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Gustafson OD, King EB, Schlussel MM, Arnold A, Wade C, Nicol PS, Rowland MJ, Dawes H, Williams MA. The impact of musculoskeletal ill health on quality of life and function after critical care: a multicentre prospective cohort study. Anaesthesia 2024; 79:821-828. [PMID: 38536762 DOI: 10.1111/anae.16285] [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] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 07/16/2024]
Abstract
Physical disability is a common component of post-intensive care syndrome, but the importance of musculoskeletal health in this population is currently unknown. We aimed to determine the musculoskeletal health state of intensive care unit survivors and assess its relationship with health-related quality of life; employment; and psychological and physical function. We conducted a multicentre prospective cohort study of adults admitted to intensive care for > 48 h without musculoskeletal trauma or neurological insult. Patients were followed up 6 months after admission where musculoskeletal health state was measured using the validated Musculoskeletal Health Questionnaire score. Of the 254 participants, 150 (59%) had a musculoskeletal problem and only 60 (24%) had received physiotherapy after discharge. Functional Comorbidity Index, Clinical Frailty Scale, duration of intensive care unit stay and prone positioning were all independently associated with worse musculoskeletal health. Musculoskeletal health state moderately correlated with quality of life, rs = 0.499 (95%CI 0.392-0.589); anxiety, rs = -0.433 (95%CI -0.538 to -0.315); and depression, rs = -0.537 (95%CI -0.631 to -0.434) (all p < 0.001). Patients with a musculoskeletal problem were less physically active than those without a problem (median (IQR [range]) number of 30 min physical activity sessions per week 1 (0-3.25 [0-7]) vs. 4 (1-7 [0-7]), p < 0.001, respectively). This study found that musculoskeletal health problems were common after intensive care unit stay. However, we observed that < 25% of patients received physical rehabilitation after discharge home. Our work has identified potential high-risk groups to target in future interventional studies.
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Affiliation(s)
- O D Gustafson
- Clinical Academic Physiotherapist, Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E B King
- Clinical Academic Physiotherapist, Oxford Allied Health Professions Research and Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M M Schlussel
- Senior Medical Statistician, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A Arnold
- Clinical Specialist Physiotherapist, Intensive Care Unit, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - C Wade
- Lead Physiotherapist, Intensive Care Unit, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
| | - P S Nicol
- Senior Physiotherapist, Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M J Rowland
- Honorary Professor, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - H Dawes
- Professor, College of Medicine and Health, University of Exeter, Exeter, UK
| | - M A Williams
- Reader, Oxford Institute of Applied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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Smaisim N, Rijsdijk M, van der Does Y, Slooter AJ. Pain and psychopathology after intensive care unit admission. Anaesth Intensive Care 2024; 52:232-240. [PMID: 38879797 DOI: 10.1177/0310057x241226716] [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] [Indexed: 07/31/2024]
Abstract
Pain and psychopathology are observed in 18% and 55% of patients, respectively, 1 year after intensive care unit (ICU) admission. It is well known that chronic pain and psychopathology have a bidirectional relation in the general population, but it is not known whether this holds true for ICU survivors. The aim of this study was to investigate whether pain before, during and after ICU admission is related to psychopathology in ICU survivors 1 year after discharge. We performed a cohort study in a mixed ICU in the Netherlands between 2013 and 2016. At 1-year follow-up, patients completed the Hospital Anxiety and Depression Scale, the Impact of Event Scale/Impact of Event Scale-Revised, and answered standardised questions regarding pain. Psychopathology was defined as having anxiety, depressive and/or post-traumatic stress disorder symptoms. We used multivariable logistic regression analysis to evaluate the association of pain before, during and after ICU admission with psychopathology at 1 year follow-up. We included 1105 patients of whom 558 (50%) (95% confidence interval (CI) 0.48 to 0.54) had psychopathology at 1 year follow-up. Pain before ICU admission (odds ratio (OR) 1.18; 95% CI 1.10 to 1.26) and pain after ICU admission (OR 2.38; 95% CI 1.68 to 3.35) were associated with psychopathology. Pain during ICU stay was not associated with psychopathology, but the memory of insufficient pain management during ICU stay was (OR 2.19; 95% CI 1.39 to 3.45). Paying attention to pain and pain treatment experiences related to ICU admission may therefore contribute to early identification of ICU survivors at risk of psychopathology development.
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Affiliation(s)
- Nour Smaisim
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mienke Rijsdijk
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Yuri van der Does
- UMC Utrecht Brain Centre, University Medical Centre, Utrecht University, Utrecht, the Netherlands
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen Jc Slooter
- UMC Utrecht Brain Centre, University Medical Centre, Utrecht University, Utrecht, the Netherlands
- Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Neurology, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Brussels, Belgium
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Dangayach NS, Kreitzer N, Foreman B, Tosto-Mancuso J. Post-Intensive Care Syndrome in Neurocritical Care Patients. Semin Neurol 2024; 44:398-411. [PMID: 38897212 DOI: 10.1055/s-0044-1787011] [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: 06/21/2024]
Abstract
Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
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Affiliation(s)
- Neha S Dangayach
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Tosto-Mancuso
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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4
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Ojeda A, Calvo A, Cuñat T, Mellado-Artigas R, Costas-Carrera A, Sánchez-Rodriguez MM, Comino-Trinidad O, Aliaga J, Arias M, Martínez-Pallí G, Dürsteler C, Ferrando C. Effectiveness of a specific follow up program for the management of the mental components of post-intensive care syndrome and chronic pain after COVID-19: results from the PAIN-COVID randomized clinical trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:349-359. [PMID: 38242358 DOI: 10.1016/j.redare.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/11/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Critical COVID-19 survivors are at risk of developing Post-intensive Care Syndrome (PICS) and Chronic ICU-Related Pain (CIRP). We determined whether a specific care program improves the quality of life (QoL) of patients at risk of developing PICS and CIRP after COVID-19. METHODS The PAIN-COVID trial was a parallel-group, single-centre, single-blinded, randomized controlled trial. The intervention consisted of a follow up program, patient education on PICS and pain, and a psychological intervention based on Rehm's self-control model in patients with abnormal depression scores (≥8) in the Hospital Anxiety and Depression Scale (HADS) at the baseline visit. QoL was evaluated with the 5-level EQ 5D (EQ 5D 5 L), mood disorders with the HADS, post-traumatic stress disorder (PTSD) with the PCL-5 checklist, and pain with the Brief Pain Inventory short form, the Douleur Neuropathique 4 questionnaire, and the Pain Catastrophizing Scale. The primary outcome was to determine if the program was superior to standard-of-care on the EQ visual analogue scale (VAS) at 6 months after the baseline visit. The secondary outcomes were EQ VAS at 3 months, and EQ index, CIRP incidence and characteristics, and anxiety, depression, and PTSD at 3 and 6 months after baseline visits. CONCLUSIONS This program was not superior to standard care in improving QoL in critical COVID-19 survivors as measured by the EQ VAS. However, our data can help establish better strategies for the study and management of PICS and CIRP in this population. TRIAL REGISTRATION # NCT04394169, registered on 5/19/2020.
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Affiliation(s)
- A Ojeda
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
| | - A Calvo
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - T Cuñat
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - R Mellado-Artigas
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - A Costas-Carrera
- Neuroscience Institute, Hospital ClÍnic, University of Barcelona, Barcelona, Spain
| | | | - O Comino-Trinidad
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - J Aliaga
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - M Arias
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - G Martínez-Pallí
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - C Dürsteler
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Department of Surgery and Surgical Specializations, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - C Ferrando
- Department of Anesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Imanaka R, Ouchi A, Sakuramoto H, Aikawa G, Hoshino T, Enomoto Y, Shimojo N, Inoue Y. Survey of sensory impairment in critically ill patients after intensive care unit discharge: An ambidirectional cohort study. Aust Crit Care 2024; 37:12-17. [PMID: 38182531 DOI: 10.1016/j.aucc.2023.09.012] [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: 02/14/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sensory impairment affects the quality of life after intensive care. However, no studies have comprehensively examined sensory impairment after intensive care. OBJECTIVES This study aimed to investigate sensory impairment in critically ill patients. METHODS This ambidirectional cohort study was conducted in the intensive care unit (ICU) of a university hospital between April 2017 and January 2020. Patients who survived despite invasive mechanical ventilation for >48 h, with a discharge period of >6 months, participated in the study. A questionnaire was sent to consenting patients to investigate the presence or absence of sensory impairment at that time, and treatment-related data were collected from their medical records. RESULTS Of 75 eligible patients, 62 responded to our survey. Twenty-seven (43.6%) patients had some sensory impairment. Nine (14.5%) patients had chronic pain after ICU discharge, 4 (6.5%) had chronic pain and visual impairment, 3 (4.8%) had visual impairment only, and 3 (4.8%) had chronic pain and taste impairment. The most common overlapping symptom was a combination of chronic pain. CONCLUSIONS Critically ill patients who survived and were discharged from the ICU accounted for 43.6% of patients with complaints of sensory impairment in the chronic phase. The results of this study suggest the need for follow-up and treatment of possible sensory impairment following ICU discharge.
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Affiliation(s)
- Ryota Imanaka
- Department of Nursing, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika Hitachi, Ibaraki, 319-1295, Japan.
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyusyu International College of Nursing, 1-1 Asty Munakata, Fukuoka, 811-4157, Japan.
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika Hitachi, Ibaraki, 319-1295, Japan.
| | - Tetsuya Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
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6
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Martinez V, Dziadzko M, Tamayo J, Schitter S, Guichard L, Richeux F, Roggerone S, Branche P, Schlaefflin L, Nacto Y, Antunes T, Negre I, Annane D, Aubrun F. Chronic pain characteristics in COVID-19 survivors after an ICU stay. A cross-sectional study. Anaesth Crit Care Pain Med 2023; 42:101267. [PMID: 37356618 PMCID: PMC10290169 DOI: 10.1016/j.accpm.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The onset and characteristics of chronic pain following an intensive care unit (ICU) stay for COVID-19 have never been thoroughly investigated. STUDY DESIGN A multicenter cohort study was conducted to describe chronic pain, according to ICD-11, among COVID-19 survivors. The chronic pain was assessed during face-to-face consultations with a pain specialist. RESULTS Among 204 COVID-19 ICU survivors, 143 patients with mean age of 60 ± 14 years were included nine months after discharge from the ICU. More than half (54%) of patients experienced new-onset chronic pain. In total, 102 different forms of pain were reported in these patients. Secondary pain was the most frequent type, comprising musculoskeletal (40%), post-traumatic (34%), neuropathic (25%), and visceral (13%). Primary chronic pain was rare (7%). The three most common sites of pain were the shoulders, chest, and head. Pain was moderate to severe in 75% of cases, and higher intensity was associated with a greater impact on daily life. Anxiety, depression, post-traumatic stress, perceived stress, and debilitating pain were frequently associated. Intubation was more frequent in patients with chronic pain. Specialized pain centre follow-up was required for 21% of the survivors, which represented 40% of the patients who developed new-onset chronic pain. CONCLUSION New-onset chronic pain is common after an ICU stay for COVID-19 and may manifest in various forms. Secondary pain caused by ICU management is the most frequent. Patients should undergo screening after ICU discharge to facilitate prompt, thorough, and personalized pain management. CLINICAL TRIAL REGISTRATION NCT04940208.
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Affiliation(s)
- Valéria Martinez
- Service d'Anesthésie douleur, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France; INSERM, U-987, Hôpital Ambroise Paré, Centre d'Evaluation et de Traitement de la Douleur, Boulogne Billancourt, F-92100, France; Université Versailles Saint-Quentin, 55 avenue de Paris, Versailles F-78035, France.
| | - Mikhail Dziadzko
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, Lyon F-69317, France; INSERM, U-1290, laboratoire RESHAEPE, Université Claude Bernard Lyon 1, Lyon F-69008, France
| | - Juan Tamayo
- Service d'Anesthésie douleur, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France
| | - Sébastien Schitter
- Service d'Anesthésie douleur, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France
| | - Leah Guichard
- Service d'Anesthésie douleur, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France
| | - Florine Richeux
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, Lyon F-69317, France
| | - Stephanie Roggerone
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, Lyon F-69317, France
| | - Patricia Branche
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, Lyon F-69317, France
| | - Leo Schlaefflin
- Hôpitaux Universitaires Paris-Sud (AP-HP), Centre d'Evaluation et de Traitement de la Douleur, Hôpital de Bicêtre, Le Kremlin Bicêtre Cedex, France
| | - Youri Nacto
- Service d'Anesthésie douleur, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France; Université Versailles Saint-Quentin, 55 avenue de Paris, Versailles F-78035, France
| | - Tiago Antunes
- Service d'Anesthésie douleur, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France
| | - Isabelle Negre
- Hôpitaux Universitaires Paris-Sud (AP-HP), Centre d'Evaluation et de Traitement de la Douleur, Hôpital de Bicêtre, Le Kremlin Bicêtre Cedex, France
| | - Djillali Annane
- Service de Réanimation médicale, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, 104 boulevard Raymond Poincaré, F-92380 Garches, France; Université Versailles Saint-Quentin, 55 avenue de Paris, Versailles, F-78035, France
| | - Frederic Aubrun
- Service d'Anesthésie Réanimation Chirurgicale, Hospices Civils de Lyon, Groupement Hospitalier Nord Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, Lyon F-69317, France; INSERM, U-1290, laboratoire RESHAEPE, Université Claude Bernard Lyon 1, Lyon F-69008, France
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7
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Bourdiol A, Legros V, Vardon-Bounes F, Rimmele T, Abraham P, Hoffmann C, Dahyot-Fizelier C, Jonas M, Bouju P, Cirenei C, Launey Y, Le Gac G, Boubeche S, Lamarche E, Huet O, Bezu L, Darrieussecq J, Szczot M, Delbove A, Schmitt J, Lasocki S, Auchabie J, Petit L, Kuhn-Bougouin E, Asehnoune K, Ingles H, Roquilly A, Cinotti R. Prevalence and risk factors of significant persistent pain symptoms after critical care illness: a prospective multicentric study. Crit Care 2023; 27:199. [PMID: 37226261 DOI: 10.1186/s13054-023-04491-w] [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: 02/21/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Prevalence, risk factors and medical management of persistent pain symptoms after critical care illness have not been thoroughly investigated. METHODS We performed a prospective multicentric study in patients with an intensive care unit (ICU) length of stay ≥ 48 h. The primary outcome was the prevalence of significant persistent pain, defined as a numeric rating scale (NRS) ≥ 3, 3 months after admission. Secondary outcomes were the prevalence of symptoms compatible with neuropathic pain (ID-pain score > 3) and the risk factors of persistent pain. RESULTS Eight hundred fourteen patients were included over a 10-month period in 26 centers. Patients had a mean age of 57 (± 17) years with a SAPS 2 score of 32 (± 16) (mean ± SD). The median ICU length of stay was 6 [4-12] days (median [interquartile]). At 3 months, the median intensity of pain symptoms was 2 [1-5] in the entire population, and 388 (47.7%) patients had significant pain. In this group, 34 (8.7%) patients had symptoms compatible with neuropathic pain. Female (Odds Ratio 1.5 95% CI [1.1-2.1]), prior use of anti-depressive agents (OR 2.2 95% CI [1.3-4]), prone positioning (OR 3 95% CI [1.4-6.4]) and the presence of pain symptoms on ICU discharge (NRS ≥ 3) (OR 2.4 95% CI [1.7-3.4]) were risk factors of persistent pain. Compared with sepsis, patients admitted for trauma (non neuro) (OR 3.5 95% CI [2.1-6]) were particularly at risk of persistent pain. Only 35 (11.3%) patients had specialist pain management by 3 months. CONCLUSIONS Persistent pain symptoms were frequent in critical illness survivors and specialized management remained infrequent. Innovative approaches must be developed in the ICU to minimize the consequences of pain. TRIAL REGISTRATION NCT04817696. Registered March 26, 2021.
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Affiliation(s)
- Alexandre Bourdiol
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Vincent Legros
- Service d'Anesthésie-Réanimation, Hôpital Maison Blanche, CHU de Reims, 51100, Reims, France
| | - Fanny Vardon-Bounes
- Service d'Anesthésie-Réanimation, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Thomas Rimmele
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- EA7426 Pathophysiology of Injury-Induced Immunosuppression (Pi3), Hospices Civils de Lyon-Biomérieux-Université Claude Bernard Lyon 1, Lyon, France
| | - Paul Abraham
- Service de médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Clément Hoffmann
- Burn Center, Percy Military Training Hospital, 101, Avenue Henri Barbusse - BP 406, 92141, Clamart, France
| | - Claire Dahyot-Fizelier
- Intensive Care and Anesthesia Department, University Hospital of Poitiers, University of Poitiers, Poitiers, France
- INSERM U1770, University of Poitiers, Poitiers, France
| | - Maud Jonas
- Service de Réanimation, Hôpital de Saint-Nazaire, Saint-Nazaire, France
| | - Pierre Bouju
- Service de Réanimation Polyvalente, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Cédric Cirenei
- Hôpital Claude Huriez, Pôle Anesthésie-Réanimation, médecine périopératoire et douleur, CHU Lille, 59000, Lille, France
| | - Yoann Launey
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
| | - Gregoire Le Gac
- Department of Anaesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- UMR_S 1242, Chemistry Oncogenesis Stress Signaling, University of Rennes, 35000, Rennes, France
| | - Samia Boubeche
- Service d'Anesthésie-Réanimation, CHU de Rouen, Rouen, France
| | - Edouard Lamarche
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 37000, Tours, France
| | - Olivier Huet
- Department of Anaesthesia and Critical Care, University Hospital of Brest, 29000, Brest, France
| | - Lucillia Bezu
- Service de Réanimation Polyvalente, Gustave Roussy, 94805, Villejuif, France
- Metabolomics and Cell Biology Platforms, Université Paris Saclay, Université de Paris, Sorbonne Université, Inserm UMR1138, Villejuif, France
| | - Julie Darrieussecq
- CH Aubagne, Pôle CARK, Service d'Anesthésie-Réanimation chirurgicale, Edmond Garcin, 179 Av. des soeurs Gastine, 13400, Aubagne, France
| | - Magdalena Szczot
- Service d'Anesthésie-Réanimation, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Johan Schmitt
- Hôpital d'Instruction des Armées Clermont Tonnerre, Rue Colonel Fonferrier, 29240, Brest, France
| | - Sigismond Lasocki
- Department of Anaesthesia and Critical Care, University Hospital of Tours, 49100, Angers, France
| | - Johann Auchabie
- Service de Réanimation, centre hospitalier de Cholet, Cholet, France
| | - Ludivine Petit
- CHU Saint-Etienne, Service d'Anesthésie-Réanimation, Saint-Étienne, France
| | - Emmanuelle Kuhn-Bougouin
- Centre d'Etude et de Traitement de la Douleur, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Karim Asehnoune
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Hugo Ingles
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
| | - Antoine Roquilly
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France
- UMR 1064, Center for Research in Transplantation and Translational Immunology, INSERM, Nantes Université, 44000, Nantes, France
| | - Raphaël Cinotti
- Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation chirurgicale, Hôtel Dieu, Nantes Université, CHU Nantes, 44093, Nantes, France.
- MethodS in Patients-Centered Outcomes and HEalth Research, SPHERE, INSERM, Nantes Université, Univ Tours, CHU Nantes, CHU Tours, 44000, Nantes, France.
- Department of Anesthesia and Critical Care, Hôtel-Dieu, University Hospital of Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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8
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Hashimoto N, Unoki T, Nagano N, Funamizu R, Sawamoto K. Prevalence, Location, and Interference With Daily Life of Chronic Pain in Long-Term Survivors After Discharge From a Tertiary Emergency Center. Cureus 2023; 15:e35382. [PMID: 36987483 PMCID: PMC10039969 DOI: 10.7759/cureus.35382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background This study aimed to investigate the prevalence, location, and characteristics of new-onset chronic pain by using a new definition in long-term survivors after discharge from a tertiary emergency center. Materials and methods We conducted a single-center ambidirectional cohort study from January to May 2022. A survey of patients was conducted by postal mail two to 2.5 years after their discharge from a tertiary emergency center. We used the Brief Pain Inventory to investigate chronic pain parameters, and the painDETECT questionnaire to investigate neuropathic pain. Patient information during hospitalization was collected retrospectively from medical records. Results The survey was sent to 78 patients, 63 (81%) of whom responded and were included in the analysis. Nine of the 63 patients (14%) had new-onset chronic pain. Of these, six (67%) had chronic pain of moderate or severe intensity which interfered with daily life. The most frequent location of chronic pain was the foot/ankle (n=4, 44%). Neuropathic pain was present in four (44%) patients with new-onset chronic pain. Conclusion New-onset chronic pain may occur for up to two to 2.5 years after discharge from a tertiary emergency center, and this may interfere with daily life. Therefore, a follow-up system for chronic pain is warranted.
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Affiliation(s)
- Naoya Hashimoto
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, JPN
- Acute and Critical Care Nursing, Graduate School of Nursing, Sapporo City University, Sapporo, JPN
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, JPN
| | - Nozomi Nagano
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, JPN
- Doctoral Program, Graduate School of Nursing, Sapporo City University, Sapporo, JPN
| | - Ryota Funamizu
- Advanced Critical Care and Emergency Center, Sapporo Medical University Hospital, Sapporo, JPN
| | - Keigo Sawamoto
- Department of Emergency Medicine, Sapporo Medical University, Sapporo, JPN
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9
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García Sánchez M, Alcántara Carmona S. Is the reduction of opiates in the critic patient really possible? Med Intensiva 2022; 46:269-272. [PMID: 35272974 DOI: 10.1016/j.medine.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- M García Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - S Alcántara Carmona
- Unidad de Cuidados Intensivos, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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10
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Ahmad A, Sohail MM, Safdar MR. Religious construction and interpretation of pain: Lived experiences of terminally ill hepatitis C Muslim patients. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:983-991. [PMID: 34416030 DOI: 10.1002/jcop.22695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/10/2021] [Indexed: 06/13/2023]
Abstract
Pain is a complex, multidimensional phenomenon and integral component of illness but little is known about its religious construction and interpretation. This article discusses an important yet neglected component of terminal illness which is the religious construction of pain. Eleven hepatitis C Muslim patients admitted to the liver center were recruited for this study. In-depth interviews helped the identification of dominant themes. The study found that terminal patients construct pain in a religious context and interpret it into religious realms. For them, pain helps to realize their debility and helplessness. They think pain has a transformatory potential and can help them turn to be very strong and brave. The participants also reported having a belief that pain in this world could be compensated in the life hereafter and they will be rewarded with good deeds and bestowed with the Jannah (paradise). The terminal patients strongly influenced by religion and spirituality believed to be experiencing pain as a punishment of their misdeeds. Thus, pain was helping them to normalize their end-of-life experiences and ease the terminal stage of their illness.
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Affiliation(s)
- Akhlaq Ahmad
- Department of Sociology, International Islamic University, Islamabad, Pakistan
| | - Malik M Sohail
- Department of Sociology, Government College University, Faisalabad, Pakistan
| | - Muhammad R Safdar
- Institute of Social and Cultural Studies, University of the Punjab, Lahore, Pakistan
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11
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Kharasch ED, Clark JD, Adams JM. Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management. Anesthesiology 2022; 136:10-30. [PMID: 34874401 PMCID: PMC10715730 DOI: 10.1097/aln.0000000000004065] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While U.S. opioid prescribing has decreased 38% in the past decade, opioid deaths have increased 300%. This opioid paradox is poorly recognized. Current approaches to opioid management are not working, and new approaches are needed. This article reviews the outcomes and shortcomings of recent U.S. opioid policies and strategies that focus primarily or exclusively on reducing or eliminating opioid prescribing. It introduces concepts of a prescription opioid ecosystem and opioid pool, and it discusses how the pool can be influenced by supply-side, demand-side, and opioid returns factors. It illuminates pressing policy needs for an opioid ecosystem that enables proper opioid stewardship, identifies associated responsibilities, and emphasizes the necessity of making opioid returns as easy and common as opioid prescribing, in order to minimize the size of the opioid pool available for potential diversion, misuse, overdose, and death. Approaches are applicable to opioid prescribing in general, and to opioid prescribing after surgery.
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Affiliation(s)
- Evan D Kharasch
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - J David Clark
- the Anesthesiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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12
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Ojeda A, Calvo A, Cuñat T, Mellado-Artigas R, Comino-Trinidad O, Aliaga J, Arias M, Ferrando C, Martinez-Pallí G, Dürsteler C. Characteristics and influence on quality of life of new-onset pain in critical COVID-19 survivors. Eur J Pain 2021; 26:680-694. [PMID: 34866276 PMCID: PMC9015597 DOI: 10.1002/ejp.1897] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/07/2023]
Abstract
Background Pain is a clinical feature of COVID‐19, however, data about persistent pain after hospital discharge, especially among ICU survivors is scarce. The aim of this study was to explore the incidence and characteristics of new‐onset pain and its impact on Health‐Related Quality of Life (HRQoL), and to quantify the presence of mood disorders in critically ill COVID‐19 survivors. Methods This is a preliminary report of PAIN‐COVID trial (NCT04394169) presenting a descriptive analysis in critically ill COVID‐19 survivors, following in person interview 1 month after hospital discharge. Pain was assessed using the Brief Pain Inventory, the Douleur Neuropathique 4 questionnaire and the Pain Catastrophizing Scale. HRQoL was evaluated with the EQ 5D/5L, and mood disorders with the Hospital Anxiety and Depression Scale (HADS). Results From 27 May to 19 July 2020, 203 patients were consecutively screened for eligibility, and 65 were included in this analysis. Of these, 50.8% patients reported new‐onset pain; 38.5% clinically significant pain (numerical rating score ≥3 for average pain intensity); 16.9% neuropathic pain; 4.6% pain catastrophizing thoughts, 44.6% pain in ≥2 body sites and 7.7% widespread pain. Patients with new‐onset pain had a worse EQ‐VAS and EQ index value (p < 0.001). Pain intensity was negatively correlated to both the former (Spearman ρ: −0.546, p < 0.001) and the latter (Spearman ρ: −0.387, p = 0.001). HADS anxiety and depression values equal or above eight were obtained in 10.8% and 7.7% of patients, respectively. Conclusion New‐onset pain in critically ill COVID‐19 survivors is frequent, and it is associated with a lower HRQoL. Trial registration No.: NCT04394169. Registered 19 May 2020. https://clinicaltrials.gov/ct2/show/NCT04394169. Significance A substantial proportion of severe COVID‐19 survivors may develop clinically significant persistent pain, post‐intensive care syndrome and chronic ICU‐related pain. Given the number of infections worldwide and the unprecedented size of the population of critical illness survivors, providing information about the incidence of new‐onset pain, its characteristics, and its influence on the patients’ quality of life might help establish and improve pain management strategies.
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Affiliation(s)
- Antonio Ojeda
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Andrea Calvo
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Tomas Cuñat
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Ricard Mellado-Artigas
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Oscar Comino-Trinidad
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Jorge Aliaga
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Marilyn Arias
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Carlos Ferrando
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Graciela Martinez-Pallí
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Dürsteler
- Department of Anaesthesiology, Critical Care and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
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13
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García Sánchez M, Alcántara Carmona S. ¿Es realmente posible la reducción del uso de opiáceos en el paciente crítico? Med Intensiva 2021. [DOI: 10.1016/j.medin.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Gustafson OD, Williams MA, McKechnie S, Dawes H, Rowland MJ. Musculoskeletal complications following critical illness: A scoping review. J Crit Care 2021; 66:60-66. [PMID: 34454181 PMCID: PMC8516358 DOI: 10.1016/j.jcrc.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/19/2021] [Accepted: 08/06/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To explore the extent to which musculoskeletal (MSK) complications have been reported following critical illness, identifying evidence gaps and providing recommendations for future research. MATERIALS AND METHODS We searched five databases from January 1st 2000 to March 31st 2021. We included published original research reporting MSK complications in patients discharged from hospital following an admission to an intensive care unit (ICU). Two reviewers independently screened English language articles for eligibility. Data extracted included the MSK area of investigation and MSK outcome measures. The overall quality of study was evaluated against standardised reporting guidelines. RESULTS 4512 titles were screened, and 32 met the inclusion criteria. Only one study included was interventional, with the majority being prospective cohort studies (n = 22). MSK complications identified included: muscle weakness or atrophy, chronic pain, neuromuscular dysfunction, peripheral joint impairment and fracture risk. The quality of the overall reporting in the studies was deemed adequate. CONCLUSIONS We identified a heterogenous body of literature reporting a high prevalence of a variety of MSK complications extending beyond muscle weakness, therefore future investigation should include evaluations of more than one MSK area. Further investigation of MSK complications could inform the development of future post critical illness rehabilitation programs.
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Affiliation(s)
- Owen D Gustafson
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; Centre for Movement, Occupational and Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0BP, UK.
| | - Mark A Williams
- Centre for Movement, Occupational and Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0BP, UK; Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Oxford OX3 0BP, UK
| | - Stuart McKechnie
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Helen Dawes
- Centre for Movement, Occupational and Rehabilitation Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford OX3 0BP, UK; Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Headington Campus, Oxford OX3 0BP, UK
| | - Matthew J Rowland
- Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; Kadoorie Centre for Critical Care Research, Oxford NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
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15
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Smith EM, Lee ACW, Smith JM, Thiele A, Zeleznik H, Ohtake PJ. COVID-19 and Post-intensive Care Syndrome: Community-Based Care for ICU Survivors. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2020. [DOI: 10.1177/1084822320974956] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Survivors of critical illness, including those with COVID-19, are likely to experience post-intensive care syndrome (PICS). PICS involves a constellation of physical, cognitive, and mental health problems that can occur following hospitalization in an intensive care unit (ICU). This focused review describes the impact of PICS on an individual’s function, societal participation, and family. Specific evidence-based screening tools for in-home identification of the deficits associated with PICS are recommended. Recognition of PICS through early screening by home health care providers is crucial in order to assemble the physical rehabilitation, mental health, and community resources needed to mitigate the long-term effects of COVID-19 and other critical illnesses. This review concludes with further PICS resources for community-based providers to enhance their knowledge and expertise and to prepare them for caring for COVID-19 and other critical illness survivors.
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Affiliation(s)
| | | | | | | | - Hallie Zeleznik
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Patricia J. Ohtake
- University at Buffalo School of Public Health and Health Professions, Buffalo, NY, USA
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16
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Jaffri A, Jaffri UA. Post-Intensive care syndrome and COVID-19: crisis after a crisis? Heart Lung 2020; 49:883-884. [PMID: 32690219 PMCID: PMC7301100 DOI: 10.1016/j.hrtlng.2020.06.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Abbis Jaffri
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, United States.
| | - Ume Abbiyha Jaffri
- Bachelors of Medicine, and Bachelors of Surgery, Ameer ud Din Medical College Lahore, Pakistan
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