- R.T. Noel Gibney
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Cynthia Blackman
- Dr. Cynthia Blackman and Associates, Edmonton, AB M5R 3R8, Canada
| | - Melanie Gauthier
- Faculty of Nursing, McGill University, Montréal, QC Canada
- President, Canadian Association of Critical Care Nurses, Quebec, QC, Canada
| | - Eddy Fan
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert Fowler
- Interdisciplinary Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
- Department of Medicine, Sunnybrook Hospital, Toronto, ON M5S 1A1, Canada
| | - Curtis Johnston
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - R. Jeremy Katulka
- Department of Medicine, Royal University Hospital, Saskatoon, SK S7N 0W8, Canada
| | - Samuel Marcushamer
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
| | - Kusum Menon
- Paediatric Intensive Care Unit, Children’s Hospital of Eastern Ontario, Ottawa, ON K1N 6N5, Canada
- Paediatric Intensive Care Unit, Department of Pediatrics, University of Ottawa, Ottawa, ON T6G 2R3, Canada
| | - Tracey Miller
- Intensive Care Unit, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
| | - Bojan Paunovic
- Department of Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- President, Canadian Critical Care Society, Winnipeg, MB R3T 2N2, Canada
| | - Teddie Tanguay
- Intensive Care Unit, Royal Alexandra Hospital, Edmonton, AB T6G 2R3, Canada
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Diamond PR, Airdrie JN, Hiller R, Fraser A, Hiscox LV, Hamilton-Giachritsis C, Halligan SL. Change in prevalence of post-traumatic stress disorder in the two years following trauma: a meta-analytic study. Eur J Psychotraumatol 2022; 13:2066456. [PMID: 35646293 PMCID: PMC9132436 DOI: 10.1080/20008198.2022.2066456] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Understanding the course of post-traumatic stress disorder (PTSD) and the factors that impact this is essential to inform decisions about when and for whom screening and intervention are likely to be beneficial. OBJECTIVE To provide meta-analytic evidence of the course of recovery from PTSD in the first year following trauma, and the factors that influence that recovery. METHOD We conducted a meta-analysis of observational studies of adult PTSD prevalence which included at least two assessments within the first 12 months following trauma exposure, examining prevalence statistics through to 2 years post-trauma. We examined trauma intentionality (intentional or non-intentional), PTSD assessment method (clinician or self-report), sample sex distribution, and age as moderators of PTSD prevalence over time. RESULTS We identified 78 eligible studies including 16,484 participants. Pooled prevalence statistics indicated that over a quarter of individuals presented with PTSD at 1 month post-trauma, with this proportion reducing by a third between 1 and 3 months. Beyond 3 months, any prevalence changes were detected over longer intervals and were small in magnitude. Intentional trauma, younger age, and female sex were associated with higher PTSD prevalence at 1 month. In addition, higher proportions of females, intentional trauma exposure, and higher baseline PTSD prevalence were each associated with larger reductions in prevalence over time. CONCLUSIONS Recovery from PTSD following acute trauma exposure primarily occurs in the first 3 months post-trauma. Screening measures and intervention approaches offered at 3 months may better target persistent symptoms than those conducted prior to this point. HIGHLIGHTS PTSD rates in the immediate aftermath of trauma exposure decline from 27% at 1 month to 18% at 3 months post-trauma, showing significant spontaneous recovery.Problems appear to stabilize after 3 months.Screening/intervention for PTSD at 3 months post-trauma is indicated.
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Affiliation(s)
- P R Diamond
- Department of Psychology, University of Bath, Bath, UK
| | - J N Airdrie
- Department of Psychology, University of Bath, Bath, UK
| | - R Hiller
- Department of Psychology, University of Bath, Bath, UK
| | - A Fraser
- Bristol Population Health Science Institute, Bristol Medical School, University of Bristol, Bristol, UK
| | - L V Hiscox
- Department of Psychology, University of Bath, Bath, UK
| | | | - S L Halligan
- Department of Psychology, University of Bath, Bath, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Kiwanuka F, Sak-Dankosky N, Alemayehu YH, Nanyonga RC, Kvist T. The evidence base of nurse-led family interventions for improving family outcomes in adult critical care settings: A mixed method systematic review. Int J Nurs Stud 2022; 125:104100. [PMID: 34736074 PMCID: PMC8560087 DOI: 10.1016/j.ijnurstu.2021.104100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 09/05/2021] [Accepted: 09/25/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated the consequences of a patient's admission to critical care settings, causing families to face more psychosocial issues than in previous years. Thus, nurses and other clinicians need to keep abreast of interventions that support the families of critical care patients. OBJECTIVE To provide evidence of nurse-led family interventions and their family outcomes in adult critical care settings. DESIGN A mixed method systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. DATA SOURCES The search included both a screen of relevant databases (PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and the Cochrane Library) and the screening of citations in relevant articles. Studies published in the English language between January 2010 and October 2020 were considered. The final database searches were performed on 20 October 2020. METHODS Screening and eligibility assessment were conducted using the Rayyan software. Studies describing the family outcomes of nurse-led interventions in adult critical care settings through either qualitative or quantitative methods were included, i.e., the mixed method synthesis permitted the inclusion of either qualitative or quantitative findings. Article quality was evaluated by three authors using the Joanna Briggs Institute's critical appraisal tools. FINDINGS A total of 15 studies - two trials, eight quasi-experimental studies, four qualitative, and one mixed method met the inclusion criteria. The described interventions were organized into five categories: educational/informational; family involvement in care; diary; communication; and bundled interventions. These categories varied in terms of elements, delivery, and family outcomes. Nurse-led interventions that resulted in small to medium improvements in family outcomes included educational interventions with digital storytelling, a bundled approach, informational nursing interventions, and nurse-driven emotional support. The included studies (n = 2) that investigated family rounds in the ICU reported that this approach did not noticeably influence family outcomes. CONCLUSION The differences in the intervention elements, tools, and outcomes evaluated in this review reflect the diversity of family needs, and that numerous interventions have already been developed to promote family health in critical care settings. The evidence suggests that interdisciplinary nurse-led family interventions can improve family outcomes. Tweetable abstract: Interprofessional nurse-led family interventions draw on diverse approaches and improve family outcomes in adult critical care settings.
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Affiliation(s)
- Frank Kiwanuka
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio 70211, Finland.
| | | | - Yisak Hagos Alemayehu
- Department of Nursing, Adigrat University of Medical and Health Sciences, Adigrat, Ethiopia
| | | | - Tarja Kvist
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Kuopio 70211, Finland
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Henao Castaño ÁM, Villamil Buitrago AV, Marín Ramírez S, Cogollo Hernandez CA. Características del síndrome post cuidado intensivo: revisión de alcance. INVESTIGACIÓN EN ENFERMERÍA: IMAGEN Y DESARROLLO 2021. [DOI: 10.11144/javeriana.ie23.csci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objetivo: identificar la evidencia disponible de las características del síndrome post unidad de cuidado intensivo en el paciente que egresa de la unidad de cuidado intensivo. Método: revisión de alcance con la metodología del Joanna Briggs Institut, en cinco bases de datos con la estrategia de búsqueda ([PostIntensive AND Care AND Syndrome] [Nursing AND Care AND PICS]). Se incluyeron estudios primarios publicados entre los años 2010 y 2020, disponibles en texto completo. Resultados: después del análisis de los 48 estudios primarios se extrajeron seis categorías temáticas así: aspecto cognitivo en el síndrome post UCI, osteomusculares, psicoemocionales, estrategias de prevención con modelos de sobrevivientes de UCI, síndrome post unidad cuidado intensivo en la familia y herramientas de evaluación. Conclusiones: mejorar la calidad de atención de los pacientes que presentan este síndrome, prevenir la aparición y aumentar la calidad de vida prestada a los sobrevivientes de UCI y sus familias. La evidencia reporta que entre los cuidadores se pueden desencadenar distintos trastornos que disminuyen su calidad de vida. La enfermería juega un papel crucial en la prevención de la aparición del síndrome mediante estrategias en la UCI e interdisciplinares; los planes de egreso y seguimiento a los pacientes pueden lograr que estos se rehabiliten más rápido y eviten discapacidades o secuelas a largo plazo.
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Petrinec A, Wilk C, Hughes JW, Zullo MD, Chen YJ, Palmieri PA. Delivering Cognitive Behavioral Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App. Am J Crit Care 2021; 30:451-458. [PMID: 34719716 DOI: 10.4037/ajcc2021962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Family members of intensive care unit (ICU) patients are at risk for post-intensive care syndrome- family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. OBJECTIVES To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. METHODS This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. RESULTS The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. CONCLUSIONS The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.
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Affiliation(s)
- Amy Petrinec
- Amy Petrinec is an assistant professor, College of Nursing, Kent State University, Kent, Ohio
| | - Cindy Wilk
- Cindy Wilk is a senior lecturer, College of Nursing, Kent State University, Kent, Ohio
| | - Joel W. Hughes
- Joel W. Hughes is a professor, Department of Psychological Sciences, Kent State University
| | - Melissa D. Zullo
- Melissa D. Zullo is an associate professor, College of Public Health, Kent State University
| | - Yea-Jyh Chen
- Yea-Jyh Chen is an assistant professor, College of Health and Human Services, University of North Carolina Wilmington
| | - Patrick A. Palmieri
- Patrick A. Palmieri is a clinical psychologist, Summa Health System, Akron, Ohio
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Miyamoto Y, Ohbe H, Goto T, Yasunaga H. Association between intensive care unit admission of a patient and mental disorders in the spouse: a retrospective matched-pair cohort study. J Intensive Care 2021; 9:69. [PMID: 34715945 PMCID: PMC8555253 DOI: 10.1186/s40560-021-00583-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background Previous prospective studies have suggested that spouses of patients who are admitted to the intensive care unit (ICU) have a high prevalence of mental disorders, termed post-intensive care syndrome-family (PICS-F). However, it remains unclear whether the patient’s ICU admission is associated with the occurrence of mental disorders in the spouse outside of the prospective study setting. We therefore investigated the proportion of ICU patients’ spouses who visited medical facilities for mental disorders and the association between ICU admission of a patient and mental disorders in the spouse using real-world data. Methods This was a retrospective matched-pair cohort study using commercially available, routinely collected administrative claims data. As the study population, we identified all married couples (both wife and husband) who were registered in the database from 1 April 2012 to 31 August 2018 using family identification codes. We identified spouses of patients who were admitted to the ICU for more than 2 days as the exposure group and defined the date of admission to the ICU as the index date. We randomly matched four individuals in the non-exposure group with one individual in the exposure group. The primary outcome was any PICS-F–related mental disorder in the spouses within 6 months from the index date. As a sensitivity analysis, we also investigated the proportion and association of individuals (excluding spouses) with a history of mental disorders. Results Among 1,082,208 married couples, we identified 8490 spouses of ICU patients, and they were matched with 33,946 individuals. The proportion of any PICS-F–related mental disorder within 6 months from the index date was 12.8% in ICU patients’ spouses and 11.3% in the matched individuals (adjusted odds ratio, 1.29; 95% confidence interval, 1.03–1.42). The sensitivity analysis showed significant associations between ICU admission and spouses’ mental disorders. Conclusions Spouses of patients who were admitted to the ICU had a slightly higher risk of mental disorders within 6 months than spouses of patients who were not admitted to the ICU. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-021-00583-3.
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Affiliation(s)
- Yuki Miyamoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan. .,Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 6028566, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.,TXP Medical Co. Ltd., 7-3-1-252 Hongo, Bunkyo-ku, Tokyo, 1138454, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
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Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Petrinec AB, Hughes JW, Zullo MD, Wilk C, George RL. Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study. JMIR Res Protoc 2021; 10:e30813. [PMID: 34346900 PMCID: PMC8374657 DOI: 10.2196/30813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy. OBJECTIVE The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients. METHODS For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura's social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study. RESULTS Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022. CONCLUSIONS The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30813.
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Affiliation(s)
- Amy B Petrinec
- College of Nursing, Kent State University, Kent, OH, United States
| | - Joel W Hughes
- Department of Psychological Sciences, College of Arts and Sciences, Kent State University, Kent, OH, United States
| | - Melissa D Zullo
- College of Public Health, Kent State University, Kent, OH, United States
| | - Cindy Wilk
- College of Nursing, Kent State University, Kent, OH, United States
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Abdul Halain A, Tang LY, Chong MC, Ibrahim NA, Abdullah KL. Psychological distress among the family members of Intensive Care Unit (ICU) patients: A scoping review. J Clin Nurs 2021; 31:497-507. [PMID: 34254377 DOI: 10.1111/jocn.15962] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To map research-based psychological distress among the family members with patients in the intensive care unit (ICU). BACKGROUND Having a loved one in the ICU is a stressful experience, which may cause psychological distress for family members. Depression, anxiety and stress are the common forms of psychological distress associated with ICU patient's family members. Directly or indirectly, psychological distress may have behavioural or physiological impacts on the family members and ICU patient's recovery. DESIGN The study was based on the five-stage methodological framework by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19) and were guided by the PRISMA-ScR Checklist. METHODS A comprehensive and systematic search was performed in five electronic databases, namely the Scopus, Web of Sciences, CINAHL® Complete @EBSCOhost, ScienceDirect and MEDLINE. Reference lists from the screened full-text articles were reviewed. RESULTS From a total of 1252 literature screened, 22 studies published between 2010-2019 were included in the review. From those articles, four key themes were identified: (a) Prevalence of psychological distress; (b) Factors affecting family members; (c) Symptoms of psychological distress; and (d) Impact of psychological distress. CONCLUSIONS Family members with a critically ill patient in ICU show high levels of anxiety, depression and stress. They had moderate to major symptoms of psychological distress that negatively impacted both the patient and family members. RELEVANCE TO CLINICAL PRACTICE The review contributed further insights on psychological distress among ICU patient's family members and proposed psychological interventions that could positively impact the family well-being and improve the patients' recovery.
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Affiliation(s)
- Azura Abdul Halain
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.,Department of Nursing, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Noor Airini Ibrahim
- Department of Anaesthesiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Khatijah Lim Abdullah
- Department of Nursing School of Medical and Life Science, Sunway University, Selangor, Malaysia
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Psychological Symptoms in Relatives of Critically Ill Patients: A Longitudinal Cohort Study. Crit Care Explor 2021; 3:e0470. [PMID: 34235457 PMCID: PMC8238357 DOI: 10.1097/cce.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To explore the psychologic impact of an ICU stay on relatives and to determine patient and relative factors, including their pre-ICU mental health status, associated with psychologic symptoms 3 months after ICU admission. DESIGN A prospective, exploratory, longitudinal cohort study. SETTING A 12-bed ICU in a Dutch tertiary teaching hospital. PATIENTS The relatives of ICU patients admitted between March 2018 and December 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Relatives completed the Hospital Anxiety and Depression Scale shortly after patients' ICU admission referring to the week before ICU admission and 3 months later, together with the Impact of Event Scale-Revised, assessing posttraumatic stress. A total of 387 were eligible of which 78 (20%) responded. Almost a quarter reported an increase of anxiety (23.1%) and depression (24.4%) between baseline and 3 months follow-up. One in six (17.9%) reported posttraumatic stress. Anxiety, depression, and posttraumatic stress at 3 months follow-up were significantly associated with preexisting anxiety and depression. Patients' factor associated with depression 3 months follow-up in relatives was length of ICU stay (odds ratio, 1.09; 95% CI, 1.02-1.16). CONCLUSIONS Relatives with preexisting psychologic symptoms before ICU admission are at risk to develop anxiety, depression, or posttraumatic stress shortly after ICU discharge of the patient. Screening and identification in an early stage enables early interventions to prevent relatives from worsening mental health during and after ICU admission.
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Chang PY, Chang TH, Yu JM. Perceived stress and social support needs among primary family caregivers of ICU Patients in Taiwan. Heart Lung 2021; 50:491-498. [PMID: 33831701 DOI: 10.1016/j.hrtlng.2021.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Family caregivers of intensive care unit (ICU) patients may experience distress due to their care recipients' unexpected ICU hospitalization. Social support in coping with stress has been discussed from different cultural perspectives, but social support does not seem to buffer stress for Chinese people. OBJECTIVES The purpose of this study was to explore stress perception and social support needs and their associations among Taiwanese primary family caregivers of patients admitted to the ICU for the first time. METHODS This descriptive correlational study used the Perceived Stress Scale (PSS), the Impact of Events Scale-Revised (IES-R), the Norbeck Social Support Questionnaire (NSSQ), and structured interviews to explore stress perception and social support needs among Taiwanese primary family caregivers of patients admitted to the ICU. RESULTS The Taiwanese primary family caregivers (N = 71) perceived considerable social support, but they still experienced high stress, either daily life stress or ICU-related event stress. Most of them required extra support, such as discussion of medical conditions, disease treatment information and psychological support, even though they had social resources to assist them. CONCLUSION ICU health professionals should actively inquire about family caregivers' actual needs, even when family caregivers perceive considerable social support. Tailor-made interventions should be provided to assist family members in coping with stress. Further research should also explore the role of social support in stress and coping processes in Asian contexts due to cultural variance.
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Affiliation(s)
- Pei-Yu Chang
- Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | | | - Jung-Min Yu
- Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
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Peach BC, Valenti M, Sole ML. A Call for the World Health Organization to Create International Classification of Disease Diagnostic Codes for Post-Intensive Care Syndrome in the Age of COVID-19. WORLD MEDICAL & HEALTH POLICY 2021; 13:373-382. [PMID: 33821196 PMCID: PMC8013409 DOI: 10.1002/wmh3.401] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023]
Abstract
Post‐intensive care syndrome (PICS), a condition found in survivors of critical illness, is characterized by persistent physical, cognitive, and psychological sequelae that impact the quality of life after discharge from an intensive care unit (ICU). At present, there are no International Classification of Disease (ICD) billing codes for this condition. Without financial alignment, clinicians cannot diagnose PICS, hindering tracking of its prevalence and impeding policy development for this condition. Clinicians should be screening for PICS in all survivors of critical illness, particularly those with acute respiratory distress syndrome (ARDS). Results from single‐center studies suggest over 75 percent of ARDS survivors develop PICS. With nearly 5 percent of patients with COVID‐19 requiring ICU admission for ARDS, it is important for clinicians to be able to diagnose PICS in survivors, and researchers to be able to track it. Member states should impress upon the World Health Organization to create ICD‐10 codes for PICS.
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40
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Naef R, von Felten S, Ernst J. Factors influencing post-ICU psychological distress in family members of critically ill patients: a linear mixed-effects model. Biopsychosoc Med 2021; 15:4. [PMID: 33588895 PMCID: PMC7885222 DOI: 10.1186/s13030-021-00206-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adverse responses to critical illness, such as symptoms of depression, anxiety or posttraumatic stress, are relatively common among family members. The role of risk factors, however, remains insufficiently understood, but may be important to target those family members most in need for support. We therefore examined the association of patient-, family member- and care-related factors with post-ICU psychological distress in family members in a general population of critical ill patients. METHODS We conducted a prospective, single-centre observational study in a twelve-bed surgical ICU in a 900-bed University Hospital in Switzerland. Participants were family members of patients treated in ICU who completed the Family Satisfaction in ICU-24 Survey, the Hospital Anxiety Depression Scale, Impact of Event Scale-Revised-6, and a demographic form within the first 3 months after their close other's ICU stay. Data were analysed using linear mixed-effects models, with depression, anxiety, and posttraumatic stress as outcome measures. RESULTS A total of 214 family members (53% return rate) returned a completed questionnaire. We found that higher levels of satisfaction were significantly associated with lower levels of depression, anxiety and posttraumatic stress. There was no statistically significant association between family member characteristics and any measure of psychological distress. Among the included patient characteristics, younger patient age was associated with higher levels of depression, and patient death was associated with higher levels of depression and posttraumatic stress. CONCLUSIONS Our results suggest that satisfaction with ICU care is strongly associated with family well-being post-ICU. Family members of younger patients and of those who die seem to be most at risk for psychological distress, requiring specific support, whereas family member characteristics may have less relevance.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Stefanie von Felten
- Department of Biostatistics, Institute of Epidemiology, Biostatistics, and Prevention, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
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Yuan C, Timmins F, Thompson DR. Post-intensive care syndrome: A concept analysis. Int J Nurs Stud 2020; 114:103814. [PMID: 33220570 DOI: 10.1016/j.ijnurstu.2020.103814] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Post-intensive care syndrome is a term used to describe new or worsening multidimensional impairments in physical, psychological cognitive and social status arising from critical illness and persisting beyond hospital discharge. It is associated with high morbidity among patients discharged from intensive care units. However, due to its complexities, which encompass physical, psychological, cognitive and social impairments, the exact nature of this condition has not been fully conceptualized. The aim of this analysis therefore was to define the concept of post-intensive care syndrome. This conceptual clarity provides a general definition that is essential for practitioners and researchers to gain a comprehensive understanding of the syndrome and provide for accurate measurement of its incidence and prevalence. DESIGN The Walker and Avant approach to concept analysis guided this investigation. DATA SOURCE An electronic search of the literature using PubMed, CINHAL, PsycArticles, Academic search complete, Science Direct, MEDLINE and Health Source databases informed the analysis. The search included both quantitative and qualitative studies related to post-intensive care syndrome published in English between 2010 and 2020. RESULTS Of the 3948 articles identified, 24 ultimately met the inclusion criteria. Analysis identified the defining attributes of post-intensive care syndrome as: (1) new or worsening multidimensional impairments; (2) physical dysfunction; (3) psychological disorder; (4) cognitive impairment; (5) failed social reconstruction; and (6) persistent impaired multidimensional symptoms extending beyond intensive care and hospital discharge. Antecedents were divided into two categories: pre-existing and those related to the intensive care admission. Consequences were identified as both positive (for example the establishment of coping processes) and adverse (for example decreased quality of life and caregiver burden). CONCLUSION Post-intensive care syndrome affects more than half of patients discharged from intensive care units. This operational definition and conceptual understanding of this syndrome will help improve understanding and inform the design of preventative strategies to improve long-term consequences of the syndrome. Future research and standardized instrument development will serve to better understand the scope and characteristics of this syndrome and inform the development of possible preventative interventions.
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Affiliation(s)
- Chu Yuan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Abstract
PURPOSE OF REVIEW In this review, we will discuss efforts and challenges in understanding and developing meaningful outcomes of critical care research, quality improvement and policy, which are patient-centered and goal concordant, rather than mortality alone. We shall discuss different aspects of what could constitute outcomes of critical illness as meaningful to the patients and other stakeholders, including families and providers. RECENT FINDINGS Different outcome pathways after critical illness impact the patients, families and providers in multiple ways. For patients who die, it is important to consider the experience of dying. For the increasing number of survivors of critical illness, challenges of survival have surfaced. The physical, mental and social debility that survivors experience has evolved into the entity called post-ICU syndrome. The importance of prehospital health state trajectory and the need for the outcome of critical care to be aligned with the patients' goals and preferences have been increasingly recognized. SUMMARY A theoretical framework is outlined to help understand the impact of critical care interventions on outcomes that are meaningful to patients, families and healthcare providers.
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González-Martín S, Becerro-de-Bengoa-Vallejo R, Angulo-Carrere MT, Iglesias MEL, Martínez-Jiménez EM, Casado-Hernández I, López-López D, Calvo-Lobo C, Rodríguez-Sanz D. Effects of a visit prior to hospital admission on anxiety, depression and satisfaction of patients in an intensive care unit. Intensive Crit Care Nurs 2019; 54:46-53. [PMID: 31358482 DOI: 10.1016/j.iccn.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/11/2019] [Accepted: 07/02/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the effects of a vists prior to hospital admission on anxiety, depression and satisfaction of patients admitted electively to an intensive care unit (ICU). DESIGN A randomised clinical trial [NCT03605407]. SETTING A sample of 38 patients was recruited who were to be electively admiited to ICU divided into experimental (n = 19 patients receiving one visit prior to hospital ICU admission for surgery) and control (n = 19 patients not receiving a visit prior to hospital ICU admission for surgery) groups. MAIN OUTCOME MEASUREMENTS Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R) were self-reported by patients before ICU admission, at 3-days and 90-days after ICU discharge. Critical Care Family Needs Inventory (CCFNI) and Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) were used to measure the users' satisfaction before ICU admission and 3-days after ICU discharge. RESULTS There were statistically significant differences between experimental and control groups for FS-ICU, but not for HADS, IES-R and CCFNI. Indeed, control group patients were more satisfied with regard to emotional support, ease of getting information, control feeling, concerns and questions expression ability and overall score for decision-making satisfaction. CONCLUSIONS The visit prior to hospital admission did not seem to modify anxiety or depression, but may impair satisfaction of ICU patients.
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Affiliation(s)
- Sara González-Martín
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain
| | | | | | | | | | | | - Daniel López-López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain.
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Institute of Biomedicine (IBIOMED), Faculty of Health Sciences, University of León, Ponferrada, León, Spain.
| | - David Rodríguez-Sanz
- School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain
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Inoue S, Hatakeyama J, Kondo Y, Hifumi T, Sakuramoto H, Kawasaki T, Taito S, Nakamura K, Unoki T, Kawai Y, Kenmotsu Y, Saito M, Yamakawa K, Nishida O. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg 2019; 6:233-246. [PMID: 31304024 PMCID: PMC6603316 DOI: 10.1002/ams2.415] [Citation(s) in RCA: 246] [Impact Index Per Article: 49.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long-term prognoses. Post-intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long-term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS-p) and the mental status of their family (PICS-F). Intensive care unit-acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow-up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.
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Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine Yokohama City Minato Red Cross Hospital Yokohama Kanagawa Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Chiba Japan
| | - Toru Hifumi
- Emergency and Critical Care Medicine St. Luke's International Hospital Tokyo Japan
| | - Hideaki Sakuramoto
- Department of Adult Health Nursing College of Nursing Ibaraki Christian University Hitachi Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care Shizuoka Children's Hospital Shizuoka Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support Division of Rehabilitation Hiroshima University Hospital Hiroshima Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine Hitachi General Hospital Hitachi Ibaraki Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing School of Nursing Sapporo City University Sapporo Japan
| | - Yusuke Kawai
- Department of Nursing Fujita Health University Hospital Toyoake Aichi Japan
| | - Yuji Kenmotsu
- Department of Nursing Tokai University Hachioji Hospital Hachioji Tokyo Japan
| | - Masafumi Saito
- Department of Disaster and Emergency and Critical Care Medicine Kobe University Graduate School of Medicine Kobe Hyogo Japan
| | - Kazuma Yamakawa
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka City Osaka Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Aichi Japan
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Abstract
OBJECTIVES Patients in the PICU frequently have limitations that impede independent interactions with their environment. Virtual reality is an immersive experience that may improve outcomes in critically ill children. The objective of this study was to assess feasibility and satisfaction with virtual reality. DESIGN Cross-sectional, single-arm pilot study. SETTING PICU. PATIENTS Convenience sample of 3- to 17-year-old patients. INTERVENTIONS Three-hundred sixty degree immersions were delivered using a simple virtual reality headset and smartphone videos. Each participant was given a choice of developmentally appropriate virtual reality experiences. Following the short (< 15 min) virtual reality experience, participants, and parents completed a brief survey. MEASUREMENTS AND MAIN RESULTS One-hundred percent of participants enjoyed using virtual reality, and 84% reported preference to use virtual reality for a longer duration. One-hundred percent of parents agreed that their child enjoyed using virtual reality, and 100% enjoyed watching their child use virtual reality. Eighty-two percent of parents reported that virtual reality calmed their child. CONCLUSIONS Virtual reality is an innovative, easily administered, and enjoyable tool that subjectively calms PICU patients in an otherwise chaotic environment.
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Abstract
OBJECTIVES To determine the feasibility of implementing an ICU diary in the pediatric critical care setting and to understand the perceptions held by family members who receive the diaries after PICU discharge. DESIGN Observational pilot study. SETTING PICU in a tertiary academic hospital in the United States. PARTICIPANTS Critically ill pediatric patients admitted to the PICU and their families. INTERVENTIONS The addition of a PICU diary to a patient's routine care. MEASUREMENTS AND MAIN RESULTS Twenty families of critically ill children admitted to the PICU were enrolled in the PICU diary pilot study between May 2017 and March 2018. Patients who had an anticipated length of stay of at least 3 days and whose families were English-speaking were included. The median age of patients was 6 years, ranging from newborns to 18 years old, and the median length of stay was 11.5 days (interquartile range, 8.5-41 d). A total of 453 diary entries were written in 19 diaries over 433 PICU days, the majority of which were composed by bedsides nurses (63%). Follow-up surveys sent to parents 2 weeks after PICU discharge revealed that of the parents who had contributed to the diary, most enjoyed doing so (7/8). Nine of 12 parents had reviewed the diary at least once since discharge, and all parent respondents found the diary to be a beneficial aspect of their experience after PICU discharge. CONCLUSIONS The use of ICU diaries in the PICU setting is feasible and perceived as beneficial by families of critically ill children. Future studies are needed to better understand if PICU diaries may objectively improve psychologic outcomes of patients and family members after PICU admission.
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Short SR, Thienprayoon R. Pediatric palliative care in the intensive care unit and questions of quality: a review of the determinants and mechanisms of high-quality palliative care in the pediatric intensive care unit (PICU). Transl Pediatr 2018; 7:326-343. [PMID: 30460185 PMCID: PMC6212394 DOI: 10.21037/tp.2018.09.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This article reviews the state and practice of pediatric palliative care (PC) within the pediatric intensive care unit (PICU) with specific consideration of quality issues. This includes defining PC and end of life (EOL) care. We will also describe PC as it pertains to alleviating children's suffering through the provision of "concurrent care" in the ICU environment. Modes of care, and attendant strengths, of both the consultant and integrated models will be presented. We will review salient issues related to the provision of PC in the PICU, barriers to optimal practice, parental, and staff perceptions. Opportunity areas for quality improvement and the role of initiatives and measures such as education, family-based initiatives, staff needs, symptom recognition, grief, and communication follow. To conclude, we will look to the literature for PC resources for pediatric intensivists and future directions of study.
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Kotwal AA, Abdoler E, Diaz-Ramirez LG, Kelley AS, Ornstein KA, Boscardin WJ, Smith AK. 'Til Death Do Us Part: End-of-Life Experiences of Married Couples in a Nationally Representative Survey. J Am Geriatr Soc 2018; 66:2360-2366. [PMID: 30251423 DOI: 10.1111/jgs.15573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether end-of-life (EOL) experiences in the first spouse in a marriage are associated with EOL experiences in the other spouse. DESIGN Nationally representative, longitudinal survey. SETTING Health and Retirement Study, Waves 1992-2012 linked to Medicare claims PARTICIPANTS: Community-dwelling older adults who died (N=4,558), representing 2,279 married heterosexual couples. MEASUREMENTS We examined 3 EOL experiences: enrollment in hospice for >3 days before death, lack of advance care planning (ACP) before death, and intensive care unit (ICU) use during the last 30 days of life. We used multiple logistic regression to determine whether the EOL experience of the first spouse was a significant predictor of the EOL experience of the second spouse after adjusting for demographic characteristics, socioeconomic status, health status, and time between the first and second spouses' deaths. RESULTS First spouses who died were on average 80 years old, and 62% were male; second spouses were on average 85 years old, and 62% were female. After adjustment, second spouses were more likely to use hospice if the first spouse used hospice (odds ratio (OR)=1.68, 95% confidence interval (CI)=1.29-2.20). Second spouses were less likely to have ACP when the first spouse did not have ACP (OR=2.91, 95% CI=2.02-4.21). Hospice and ACP associations were stronger when deaths were closer in time to one another (p-value for interaction < .05). Second spouses were more likely to use ICU services if the first spouse did (OR=1.80, 95% CI=1.27-2.55). CONCLUSIONS The EOL experiences of older spouses are strongly associated, which may be relevant when framing ACP discussions. J Am Geriatr Soc 66:2360-2366, 2018.
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Affiliation(s)
- Ashwin A Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,Geriatrics, Palliative, and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Emily Abdoler
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - L Grisell Diaz-Ramirez
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - W John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,Geriatrics, Palliative, and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,Geriatrics, Palliative, and Extended Care, San Francisco Veterans Affairs Medical Center, San Francisco, California
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