1
|
Rousseau AF, Minguet P, Neis-Gilson S, Misset B, Lambermont B. Post-intensive care unit follow-up: don't stop it now! Intensive Care Med 2024; 50:1382-1383. [PMID: 38713214 DOI: 10.1007/s00134-024-07467-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Affiliation(s)
- Anne-Françoise Rousseau
- Intensive Care Department, Post-ICU Follow-Up Clinic, University Hospital of Liège, University of Liège, Avenue de l'Hôpital 1, 4000, Liège, Belgium.
| | - Pauline Minguet
- Intensive Care Department, Post-ICU Follow-Up Clinic, University Hospital of Liège, University of Liège, Avenue de l'Hôpital 1, 4000, Liège, Belgium
| | - Sarah Neis-Gilson
- Intensive Care Department, Post-ICU Follow-Up Clinic, University Hospital of Liège, University of Liège, Avenue de l'Hôpital 1, 4000, Liège, Belgium
| | - Benoit Misset
- Intensive Care Department, Post-ICU Follow-Up Clinic, University Hospital of Liège, University of Liège, Avenue de l'Hôpital 1, 4000, Liège, Belgium
| | - Bernard Lambermont
- Intensive Care Department, Post-ICU Follow-Up Clinic, University Hospital of Liège, University of Liège, Avenue de l'Hôpital 1, 4000, Liège, Belgium
| |
Collapse
|
2
|
You H, Docherty SL, Ashana DC, Oyesanya TO. Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care. AACN Adv Crit Care 2024; 35:97-108. [PMID: 38848572 DOI: 10.4037/aacnacc2024982] [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: 06/09/2024]
Abstract
Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another location or level of care. Transitions theory is a middle-range nursing theory that aims to provide guidance for safe and effective nursing care and research while an individual experiences a transition. Intensive care unit nurses are well positioned to provide ICU transitional care planning early. This article applies the transitions theory as a theoretical model to guide the study of the transition to home after acute hospital care for ICU patients and their families. This theory application can help ICU nurses provide holistic patient- and family-centered transitional care to achieve optimal outcomes by addressing the predischarge and postdischarge needs of patients and families.
Collapse
Affiliation(s)
- HyunBin You
- HyunBin You is a PhD candidate, School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham, NC 27710
| | - Sharron L Docherty
- Sharron L. Docherty is Associate Professor, School of Nursing, and Associate Professor, Department of Medicine, Duke University, Durham, North Carolina
| | - Deepshikha C Ashana
- Deepshikha C. Ashana is Assistant Professor, Department of Medicine; Core Faculty Member, Duke-Margolis Center for Health Policy; and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Tolu O Oyesanya
- Tolu O. Oyesanya is Associate Professor, School of Nursing, Duke University, Durham, North Carolina
| |
Collapse
|
3
|
da Silva AA, Granger CL, Abo S, Sheehan J, Barson E, Beach L, Pound G, Ali Abdelhamid Y, Fetterplace K, Fini NA, Merolli M, Sloan E, Parry SM. "How Do I Test the Waters? How Do I Go Forward?": Codesigning a Supportive Pathway after Critical Illness. Ann Am Thorac Soc 2024; 21:916-927. [PMID: 38330169 DOI: 10.1513/annalsats.202307-599oc] [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: 07/06/2023] [Accepted: 02/08/2024] [Indexed: 02/10/2024] Open
Abstract
Rationale: Long-term recovery after critical illness can be affected by post-intensive care syndrome (PICS), a significant burden, which can impact return to activities and work. There is a need for streamlined support for intensive care unit (ICU) patients in their recovery while enduring PICS symptoms. Objectives: To explore critical illness recovery from the experiences, perspectives, and beliefs of former ICU patients, their caregivers, and multidisciplinary clinicians to design a future rehabilitation intervention prototype to support ICU patients. Methods: This was an experience-based codesign (EBCD) study underpinned by the Behavior Change Wheel framework involving ICU patients (<5 years after illness), caregivers, and multidisciplinary clinicians with current clinical experience with ICU recovery at any point along the care continuum (ICU, acute, subacute, or community settings) from two metropolitan hospitals in Melbourne, Australia. Two rounds of experience-based codesign workshops were held between August 2021 and February 2022. Workshop content was analyzed via a reflective thematic approach to determine themes and develop an intervention. The intervention was mapped according to the template for intervention description and replication framework. Results: Forty people participated in the codesign process: 15 ICU patients, 2 caregivers, and 23 clinicians. Fifteen major themes were identified in the experience of ICU recovery. Returning home was a key time point for change, acceptance, and adjustment, with the burden of physical limitations and mental health problems becoming apparent. Most participants expressed that PICS was poorly understood in the community, and there was a lack of support to aid recovery. Based on these results, an intervention prototype was developed with a primary goal of improving care after hospital discharge. This was further refined in the second round of workshops. A resource toolkit was deemed most acceptable to end-users, including a hospital-directed support program involving psychology and physical therapy and an accompanying digital health package. Conclusions: A critical time point for more support in the recovery journey was the transition from hospital to home. To address this, a rehabilitation prototype including a physical and psychological support intervention and supporting digital health toolkit was codesigned. The intervention package will be developed and trialed with future ICU patients and their families. Clinical trial registered with www.clinicaltrials.gov (NCT05044221).
Collapse
Affiliation(s)
- Alisha A da Silva
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
- Department of Physiotherapy
| | - Catherine L Granger
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
- Department of Physiotherapy
| | - Shaza Abo
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
- Department of Physiotherapy
| | | | - Elizabeth Barson
- Department of Psychology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - Gemma Pound
- Department of Physiotherapy, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia; and
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Intensive Care Unit, and
| | - Kate Fetterplace
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Clinical Nutrition, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Natalie A Fini
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
| | - Mark Merolli
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
| | - Evelyn Sloan
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
| | - Selina M Parry
- Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, and
- Department of Physiotherapy
| |
Collapse
|
4
|
Pilowsky JK, von Huben A, Elliott R, Roche MA. Development and validation of a risk score to predict unplanned hospital readmissions in ICU survivors: A data linkage study. Aust Crit Care 2024; 37:383-390. [PMID: 37339922 DOI: 10.1016/j.aucc.2023.05.002] [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: 02/22/2023] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Intensive Care Unit (ICU) follow-up clinics are growing in popularity internationally; however, there is limited evidence as to which patients would benefit most from a referral to this service. OBJECTIVES The objective of this study was to develop and validate a model to predict which ICU survivors are most likely to experience an unplanned hospital readmission or death in the year after hospital discharge and derive a risk score capable of identifying high-risk patients who may benefit from referral to follow-up services. METHODS A multicentre, retrospective observational cohort study using linked administrative data from eight ICUs was conducted in the state of New South Wales, Australia. A logistic regression model was developed for the composite outcome of death or unplanned readmission in the 12 months after discharge from the index hospitalisation. RESULTS 12,862 ICU survivors were included in the study, of which 5940 (46.2%) patients experienced unplanned readmission or death. Strong predictors of readmission or death included the presence of a pre-existing mental health disorder (odds ratio [OR]: 1.52, 95% confidence interval [CI]: 1.40-1.65), severity of critical illness (OR: 1.57, 95% CI: 1.39-1.76), and two or more physical comorbidities (OR: 2.39, 95% CI: 2.14-2.68). The prediction model demonstrated reasonable discrimination (area under the receiver operating characteristic curve: 0.68, 95% CI: 0.67-0.69) and overall performance (scaled Brier score: 0.10). The risk score was capable of stratifying patients into three distinct risk groups-high (64.05% readmitted or died), medium (45.77% readmitted or died), and low (29.30% readmitted or died). CONCLUSIONS Unplanned readmission or death is common amongst survivors of critical illness. The risk score presented here allows patients to be stratified by risk level, enabling targeted referral to preventative follow-up services.
Collapse
Affiliation(s)
- Julia K Pilowsky
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
| | - Amy von Huben
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, NSW, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Nursing and Midwifery Directorate, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Michael A Roche
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; University of Canberra and ACT Health Directorate, Canberra, ACT, Australia
| |
Collapse
|
5
|
Kang J, Lee KM. Three-year mortality, readmission, and medical expenses in critical care survivors: A population-based cohort study. Aust Crit Care 2024; 37:251-257. [PMID: 37574386 DOI: 10.1016/j.aucc.2023.07.036] [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: 10/10/2022] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Due to the increasing number of critical care survivors, population-based studies on the long-term outcomes after discharge are necessary to inform local decision-making. OBJECTIVES This study aimed to investigate mortality and its risk factors, readmissions, and medical expenses of intensive care unit survivors for 3 years after hospital discharge. METHODS This retrospective study analysed data from the National Health Insurance Service-National Sample Cohort in Korea. Of the 195,702 patients who survived and were discharged from hospital in 2012, 2693 intensive care unit patients were assigned to the case group for the study, and the remaining 193,009 were assigned to the comparison group. The primary outcome was all-cause mortality for 3 years after discharge. Secondary outcomes were all-cause hospital readmission and medical expenses in 3 years. We analysed risk factors for mortality using the Cox proportional hazard regression. The differences in hospital readmission and medical expenses between the case and comparison groups were analysed by multivariate logistic regression and independent t-tests. RESULTS The 1-year, 2-year, and 3-year cumulative mortality rates in the case group were 15.9%, 20.5%, and 24.4%, respectively, and older age, disability, medical admission, and longer hospital stay increased mortality. Almost 40% of intensive care unit survivors were readmitted to hospital within 6 months of discharge, and their odds of being readmitted were significantly higher than those of the comparison group. Medical expenses were also significantly higher in the case group, with the highest paid within 6 months. CONCLUSIONS Mortality, hospital readmission, and medical expenses for intensive care unit survivors were the worst within 6 months of discharge. In light of the long-term recovery trajectory of critical illness, it is necessary to investigate what factors may have contributed to the negative outcome during this period. Further research is needed to determine which services primarily contributed to the increase in medical expenses.
Collapse
Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, South Korea.
| | - Kwang Min Lee
- Industry-Academy Cooperation, Dong-A University, Busan, South Korea
| |
Collapse
|
6
|
Drewitz KP, Hasenpusch C, Bernardi C, Brandstetter S, Fisser C, Pielmeier K, Rohr M, Brunnthaler V, Schmidt K, Malfertheiner MV, Apfelbacher CJ. Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): feasibility of a pragmatic randomised controlled trial. BMC Anesthesiol 2023; 23:344. [PMID: 37838669 PMCID: PMC10576359 DOI: 10.1186/s12871-023-02255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 08/24/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND ICU survivors often suffer from prolonged physical and mental impairments resulting in the so called "Post-Intensive Care Syndrome" (PICS). The aftercare of former ICU patients affected by PICS in particular has not been addressed sufficiently in Germany so far. The aim of this study was to evaluate the feasibility of a pragmatic randomised trial (RCT) comparing an intensive care unit (ICU) follow-up clinic intervention to usual care. METHODS This pilot study in a German university hospital evaluated the feasibility of a pragmatic RCT. Patients were assigned in a 1:1 ratio to an ICU follow-up clinic intervention or to usual care. The concept of this follow-up clinic was previously developed in a participatory process with patients, next of kin, health care professionals and researchers. We performed a process evaluation and determined acceptability, fidelity, completeness of measurement instruments and practicality as feasibility outcomes. The RCT's primary outcome (health-related quality of life) was assessed six months after ICU discharge by means of the physical component scale of the Short-Form-12 self-report questionnaire. RESULTS The pilot study was conducted from June 2020 to May 2021 with 21 and 20 participants in the intervention and control group. Principal findings related to feasibility were 85% consent rate (N = 48), 62% fidelity rate, 34% attrition rate (N = 41) and 77% completeness of outcome measurements. The primary effectiveness outcome (health-related quality of life) could be measured in 93% of participants who completed the study (N = 27). The majority of participants (85%) needed assistance with follow-up questionnaires (practicality). Median length of ICU stay was 13 days and 85% (N = 41) received mechanical ventilation, median Sequential Organ Failure Assessment Score was nine. Six-month follow-up assessment was planned for all study participants and performed for 66% (N = 41) of the participants after 197 days (median). CONCLUSION The participatory developed intervention of an ICU follow-up clinic and the pragmatic pilot RCT both seem to be feasible. We recommend to start a pragmatic RCT on the effectiveness of the ICU follow-up clinic. TRIAL REGISTRATION ClinicalTrials.gov US NLM, NCT04186468, Submission: 02/12/2019, Registration: 04/12/2019, https://clinicaltrials.gov/ct2/show/NCT04186468.
Collapse
Affiliation(s)
- Karl Philipp Drewitz
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Claudia Hasenpusch
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Bernardi
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - Susanne Brandstetter
- University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Katharina Pielmeier
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Magdalena Rohr
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr. 1-3, 93049, Regensburg, Germany
| | - Vreni Brunnthaler
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
- Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Maximilian V Malfertheiner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Germany
| | - Christian J Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
| |
Collapse
|
7
|
Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
Collapse
Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
| |
Collapse
|
8
|
Lin F, Craswell A, Murray L, Brailsford J, Cook K, Anagi S, Muir R, Garrett P, Pusapati R, Carlini J, Ramanan M. Establishing critical care nursing research priorities for three Australian regional public hospitals: A mixed method priority setting study. Intensive Crit Care Nurs 2023; 77:103440. [PMID: 37104948 DOI: 10.1016/j.iccn.2023.103440] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To determine key priorities for critical care nursing research in three Australian regional public hospitals, representing the shared priorities of healthcare professionals and patient representatives. METHODS A three phase priority setting study, including consensus methods (nominal group), survey, qualitative interviews and focus groups were conducted between May 2021 and March 2022. Healthcare professionals and patient representatives from critical care units in regional public hospitals in Australia participated. A patient representative contributed to research design and co-authored this paper. RESULTS In phase one, 29 research topics were generated. In phase two, during a nominal group ranking process, the top 5 priority areas for each site were identified. In the final phase, three themes from focus groups and interviews included patient flow through intensive care, patient care through intensive care journey and intensive care patient recovery. CONCLUSION Identifying context specific research priorities through a priority setting exercise provides insight into the topics that are important to healthcare professionals and to patients in critical care. The top research priorities for nursing research in critical care in regional Australian hospitals include patient flow, patient recovery, and evidence based patient care through the intensive care journey, such as delirium management, pain and sedation, and mobilisation. These shared priorities will be used to guide future nursing research in critical care over the next 3-5 years. IMPLICATIONS FOR CLINICAL PRACTICE The method we used in identifying the research priorities can be used by other researchers and clinicians; close collaboration among researchers and clinicians will be beneficial for practice improvement; and how we can be reassured that our practice is evidence based is worthy of attention.
Collapse
Affiliation(s)
- Frances Lin
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Sunshine Coast, Queensland, Australia.
| | - Alison Craswell
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Sunshine Coast, Queensland, Australia; Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Lauren Murray
- Intensive Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Jane Brailsford
- Intensive Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Katrina Cook
- Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| | - Shivaprasad Anagi
- Intensive Care Unit, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Rachel Muir
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, UK
| | - Peter Garrett
- Intensive Care Unit, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Raju Pusapati
- Intensive Care Unit, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
| | - Joan Carlini
- Department of Marketing, Griffith University, Gold Coast, Queensland, Australia; Consumer Advisory Group, Gold Coast Health, Queensland, Australia
| | - Mahesh Ramanan
- Intensive Care Unit, Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, Queensland, Australia
| |
Collapse
|
9
|
Turnbull AE, Lee EM, Dinglas VD, Beesley S, Bose S, Banner-Goodspeed V, Hopkins RO, Jackson JC, Mir-Kasimov M, Sevin CM, Brown SM, Needham DM. Fulfillment of Patient Expectations after Acute Respiratory Failure: A Multicenter Prospective Cohort Study. Ann Am Thorac Soc 2023; 20:566-573. [PMID: 36227771 PMCID: PMC10112405 DOI: 10.1513/annalsats.202207-600oc] [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: 07/12/2022] [Accepted: 10/13/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale: Discussion of patient expectations for recovery is a component of intensive care unit (ICU) follow-up clinics. However, few studies have formally evaluated recovery-related expectations of ICU survivors. Objectives: To estimate the prevalence of unmet expectations for recovery 6 months after hospital discharge among adult survivors of acute respiratory failure (ARF). Methods: This was a prospective, longitudinal, cohort study of survivors of ARF discharged to home from five U.S. medical centers. Expectations for functional recovery were assessed by asking which activities and instrumental activities of daily living (I/ADLs) survivors expected to perform independently at 6 months. Survivors' expectations for overall health status were assessed using a visual analogue scale ranging from 0 to 100. At 6-month follow-up, participants reported which I/ADLs they could perform independently and rated their overall health status using a 100-point visual analogue scale. We defined a participant's functional expectations as being met if they reported independently performing I/ADLs as expected at hospital discharge. Health expectations were considered to be met when self-rated health status at 6 months was no more than 8 points lower than expected at enrollment. Results: Among 180 enrollees, 169 (94%) were alive, and 160 of these (95%) participated in 6-month follow-up. Functional expectations were met for 71% of participating survivors, and overall health expectations were met for 50%. Expectations for functional independence were high, ranging from 87% (housekeeping) to 99% (using a telephone). General health expectations were variable (median, 85; interquartile range [IQR], 75-95). At 6-month follow-up, self-rated, overall health ranged from 2 to 100 (median, 80; IQR, 60-85). In exploratory analyses, participants with met versus unmet expectations differed most in formal education (functional expectations standardized difference = 0.88; health expectations standardized difference = 0.41). Conclusions: Expectations of survivors of ARF about independent functioning were high and generally met, but half had unmet general health expectations 6 months after discharge. It is difficult to predict whose health expectations will be unmet, but possessing less formal education may be a risk factor. Clinical trial registered with www.clinicaltrials.gov (NCT03797313).
Collapse
Affiliation(s)
- Alison E. Turnbull
- Division of Pulmonary and Critical Care Medicine and
- Department of Epidemiology, Bloomberg School of Public Health, and
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland
| | - Emma M. Lee
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Victor D. Dinglas
- Division of Pulmonary and Critical Care Medicine and
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland
| | - Sarah Beesley
- Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, Utah
- Pulmonary and Critical Care Medicine and
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, Utah
| | - Somnath Bose
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Valerie Banner-Goodspeed
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ramona O. Hopkins
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, Utah
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
| | - James C. Jackson
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Mustafa Mir-Kasimov
- Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, Utah
- Salt Lake City Veterans Administration, Salt Lake City, Utah
| | - Carla M. Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Samuel M. Brown
- Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, Utah
- Pulmonary and Critical Care Medicine and
- Center for Humanizing Critical Care, Intermountain Medical Center, Salt Lake City, Utah
| | - Dale M. Needham
- Division of Pulmonary and Critical Care Medicine and
- Department of Physical Medicine and Rehabilitation, School of Medicine
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
10
|
Killien EY, Maddux AB, Tse SM, Watson RS. Outcomes of Children Surviving Pediatric Acute Respiratory Distress Syndrome: From the Second Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2023; 24:S28-S44. [PMID: 36661434 PMCID: PMC9869462 DOI: 10.1097/pcc.0000000000003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To summarize the evidence for the Second Pediatric Acute Lung Injury Consensus Conference-2 (PALICC-2) recommendations for assessment of outcomes among patients surviving pediatric acute respiratory distress syndrome (PARDS). DATA SOURCES MEDLINE (Ovid), Embase (Elsevier), and CINAHL Complete (EBSCOhost). STUDY SELECTION We conducted a scoping review to identify studies evaluating outcomes following PARDS. We included studies of survivors of PARDS, acute respiratory failure with a high proportion of PARDS patients, or other critical illnesses if PARDS-specific outcomes could be extracted. DATA EXTRACTION Title/abstract review, full-text review, and data extraction using a standardized data collection form. DATA SYNTHESIS The Grading of Recommendations Assessment, Development and Evaluation approach was used to identify and summarize evidence and develop recommendations. Of 8,037 abstracts screened, we identified 20 articles for inclusion. Morbidity following PARDS was common and affected multiple domains of pulmonary and nonpulmonary function. There was insufficient evidence to generate any evidence-based recommendations. We generated eight good practice statements and five research statements. A panel of 52 experts discussed each proposed good practice statement and research statement, and the agreement rate was measured with an online voting process. Good practice statements describe the approach to clinical outcome assessment, assessment of pulmonary outcomes of children surviving PARDS, and assessment of nonpulmonary outcomes of children surviving PARDS including health-related quality of life and physical, neurocognitive, emotional, family, and social functioning. The five research statements relate to assessment of patient preillness status, use of postdischarge endpoints for clinical trials, the association between short-term and longer term outcomes, the trajectory of recovery following PARDS, and practices to optimize follow-up. CONCLUSIONS There is increasing evidence that children are at risk for impairments across a range of pulmonary and nonpulmonary health domains following hospitalization for PARDS. The results of this extensive scoping review and consensus conference involving experts in PARDS research, clinical care, and outcomes assessment provide guidance to clinicians and researchers on postdischarge follow-up to optimize the long-term health of patients surviving PARDS.
Collapse
Affiliation(s)
- Elizabeth Y. Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Aline B. Maddux
- Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Sze Man Tse
- Department of Pediatrics, University of Montréal, Montréal, Canada
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center, Montréal, Québec, Canada
| | - R. Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Child Health, Behavior, & Development, Seattle Children’s Research Institute, Seattle, WA
| | | |
Collapse
|
11
|
Vanderhaeghen SFM, Decruyenaere JM, Benoit DD, Oeyen SG. Organization, feasibility and patient appreciation of a follow-up consultation in surgical critically ill patients with favorable baseline quality of life and prolonged ICU-stay: a pilot study. Acta Clin Belg 2023; 78:25-35. [PMID: 35261330 DOI: 10.1080/17843286.2022.2050003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Intensive care unit (ICU) survivors are often left with impairments in physical, mental and cognitive functioning (Post-Intensive Care Syndrome (PICS)). We evaluated the organization, the feasibility for caregivers and patients and the patients' appreciation of a post-ICU consultation aiming to detect these PICS-symptoms. METHODS A single-center prospective observational pilot study was conducted during an 18 month-period in the surgical ICU of a tertiary care hospital. Consecutive adult patients with an ICU-stay of ≥8 days and a favorable baseline quality of life (utility index ≥0.6 on EQ-5D-3 L) were eligible for inclusion. A post-ICU follow-up consultation consisting of a structured interview was scheduled 3 months after hospital discharge. Characteristics of the consultation (CG) and no consultation group (NCG) were compared. P-values <0.05 were considered significant. RESULTS Of 133 eligible patients, 85 (64%) consented for the study and 42 (49%) attended the consultation. A total of 148 phone calls were made to schedule the consultations. Consultations took a median of 68 (61-74) minutes. Compared to CG-patients, NCG-patients were more often discharged to a care facility (P = 0.003) and had more problems with mobility (P = 0.014), self-care (P < 0.001) and usual activities (P = 0.005) after 3 months. At least one PICS-related problem was documented in all patients in the CG and NCG. Thirty-four CG-patients (81%) appreciated the initiative. CONCLUSION Organizing an ICU-follow-up consultation was difficult and feasibility was low, but most attending patients appreciated the initiative. Better developed structures for ICU-follow-up are needed in view of the high number of PICS-related problems documented.
Collapse
Affiliation(s)
| | | | | | - Sandra G Oeyen
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
12
|
Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
Collapse
Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| |
Collapse
|
13
|
Holod AF, Choi J, Tate J. Optimizing Recovery Following Critical Illness: A Systematic Review of Home-Based Interventions. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221127440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Around 5 million Americans are treated in an intensive care unit (ICU) annually. Upon discharge, it is not uncommon for ICU survivors to experience psychological, physical, or cognitive symptoms related to their ICU stay. Home-based interventions have been touted as a potential treatment modality for post-ICU sequelae. However, limited evidence exists regarding the effectiveness of home-based interventions for patients in the post-ICU recovery period. As such, the purpose of this review was to aggregate and summarize the findings of studies focused on post-ICU rehabilitation, following critical illness, delivered in the home setting. A literature search was performed in MEDLINE, CINAHL, EMBASE, APA PsycINFO, and Google Scholar. Studies were included if they: used a RCT or quasi-experimental study design; included participants aged ≥18 years discharged home from an ICU; examined the effectiveness of a home-based, post-ICU intervention; were published in English after the year 2010; and were peer-reviewed. Nine studies met inclusion criteria. Sample sizes ranged from 21 to 386, with most participants receiving mechanical ventilation. Target outcomes included: physical function, psychological well-being, cognitive function, quality of life, and healthcare utilization. Interventions included face-to-face, web-based, telephone, or self-directed activities. Findings of included studies were mixed or inconclusive. Limitations of this review include: inclusion of only adult ICU survivors, exclusion of Post-Intensive Care Syndrome as a search term, and search restricted to pre-pandemic studies. Findings suggest a need for more rigorous research to develop and test home-based interventions.
Collapse
Affiliation(s)
- Alicia F. Holod
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - JiYeon Choi
- Yonsei University College of Nursing, Seoul, South Korea
| | - Judith Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
| |
Collapse
|
14
|
Post-Intensive Care COVID Survivorship Clinic: A Single-Center Experience. Crit Care Explor 2022; 4:e0700. [PMID: 35783553 PMCID: PMC9243244 DOI: 10.1097/cce.0000000000000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients discharged from the ICU post-COVID-19 pneumonitis may experience long-term morbidity related to their critical illness, the treatment for this and the ICU environment. The aim of this study was to characterize the cognitive, psychologic, and physical consequences of COVID-19 in patients admitted to the ICU and discharged alive.
Collapse
|
15
|
Horlait G, Beaudart C, Bougard L, Bornheim S, Colson C, Misset B, Bruyère O, Boustani M, Rousseau AF. Post-intensive care screening: French translation and validation of the Healthy Aging Brain Care-Monitor, hybrid version. Health Qual Life Outcomes 2022; 20:59. [PMID: 35366901 PMCID: PMC8976274 DOI: 10.1186/s12955-022-01967-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Healthy Aging Brain Care-Monitor (HABC-M) questionnaires (self-reported version and caregiver version) have been validated for post-intensive care syndrome (PICS) detection in patients surviving a stay in the intensive care unit (ICU). Their authors have also developed a hybrid version (HABC-M-HV) suited to the daily needs of their post-ICU follow-up clinic. The objectives of the present cross-sectional observational study were to translate the HABC-M-HV questionnaire into French (HABC-M-HV-F) according to international guidelines and to test its measurement properties. Methods The HABC-M-HV was translated according to international guidelines. The measurement performances of the questionnaire were tested using internal consistency, test–retest reliability, Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) calculation, floor and ceiling effect measurement and construct validity. Results The validation study included 51 ICU survivors (27.5% women, 63 [55–71] years old). The questionnaire was administered by phone. The internal consistency was very good (Cronbach’s alpha coefficient 0.79). The intra- and inter-examinator reliabilities were excellent (Intraclass Coefficient Correlation = 0.99 and 0.97, respectively). The SEM was 0.62 and the SDC was 1.72. No floor or ceiling effects were observed. The convergent validity was almost entirely confirmed with 71.4% of our hypothesis confirmed. Conclusion The HABC-M-HV-F has been shown to be a valid and reliable tool for PICS screening and follow-up in French-speaking ICU survivors. A remote administration by phone was feasible. Trial registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01967-1.
Collapse
|
16
|
Bartel NJ, Boyle DW, Hines AC, Tomlin AM, Nitu ME, Szczepaniak D, Abu-Sultaneh SMA. Virtual Developmental Screening After Invasive Mechanical Ventilation in Children: A Prospective Cohort Pilot Study. Pediatr Crit Care Med 2022; 23:e219-e223. [PMID: 34991139 DOI: 10.1097/pcc.0000000000002888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With decreasing PICU mortality, survivor morbidity has increased. This study aims to evaluate feasibility of virtual PICU-led follow-up of patients at risk for pediatric postintensive care syndrome. DESIGN Prospective cohort study. SETTING Single-center, quaternary children's hospital. PATIENTS Children less than or equal to 4 years without known preexisting neurodevelopmental deficits requiring greater than or equal to 12 hours mechanical ventilation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Age-appropriate Ages and Stages Questionnaires, Third Edition (ASQ-3) were administered via a web-based system at 3, 6, and 12 months following PICU discharge. Primary-care physicians were notified of results; at-risk patients were referred to early developmental intervention. Forty-eight patients enrolled with median age 11.5 months (interquartile range [IQR], 2-19.5 mo) and median mechanical ventilation duration 92.5 hours (IQR, 40.5-147 hr). Fifty-eight percent completed greater than or equal to 1 ASQ-3. Lower caregiver educational achievement, lower income, and single-caregiver status were associated with lower ASQ-3 completion rates. Of those completing any ASQ-3, 50% flagged as at-risk for developmental delay and referred to early developmental intervention. There was no association between patient characteristics and abnormal ASQ-3. CONCLUSIONS Virtual caregiver-completed surveillance is a promising method to screen children for neurodevelopmental abnormalities following PICU hospitalization and facilitate early referral for developmental intervention, but special attention must be dedicated to families with limited resources for follow-up.
Collapse
Affiliation(s)
- Nicholas J Bartel
- Department of Pediatrics, Indiana University Schoolof Medicine, Indianapolis, IN
| | - David W Boyle
- Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Abbey C Hines
- Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Angela M Tomlin
- Department of Child Development, Indiana University School of Medicine, Indianapolis, IN
| | - Mara E Nitu
- Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Dorota Szczepaniak
- Department of Pediatrics, Indiana University Schoolof Medicine, Indianapolis, IN
| | - Samer M A Abu-Sultaneh
- Division of Pediatric Critical Care, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| |
Collapse
|
17
|
Abstract
The multifaceted long-term impairments resulting from critical illness and COVID-19 require interdisciplinary management approaches in the recovery phase of illness. Operational insights into the structure and process of recovery clinics (RCs) from heterogeneous health systems are needed. This study describes the structure and process characteristics of existing and newly implemented ICU-RCs and COVID-RCs in a subset of large health systems in the United States.
Collapse
|
18
|
Turnbull AE, Ji H, Dinglas VD, Wu AW, Mendez-Tellez PA, Himmelfarb CD, Shanholtz CB, Hosey MM, Hopkins RO, Needham DM. Understanding Patients' Perceived Health After Critical Illness: Analysis of Two Prospective, Longitudinal Studies of ARDS Survivors. Chest 2022; 161:407-417. [PMID: 34419426 PMCID: PMC8941599 DOI: 10.1016/j.chest.2021.07.2177] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Perceived health is one of the strongest determinants of subjective well-being, but it has received little attention among survivors of ARDS. RESEARCH QUESTION How well do self-reported measures of physical, emotional, and social functioning predict perceived overall health (measured using the EQ-5D visual analog scale [EQ-5D-VAS]) among adult survivors of ARDS? Are demographic features, comorbidity, or severity of illness correlated with perceived health after controlling for self-reported functioning? STUDY DESIGN AND METHODS We analyzed the ARDSNet Long Term Outcomes Study (ALTOS) and Improving Care of Acute Lung Injury Patients (ICAP) Study, two longitudinal cohorts with a total of 823 survivors from 44 US hospitals, which prospectively assessed survivors at 6 and 12 months after ARDS. Perceived health, evaluated using the EQ-5D-VAS, was predicted using ridge regression and self-reported measures of physical, emotional, and social functioning. The difference between observed and predicted perceived health was termed perspective deviation (PD). Correlations between PD and demographics, comorbidities, and severity of illness were explored. RESULTS The correlation between observed and predicted EQ-5D-VAS scores ranged from 0.68 to 0.73 across the two cohorts and time points. PD ranged from -80 to +34 and was more than the minimum clinically important difference for 52% to 55% of survivors. Neither demographic features, comorbidity, nor severity of illness were correlated strongly with PD, with |r| < 0.25 for all continuous variables in both cohorts and time points. The correlation between PD at 6- and 12-month assessments was weak (ALTOS: r = 0.22, P < .001; ICAP: r = 0.20, P = .02). INTERPRETATION About half of survivors of ARDS showed clinically important differences in actual perceived health vs predicted perceived health based on self-reported measures of functioning. Survivors of ARDS demographic features, comorbidities, and severity of illness were correlated only weakly with perceived health after controlling for measures of perceived functioning, highlighting the challenge of predicting how individual patients will respond psychologically to new impairments after critical illness.
Collapse
Affiliation(s)
- Alison E Turnbull
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Hongkai Ji
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Albert W Wu
- Center for Health Services and Outcomes Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Division of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Pedro A Mendez-Tellez
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Cheryl Dennison Himmelfarb
- Office for Science and Innovation, Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Carl B Shanholtz
- Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD
| | - Megan M Hosey
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT; Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD; Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
19
|
Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. SPLIT ENZ: Survivorship of Patients post Long Intensive care stay, Exploration/Experience in a New Zealand cohort (A mixed methods study protocol) (Preprint). JMIR Res Protoc 2021; 11:e35936. [PMID: 35297773 PMCID: PMC8972103 DOI: 10.2196/35936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment–BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/35936
Collapse
Affiliation(s)
- Lynsey Sutton
- Intensive Care Unit, Level 3, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| |
Collapse
|
20
|
Parker AM, Brigham E, Connolly B, McPeake J, Agranovich AV, Kenes MT, Casey K, Reynolds C, Schmidt KFR, Kim SY, Kaplin A, Sevin CM, Brodsky MB, Turnbull AE. Addressing the post-acute sequelae of SARS-CoV-2 infection: a multidisciplinary model of care. THE LANCET. RESPIRATORY MEDICINE 2021; 9:1328-1341. [PMID: 34678213 PMCID: PMC8525917 DOI: 10.1016/s2213-2600(21)00385-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
As of July 31, 2021, SARS-CoV-2 had infected almost 200 million people worldwide. The growing burden of survivorship is substantial in terms of the complexity of long-term health effects and the number of people affected. Persistent symptoms have been reported in patients with both mild and severe acute COVID-19, including those admitted to the intensive care unit (ICU). Early reports on the post-acute sequelae of SARS-CoV-2 infection (PASC) indicate that fatigue, dyspnoea, cough, headache, loss of taste or smell, and cognitive or mental health impairments are among the most common symptoms. These complex, multifactorial impairments across the domains of physical, cognitive, and mental health require a coordinated, multidisciplinary approach to management. Decades of research on the multifaceted needs of and models of care for patients with post-intensive care syndrome provide a framework for the development of PASC clinics to address the immediate needs of both hospitalised and non-hospitalised survivors of COVID-19. Such clinics could also provide a platform for rigorous research into the natural history of PASC and the potential benefits of therapeutic interventions.
Collapse
Affiliation(s)
- Ann M Parker
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Emily Brigham
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Bronwen Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK; Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Joanne McPeake
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Anna V Agranovich
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Michael T Kenes
- College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Kelly Casey
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia Reynolds
- Sydney and Lois Eskenazi Health Critical Care Recovery Center, Indianapolis, IN, USA
| | - Konrad F R Schmidt
- Institutes of General Practice & Family Medicine, Charité University Medicine, Berlin, Germany; Institute of General Practice & Family Medicine, Jena University Hospital, Jena, Germany
| | - Soo Yeon Kim
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Adam Kaplin
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Martin B Brodsky
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Parents' experiences during and after their child's stay in the paediatric intensive care unit - A qualitative interview study. Intensive Crit Care Nurs 2021; 67:103089. [PMID: 34238647 DOI: 10.1016/j.iccn.2021.103089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Having a child admitted to the paediatric intensive care unit (PICU) is often an emotional and stressful experience for parents. AIM The aim of the study was to explore parents' experiences during and after their child's hospitalization in the PICU and to investigate whether parents have a need for post-PICU follow-up. MATERIAL AND METHODS The research design was a qualitative study inspired by Ricoeur's phenomenological-hermeneutic approach. The context of the study was a six-bed PICU in a university hospital in Denmark. In 2017, semi-structured interviews were conducted with four couples and three mothers six to 14 weeks after their child had been discharged from the PICU. The data were analysed and interpreted through Ricoeur's three analytical levels and presented in themes and subthemes. FINDINGS Three themes were identified in the analytical process: "The challenging PICU stay", "The value of a network" and "The uncertain post-PICU trajectory". CONCLUSION Information, dialogue and interaction with familiar health professionals, the diary written by PICU nurses, the parents' personal network and social media supported the parents during and after the PICU stay. The parents expressed that post-PICU follow-up was not the most essential but that follow-up initiatives may be arranged individually.
Collapse
|
23
|
[Post-intensive care syndrome]. Rev Med Interne 2021; 42:855-861. [PMID: 34088516 DOI: 10.1016/j.revmed.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022]
Abstract
Post-intensive care syndrome is an entity defined in 2010 and covering any sequelae following an extended hospitalization in intensive care unit. It comprises psychological, cognitive and physical disorders (neuromyopathy, respiratory dysfunction, joint stiffness, among others). These sequelae have important consequences on autonomy and quality of life of these patients, as well as on their healthcare consumption and on mortality. Psychological sequelae can also be seen in hospitalized patients' relatives. Screening and management of these disorders is more and more frequent but no method has formally proven effective. The number of patients surviving an intensive care unit hospitalization is increasing, and management of post-intensive care syndrome is a major issue. It seems important that the internist be aware of this syndrome, given his pivotal role in global management of patients and frequent implication into care after the intensive care unit.
Collapse
|
24
|
A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project. Crit Care Med 2021; 48:e1164-e1170. [PMID: 33003081 DOI: 10.1097/ccm.0000000000004579] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care. DESIGN Population health quality improvement comparative study with retrospective data analysis. SETTING A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs. PATIENTS ICU survivors. INTERVENTIONS Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process. MEASUREMENTS AND MAIN RESULTS Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed. CONCLUSIONS Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.
Collapse
|
25
|
Prediction Models for Physical, Cognitive, and Mental Health Impairments After Critical Illness: A Systematic Review and Critical Appraisal. Crit Care Med 2021; 48:1871-1880. [PMID: 33060502 PMCID: PMC7673641 DOI: 10.1097/ccm.0000000000004659] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Objectives: Improved ability to predict impairments after critical illness could guide clinical decision-making, inform trial enrollment, and facilitate comprehensive patient recovery. A systematic review of the literature was conducted to investigate whether physical, cognitive, and mental health impairments could be predicted in adult survivors of critical illness. Data Sources: A systematic search of PubMed and the Cochrane Library (Prospective Register of Systematic Reviews ID: CRD42018117255) was undertaken on December 8, 2018, and the final searches updated on January 20, 2019. Study Selection: Four independent reviewers assessed titles and abstracts against study eligibility criteria. Studies were eligible if a prediction model was developed, validated, or updated for impairments after critical illness in adult patients. Discrepancies were resolved by consensus or an independent adjudicator. Data Extraction: Data on study characteristics, timing of outcome measurement, candidate predictors, and analytic strategies used were extracted. Risk of bias was assessed using the Prediction model Risk Of Bias Assessment Tool. Data Synthesis: Of 8,549 screened studies, three studies met inclusion. All three studies focused on the development of a prediction model to predict (1) a mental health composite outcome at 3 months post discharge, (2) return-to-pre-ICU functioning and residence at 6 months post discharge, and (3) physical function 2 months post discharge. Only one model had been externally validated. All studies had a high risk of bias, primarily due to the sample size, and statistical methods used to develop and select the predictors for the prediction published model. Conclusions: We only found three studies that developed a prediction model of any post-ICU impairment. There are several opportunities for improvement for future prediction model development, including the use of standardized outcomes and time horizons, and improved study design and statistical methodology.
Collapse
|
26
|
Rohr M, Brandstetter S, Bernardi C, Fisser C, Drewitz KP, Brunnthaler V, Schmidt K, Malfertheiner MV, Apfelbacher CJ. Piloting an ICU follow-up clinic to improve health-related quality of life in ICU survivors after a prolonged intensive care stay (PINA): study protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2021; 7:90. [PMID: 33785064 PMCID: PMC8007452 DOI: 10.1186/s40814-021-00796-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
Background Intensive care unit (ICU) survivors often suffer from cognitive, physical and mental impairments, known as post-intensive care syndrome (PICS). ICU follow-up clinics may improve aftercare of these patients. There is a lack of evidence whether or which concept of an ICU follow-up clinic is effective. Within the PINA study, a concept for an ICU follow-up clinic was developed and will be tested in a pilot randomised controlled trial (RCT), primarily to evaluate the feasibility and additionally the potential efficacy. Methods/design Design: Pilot RCT with intervention and control (usual care) arms plus mixed-methods process evaluation. Participants: 100 ICU patients (50 per arm) of three ICUs in a university hospital (Regensburg, Germany), ≥ 18 years with an ICU stay of > 5 days, a sequential organ failure assessment (SOFA) score > 5 during the ICU stay and a life expectancy of more than 6 months. Intervention: The intervention will contain three components: information, consultation and networking. Information will be available in form of an intensive care guide for patients and next of kin at the ICU and phone support during follow-up. For consultation, patients will visit the ICU follow-up clinic at least once during the first 6 months after discharge from ICU. During these visits, patients will be screened for symptoms of PICS and, if required, referred to specialists for further treatment. The networking part (e.g. special referral letter from the ICU follow-up clinic) aims to provide a network of outpatient care providers for former ICU patients. Feasibility Outcomes: Qualitative and quantitative evaluation will be used to explore reasons for non-participation and the intervention´s acceptability to patients and caregivers. Efficacy Outcomes: Health-related quality of life (HRQOL) will be assessed as primary outcome by the physical component score (PCS) of the Short-Form 12 Questionnaire (SF-12). Secondary outcomes encompass further patient-reported outcomes. All outcomes are assessed at 6 months after discharge from ICU. Discussion The PINA study will determine feasibility and potential efficacy of a complex intervention in a pilot RCT to enhance follow-up care of ICU survivors. The pilot study is an important step for further studies in the field of ICU aftercare and especially for the implementation of a pragmatic multi-centre RCT. Trial registration ClinicalTrials.gov, NCT04186468. Submitted 2 December 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00796-1.
Collapse
Affiliation(s)
- M Rohr
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.
| | - S Brandstetter
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,University Children's Hospital Regensburg, University of Regensburg, Klinik St. Hedwig, Steinmetzstr., 1-3, 93049, Regensburg, Germany
| | - C Bernardi
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - C Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - K P Drewitz
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - V Brunnthaler
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany
| | - K Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, 10117, Berlin, Germany.,Institute of General Practice and Family Medicine, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - M V Malfertheiner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C J Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Dr.-Gessler-Str. 17, 93051, Regensburg, Germany.,Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| |
Collapse
|
27
|
Curb Your Enthusiasm: Definitions, Adaptation, and Expectations for Quality of Life in ICU Survivorship. Ann Am Thorac Soc 2021; 17:406-411. [PMID: 31944829 DOI: 10.1513/annalsats.201910-772ip] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
28
|
Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis. Ann Am Thorac Soc 2021; 17:89-97. [PMID: 31644304 DOI: 10.1513/annalsats.201907-514oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Rationale: Postsepsis care recommendations target specific deficits experienced by sepsis survivors in elements such as optimization of medications, screening for functional impairments, monitoring for common and preventable causes of health deterioration, and consideration of palliative care. However, few data are available regarding the application of these elements in clinical practice.Objectives: To quantify the delivery of postsepsis care for patients discharged after hospital admission for sepsis and evaluate the association between receipt of postsepsis care elements and reduced mortality and hospital readmission within 90 days.Methods: We conducted a retrospective chart review of a random sample of patients who were discharged alive after an admission for sepsis (identified from International Classification of Diseases, 10th Revision discharge codes) at 10 hospitals during 2017. We used a structured chart abstraction to determine whether four elements of postsepsis care were provided within 90 days of hospital discharge, per expert recommendations. We used multivariable logistic regression to evaluate the association between receipt of care elements and 90-day hospital readmission and mortality, adjusted for age, comorbidity, length of stay, and discharge disposition.Results: Among 189 sepsis survivors, 117 (62%) had medications optimized, 123 (65%) had screening for functional or mental health impairments, 86 (46%) were monitored for common and preventable causes of health deterioration, and 110 (58%) had care alignment processes documented (i.e., assessed for palliative care or goals of care). Only 20 (11%) received all four care elements within 90 days. Within 90 days of discharge, 66 (35%) patients were readmitted and 33 (17%) died (total patients readmitted or died, n = 82). Receipt of two (odds ratio [OR], 0.26; 95% confidence interval [95% CI], 0.10-0.69) or more (three OR, 0.28; 95% CI, 0.11-0.72; four OR, 0.12; 95% CI, 0.03-0.50) care elements was associated with lower odds of 90-day readmission or 90-day mortality compared with zero or one element documented. Optimization of medications (no medication errors vs. one or more errors; OR, 0.44; 95% CI, 0.21-0.92), documented functional or mental health assessments (physical function plus swallowing/mental health assessments vs. no assessments; OR, 0.14; 95% CI, 0.05-0.40), and documented goals of care or palliative care screening (OR, 0.52; 95% CI, 0.25-1.05; not statistically significant) were associated with lower odds of 90-day readmission or 90-day mortality.Conclusions: In this retrospective cohort study of data from a single health system, we found variable delivery of recommended postsepsis care elements that were associated with reduced morbidity and mortality after hospitalization for sepsis. Implementation strategies to efficiently overcome barriers to adopting recommended postsepsis care may help improve outcomes for sepsis survivors.
Collapse
|
29
|
Mayr FB, Plowman JL, Blakowski S, Sell-Shemansky K, Young JM, Yende S. Feasibility of a Home-Based Palliative Care Intervention for Elderly Multimorbid Survivors of Critical Illness. Am J Crit Care 2021; 30:e12-e31. [PMID: 33385209 DOI: 10.4037/ajcc2021117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Elderly patients frequently experience deteriorating health after critical illness, which may threaten their independence and predispose them to unplanned hospital readmissions and premature death. OBJECTIVES To evaluate the operational feasibility of a 90-day home-based palliative care intervention in multimorbid elderly Veteran survivors of critical illness. METHODS A multidisciplinary home-based palliative care intervention was provided for multimorbid elderly veterans who were discharged home after admission to the intensive care unit for sepsis, pneumonia, heart failure, or exacerbation of chronic obstructive lung disease. RESULTS Fifteen patients enrolled in the study, 11 (73%) of whom completed all visits; thus the prespecified goal of >70% completion was met. Median (interquartile range [IQR]) age of the patients was 76 (69-87) years. Participants had a median (IQR) of 8 (7-8) concurrent chronic health conditions, were moderately debilitated at baseline, and were all male. The median (IQR) time to the first study visit was 8 (5-12) days. Patients had a median (IQR) of 8 (5-11) in-home visits and 6 (3-7) telephone encounters during the 90-day study period. Nurses spent a median (IQR) cumulative time of 330 (240-585) minutes on home visits and 30 (10-70) minutes on telephone visits. The median (IQR) time per home provider visit was 90 (75-90) minutes. We estimated the median (IQR) cost per patient to be $2321 ($1901-$3331). CONCLUSION A comprehensive home-based palliative care intervention is operationally feasible in elderly multi-morbid survivors of critical illness and may result in improved physical functioning and quality of life and fewer unplanned emergency department visits.
Collapse
Affiliation(s)
- Florian B. Mayr
- Florian B. Mayr is a staff physician, Critical Care Service Line, VA Pittsburgh Healthcare System, and an assistant professor, Clinical Research, Investigation, and Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Judith L. Plowman
- Judith L. Plowman is a staff physician, Community Based Care Service Line, VA Pittsburgh Healthcare System
| | - Sandra Blakowski
- Sandra Blakowski is a section chief, Medicine Service Line, Division of Palliative Care and Hospice, VA Pittsburgh Healthcare System
| | - Kimberly Sell-Shemansky
- Kimberly Sell-Shemansky is a vice-president, Community Based Care Service Line, VA Pittsburgh Healthcare System
| | - Joleene M. Young
- Joleene M. Young is a nurse practitioner, Critical Care Service Line, VA Pittsburgh Healthcare System
| | - Sachin Yende
- Sachin Yende is a vice-president, Critical Care Service Line, VA Pittsburgh Healthcare System, and a professor, Clinical Research, Investigation, and Modeling of Acute Illness Center, Department of Critical Care Medicine, University of Pittsburgh
| |
Collapse
|
30
|
Calkins K, Kako P, Guttormson J. Patients' experiences of recovery: Beyond the intensive care unit and into the community. J Adv Nurs 2020; 77:1867-1877. [PMID: 33349962 DOI: 10.1111/jan.14729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
AIMS To understand barriers and facilitators of recovery for critical illness survivors', who are discharged home from the hospital and do not have access to dedicated outpatient care. DESIGN Multi-site descriptive study guided by interpretive phenomenology using semi-structured interviews. METHODS Interviews were conducted between December 2017 -July 2018. Eighteen participants were included. Data were collected from interview recordings, transcripts, field notes, and a retrospective chart review for sample demographics. Analysis was completed using Interpretive Phenomenological Analysis which provided a unique view of recovery through the survivors' personal experiences and perception of those experiences. RESULTS Participants encountered several barriers to their recovery; however, they were resilient and initiated ways to overcome these barriers and assist with their recovery. Facilitators of recovery experienced by survivors included seeking support from family and friends, lifestyle adaptations, and creative management of their multiple medical needs. Barriers included unmet needs experienced by survivors such as mental health issues, coordination of care, and spiritual needs. These unmet needs left participants feeling unsupported from healthcare providers during their recovery. CONCLUSION This study highlights important barriers and facilitators experienced by critical illness survivors during recovery that need be addressed by healthcare providers. New ways to support critical illness survivors, that can reach a broader population, must be developed and evaluated to support survivors during their recovery in the community. IMPACT This study addressed ICU survivors' barriers and facilitators to recovery. Participants encountered several barriers to recovery at home, such as physical, cognitive, psychosocial, financial, and transportation barriers, however, these survivors were also resilient and resourceful in the development of strategies to try to manage their recovery at home. These results will help healthcare providers develop interventions to better support ICU survivors in the community.
Collapse
Affiliation(s)
| | - Peninnah Kako
- University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | | |
Collapse
|
31
|
Prevedello D, Fiore M, Creteur J, Preiser JC. Intensive care units follow-up: a scoping review protocol. BMJ Open 2020; 10:e037725. [PMID: 33148730 PMCID: PMC7643502 DOI: 10.1136/bmjopen-2020-037725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/30/2020] [Accepted: 10/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Increasing numbers of patients are surviving critical illness, leading to growing concern about the potential impact of the long-term consequences of intensive care on patients, families and society as a whole. These long-term effects are together known as postintensive care syndrome and their presence can be evaluated at intensive care unit (ICU) follow-up consultations. However, the services provided by these consultations vary across hospitals and units, in part because there is no validated standard model to evaluate patients and their quality of life after ICU discharge. We describe a protocol for a scoping review focusing on models of ICU follow-up and the impact of such strategies on improving patient quality of life. METHODS AND ANALYSIS In this scoping review, we will search the literature systematically using electronic databases (MEDLINE - from database inception to June 15th 2020) and a grey literature search. We will involve stakeholders as recommended by the Joanna Briggs Institute approach developed by Peters et al. The research will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION This study does not require ethics approval, because data will be obtained through a review of published primary studies. The results of our evaluation will be published in a peer-reviewed journal and will also be disseminated through presentations at national and international conferences.
Collapse
Affiliation(s)
- Danielle Prevedello
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Marco Fiore
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - Jacques Creteur
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| | - J C Preiser
- Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium
| |
Collapse
|
32
|
Parker AM, Nelliot A, Chessare CM, Malik AM, Koneru M, Hosey MM, Ozok AA, Lyons KD, Needham DM. Usability and acceptability of a mobile application prototype for a combined behavioural activation and physical rehabilitation intervention in acute respiratory failure survivors. Aust Crit Care 2020; 33:511-517. [PMID: 32340769 DOI: 10.1016/j.aucc.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Acute respiratory failure survivors experience depression symptoms and new impairments in physical function. Behavioural activation, an evidence-based nonpharmacological treatment for depression, combined with physical rehabilitation, is a promising intervention. Notably, mHealth applications (Apps) are potentially effective methods of delivering home-based interventions. OBJECTIVES The objective of this study was to evaluate the usability and acceptability of a prototype App to deliver a combined, home-based behavioural activation and rehabilitation intervention to acute respiratory failure survivors. METHODS A prospective user-preference study was conducted with acute respiratory failure survivors and self-designated care partners. Survivors were adults with at least mild depression symptoms before hospital discharge who received mechanical ventilation in the intensive care unit for ≥24 h. Survivors and care partners reviewed the App during a single in-person home visit and completed the System Usability Scale (range: 0-100; score >73 considered "good") and a semistructured interview. RESULTS Ten patient/care partner dyads completed study. The median [interquartile range] patient age was 50 [40-64] years, and 50% were female. The median System Usability Scale scores among patients and care partners were 76 [68-83] and 88 [75-94], respectively. Qualitative feedback supported usability and acceptability of the App, with three themes reported: (1) stigma associated with depression, (2) App as a motivator for recovery, and (3) App providing multidisciplinary support for survivor and care partner. CONCLUSIONS A mobile App prototype designed to deliver a combined behavioural activation and rehabilitation intervention was usable and acceptable to survivors of acute respiratory failure and their care partners. Given the reported stigma associated with depression, the self-directed App may be particularly valuable for motivation and multidisciplinary support.
Collapse
Affiliation(s)
- Ann M Parker
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Archana Nelliot
- Department of Pediatrics, Hershey Medical Center, Hershey, PA, USA
| | - Caroline M Chessare
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albahi M Malik
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounica Koneru
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan M Hosey
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Ant Ozok
- Department of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Kathleen D Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Dartmouth College, Hanover, NH, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
33
|
Bai C, Chotirmall SH, Rello J, Alba GA, Ginns LC, Krishnan JA, Rogers R, Bendstrup E, Burgel PR, Chalmers JD, Chua A, Crothers KA, Duggal A, Kim YW, Laffey JG, Luna CM, Niederman MS, Raghu G, Ramirez JA, Riera J, Roca O, Tamae-Kakazu M, Torres A, Watkins RR, Barrecheguren M, Belliato M, Chami HA, Chen R, Cortes-Puentes GA, Delacruz C, Hayes MM, Heunks LMA, Holets SR, Hough CL, Jagpal S, Jeon K, Johkoh T, Lee MM, Liebler J, McElvaney GN, Moskowitz A, Oeckler RA, Ojanguren I, O'Regan A, Pletz MW, Rhee CK, Schultz MJ, Storti E, Strange C, Thomson CC, Torriani FJ, Wang X, Wuyts W, Xu T, Yang D, Zhang Z, Wilson KC. Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020). Eur Respir Rev 2020; 29:29/157/200287. [PMID: 33020069 PMCID: PMC7537943 DOI: 10.1183/16000617.0287-2020] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.
Collapse
Affiliation(s)
- Chunxue Bai
- Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jordi Rello
- Vall d'Hebron Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,CHU Nîmes, Nîmes, France
| | - George A Alba
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leo C Ginns
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jerry A Krishnan
- Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert Rogers
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Pierre-Regis Burgel
- Dept of Respiratory Medicine, Cochin Hospital, Assistance Publique Hopîtaux de Paris, Université de Paris and Institut Cochin, Inserm U1016, Paris, France
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Abigail Chua
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Kristina A Crothers
- Dept of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle WA, USA
| | - Abhijit Duggal
- Dept of Critical Care, Cleveland Clinic, Cleveland OH, USA
| | - Yeon Wook Kim
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - John G Laffey
- Dept of Anesthesia and Intensive Care Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - Carlos M Luna
- Dept of Medicine, Pulmonary Diseases Division, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Michael S Niederman
- Division of Pulmonary and Critical Care, Dept of Medicine, Weill Cornell Medicine, New York NY, USA
| | - Ganesh Raghu
- Dept of Medicine, University of Washington, Seattle WA, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, Dept of Medicine, University of Louisville, Louisville KY, USA
| | - Jordi Riera
- Vall d'Hebron Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Critical Care Dept, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain.,Dept de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Oriol Roca
- Vall d'Hebron Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Critical Care Dept, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain.,Dept de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maximiliano Tamae-Kakazu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Spectrum Health-Michigan State University, Grand Rapids MI, USA
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Pulmonology Dept, University of Barcelona Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Richard R Watkins
- Dept of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.,Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH, USA
| | - Miriam Barrecheguren
- Respiratory Dept, Vall d'Hebron University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - Mirko Belliato
- UOC Anestesia e Rianimazione 1, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hassan A Chami
- Dept of Medicine, American University of Beirut, Beirut, Lebanon
| | - Rongchang Chen
- Dept of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital, First Affiliated Hospital of South University of Science and Technology of China, Shenzhen, China
| | | | - Charles Delacruz
- Dept of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven CT, USA
| | - Margaret M Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston MA, USA
| | - Leo M A Heunks
- Dept of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Catherine L Hough
- Division of Pulmonary and Critical Care, Dept of Medicine, Oregon Health Sciences University, Portland, OR, USA
| | - Sugeet Jagpal
- Dept of Medicine, Robert Wood Johnson University Hospital, New Brunswick NJ, USA
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Takeshi Johkoh
- Dept of Radiology, Kansai Rosai Hospital, Amagaski, Japan
| | - May M Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, University of Southern California, Los Angeles CA, USA
| | - Janice Liebler
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, University of Southern California, Los Angeles CA, USA
| | - Gerry N McElvaney
- Department of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ari Moskowitz
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston MA, USA
| | | | - Iñigo Ojanguren
- Respiratory Dept, Vall d'Hebron University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - Anthony O'Regan
- Dept of Respiratory Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - Mathias W Pletz
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Dept of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marcus J Schultz
- Dept of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Enrico Storti
- Dept of Anesthesia and Critical Care, Ospedale Maggiore di Lodi, Lodi, Italy
| | - Charlie Strange
- Dept of Medicine, Medical University of South Carolina, Charleston SC, USA
| | - Carey C Thomson
- Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge MA, Harvard Medical School, Boston MA, USA
| | - Francesca J Torriani
- Infection Prevention and Clinical Epidemiology Unit at UC San Diego Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego, San Diego CA, USA
| | - Xun Wang
- Dept of Pulmonary and Critical Care Medicine, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China
| | - Wim Wuyts
- Dept of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Tao Xu
- Dept of Pulmonary and Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Dawei Yang
- Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Ziqiang Zhang
- Dept of Pulmonary and Critical Care Medicine, Tongji Hospital Tongji University, Shanghai, China
| | - Kevin C Wilson
- Dept of Medicine, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
34
|
Gonçalves AC, Leckie T, Hunter A, Fitzpatrick D, Richardson A, Hardy B, Koulouglioti C, Venn R, Hodgson L. Technology supported rehabilitation for patients of critical illness caused by COVID-19: a protocol for a mixed-methods feasibility study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2020.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The COVID-19 pandemic has created the need for research on how to effectively rehabilitate patients who have been discharged from an intensive care unit. This study is a protocol for a mixed methods feasibility study addressing the research questions: 1) what are the needs of patients who have survived COVID-19? 2) is the use of technology feasible to support their recovery? Methods A multicentre, technology supported, rehabilitation intervention for survivors of critical illness caused by COVID-19 will be assessed. Survivors in the study population will be offered a smartwatch to monitor their activity levels and will have biopsychosocial outcome measures monitored at three time points: discharge from hospital, 2–3 months post discharge and 1 year post discharge. Semi-structured interviews will be conducted across eight hospital sites with survivors, their relatives and professionals to understand their recovery experiences. Conclusions Designed by frontline clinicians, this protocol outlines a feasibility study that will provide new knowledge on the process of recovery of critical illness caused by COVID-19.
Collapse
Affiliation(s)
| | - Todd Leckie
- Western Sussex Hospitals NHS Foundation Trust, UK
| | | | - Daniel Fitzpatrick
- University of Brighton, Brighton, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Richard Venn
- Western Sussex Hospitals NHS Foundation Trust, UK
| | - Luke Hodgson
- Western Sussex Hospitals NHS Foundation Trust, UK
- University of Surrey, Guildford, UK
| |
Collapse
|
35
|
Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: implications for rehabilitation. Br J Anaesth 2020; 125:436-440. [PMID: 32560913 PMCID: PMC7261464 DOI: 10.1016/j.bja.2020.05.021] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Harriet I Kemp
- Pain Research Group, Imperial College London, London, UK.
| | - Eve Corner
- Department of Clinical Sciences, Brunel University London, London, UK
| | - Lesley A Colvin
- Division of Population Health & Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| |
Collapse
|
36
|
An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci 2020; 190:461-468. [PMID: 32894436 PMCID: PMC7475726 DOI: 10.1007/s11845-020-02354-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
Background In January 2020, the WHO declared the SARS-CoV-2 outbreak a public health emergency; by March 11, a pandemic was declared. To date in Ireland, over 3300 patients have been admitted to acute hospitals as a result of infection with COVID-19. Aims This article aims to describe the establishment of a COVID Recovery Service, a multidisciplinary service for comprehensive follow-up of patients with a hospital diagnosis of COVID-19 pneumonia. Methods A hybrid model of virtual and in-person clinics was established, supported by a multidisciplinary team consisting of respiratory, critical care, infectious diseases, psychiatry, and psychology services. This model identifies patients who need enhanced follow-up following COVID-19 pneumonia and aims to support patients with complications of COVID-19 and those who require integrated community care. Results We describe a post-COVID-19 service structure together with detailed protocols for multidisciplinary follow-up. One hundred seventy-four patients were discharged from Beaumont Hospital after COVID-19 pneumonia. Sixty-seven percent were male with a median age (IQR) of 66.5 (51–97). Twenty-two percent were admitted to the ICU for mechanical ventilation, 11% had non-invasive ventilation or high flow oxygen, and 67% did not have specialist respiratory support. Early data suggests that 48% of these patients will require medium to long-term specialist follow-up. Conclusions We demonstrate the implementation of an integrated multidisciplinary approach to patients with COVID-19, identifying those with increased physical and mental healthcare needs. Our initial experience suggests that significant physical, psychological, and cognitive impairments may persist despite clinical resolution of the infection.
Collapse
|
37
|
Nurses’ experiences of ICU diaries following implementation of national recommendations for diaries in intensive care units: A quality improvement project. Intensive Crit Care Nurs 2020; 59:102828. [DOI: 10.1016/j.iccn.2020.102828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 11/24/2022]
|
38
|
Cook K, Bartholdy R, Raven M, von Dohren G, Rai S, Haines K, Ramanan M. A national survey of intensive care follow-up clinics in Australia. Aust Crit Care 2020; 33:533-537. [PMID: 32430169 DOI: 10.1016/j.aucc.2020.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/11/2020] [Accepted: 03/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Intensive care follow-up clinics (ICFCs) have been implemented internationally with the aim to address the growing number of patients living with sequalae of critical illness and intensive care. However, data on Australian intensive care follow-up practice are rare. OBJECTIVES The primary objective was to determine the proportion of Australian intensive care units (ICUs) that offer a dedicated ICFC to ICU survivors, with the intention of improving long-term outcomes of critical illness. Secondary objectives were to identify models of ICU follow-up and barriers to the implementation of ICFCs. METHODS A custom-designed, pilot-tested 12-question online survey was sent to the nurse unit managers and medical directors of all 167 Australian ICUs listed in the database of the Australian and New Zealand Intensive Care Society. Outcome measures included proportion of ICUs offering ICFCs, details on types of follow-up services with staffing, funding source, and reasons for not providing ICU follow-up. RESULTS One hundred seven of the 167 ICUs contacted responded to the survey. Of these, two (2%) operated a dedicated ICFC. Both ICFCs were nursing-led, with one receiving dedicated funding and the other being unfunded. Three units (3%) conducted routine outpatient follow-up by telephone; one of these services was doctor-led, and two were nurse-led. Four units (4%) were performing outpatient follow-up as part of research studies only. Among the units not operating an ICFC, the main reason given for not doing so were financial constraints (58%), followed by lack of clinical need (19%) and perceived lack of evidence (11%). CONCLUSION In Australia, only two ICUs operated an ICFC. Only one outpatient follow-up service received dedicated funding, and financial constraints were the main reason given for units not offering outpatient follow-up services.
Collapse
Affiliation(s)
- Katrina Cook
- Department of Intensive Care, Caboolture Hospital, Australia.
| | - Roland Bartholdy
- Department of Intensive Care, Caboolture Hospital, Australia; Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia; LifeFlight Queensland, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Monique Raven
- Department of Intensive Care, Redcliffe Hospital, Australia
| | | | - Sumeet Rai
- Department of Intensive Care, Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Kimberley Haines
- Department of Physiotherapy, Western Health, Melbourne, Australia; The University of Melbourne, Melbourne, Australia; ANZICS Research Centre, Melbourne, Australia
| | - Mahesh Ramanan
- Department of Intensive Care, Caboolture Hospital, Australia; Department of Intensive Care, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; The George Institute, University of New South Wales, Sydney, Australia
| |
Collapse
|
39
|
Haines KJ, McPeake J, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, Bastin AJ, Beesley SJ, Beveridge L, Butcher BW, Drumright K, Eaton TL, Farley T, Firshman P, Fritschle A, Holdsworth C, Hope AA, Johnson A, Kenes MT, Khan BA, Kloos JA, Kross EK, Mactavish P, Meyer J, Montgomery-Yates A, Quasim T, Saft HL, Slack A, Stollings J, Weinhouse G, Whitten J, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna TJ, Sevin CM. Enablers and Barriers to Implementing ICU Follow-Up Clinics and Peer Support Groups Following Critical Illness: The Thrive Collaboratives. Crit Care Med 2020; 47:1194-1200. [PMID: 31241499 DOI: 10.1097/ccm.0000000000003818] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Data are lacking regarding implementation of novel strategies such as follow-up clinics and peer support groups, to reduce the burden of postintensive care syndrome. We sought to discover enablers that helped hospital-based clinicians establish post-ICU clinics and peer support programs, and identify barriers that challenged them. DESIGN Qualitative inquiry. The Consolidated Framework for Implementation Research was used to organize and analyze data. SETTING Two learning collaboratives (ICU follow-up clinics and peer support groups), representing 21 sites, across three continents. SUBJECTS Clinicians from 21 sites. MEASUREMENT AND MAIN RESULTS Ten enablers and nine barriers to implementation of "ICU follow-up clinics" were described. A key enabler to generate support for clinics was providing insight into the human experience of survivorship, to obtain interest from hospital administrators. Significant barriers included patient and family lack of access to clinics and clinic funding. Nine enablers and five barriers to the implementation of "peer support groups" were identified. Key enablers included developing infrastructure to support successful operationalization of this complex intervention, flexibility about when peer support should be offered, belonging to the international learning collaborative. Significant barriers related to limited attendance by patients and families due to challenges in creating awareness, and uncertainty about who might be appropriate to attend and target in advertising. CONCLUSIONS Several enablers and barriers to implementing ICU follow-up clinics and peer support groups should be taken into account and leveraged to improve ICU recovery. Among the most important enablers are motivated clinician leaders who persist to find a path forward despite obstacles.
Collapse
Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom.,School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland, United Kingdom
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | | | | | - Rita N Bakhru
- Wake Forest University School of Medicine, Department of Internal Medicine, Section of Pulmonary, Critical Care, Allergy and Immunology, Winston Salem, NC
| | - Anthony J Bastin
- Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Sarah J Beesley
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT.,Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.,Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT
| | - Lynne Beveridge
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN
| | - Tammy L Eaton
- Palliative and Supportive Institute, UPMC Mercy, Pittsburgh, PA
| | - Thomas Farley
- School of Nursing, University of California San Francisco, San Francisco, CA
| | | | | | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
| | | | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Babar A Khan
- Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN
| | - Janet A Kloos
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Erin K Kross
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Pamela Mactavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Joel Meyer
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Scotland, United Kingdom
| | - Howard L Saft
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Andrew Slack
- Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanna Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN
| | - Gerald Weinhouse
- Department of Medicine, Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | | | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT.,Department of Medicine, Pulmonary and Critical Care Division, Intermountain Medical Center, Murray, UT.,Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Carla M Sevin
- Department of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
40
|
Zucato da Silva C, José Gomes Campos C, Ferraz Martins Jamarim M, Marcondes pimentel de abreu lima G. Experiencias de pacientes con discapacidades funcionales posteriores al tratamiento en la Unidad de Cuidados Intensivos. REVISTA CUIDARTE 2020. [DOI: 10.15649/cuidarte.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introducción: Comprender las experiencias de los pacientes con discapacidades funcionales después del tratamiento en la Unidad de Cuidados Intensivos a su regreso a casa. Materiales y métodos: Se trata de un estudio de enfoque cualitativo que utilizó el estudio de caso como método de investigación. La muestra de ocho participantes fue compuesta intencionalmente y cerrada por saturación teórica. La recolección de datos se realizó a través de entrevistas domiciliarias semiestructuradas complementadas con notas y diarios de campo. Los datos fueron analizados mediante el análisis de contenido temático propuesto por Minayo. Resultados: La atención primaria, a través de la atención domiciliaria, fue la principal responsable del seguimiento posterior al alta de los participantes. Del material empírico, surgieron las categorías "sufrimiento emocional y sus repercusiones en la recuperación funcional" y "la pérdida del rol familiar y los conflictos con los cuidadores". Discusión y conclusiones: La recuperación funcional de pacientes con discapacidades funcionales después de pasar por cuidados intensivos puede ser compleja y requiere, además de rehabilitación física, monitoreo psicoemocional adecuado, aclaración de los recuerdos de hospitalización y apoyo profesional a la familia. Se sugiere que la atención primaria reciba capacitación sobre la complejidad de estos pacientes y la creación de estrategias que lo acerquen a la atención hospitalaria, lo que permite una atención compartida y continua.
Como citar este artículo: Silva, Camila Zucato; Campos, Claudinei José Gomes; Jamarim, Michelle Ferraz Martins; Lima, Gerusa Marcondes Pimentel de Abreu. Vivências de pacientes diante de incapacidades funcionais pós-tratamento em Unidade de Terapia Intensiva. Revista Cuidarte. 2020; 11(2): e1018. http://dx.doi.org/10.15649/cuidarte.1018
Collapse
|
41
|
Abstract
Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness outcomes.
Collapse
|
42
|
Minton C, Power T, Wilson S, Jackson D. Understanding recovery and survivorship after a prolonged critical illness. J Clin Nurs 2020; 29:665-666. [DOI: 10.1111/jocn.15018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Claire Minton
- School of Nursing College of HealthMassey University Palmerston North New Zealand
| | - Tamara Power
- Faculty of Health University of Technology Sydney Sydney Australia
| | - Stacey Wilson
- School of Nursing College of HealthMassey University Palmerston North New Zealand
| | - Debra Jackson
- Faculty of Health University of Technology Sydney Sydney Australia
| |
Collapse
|
43
|
Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
Collapse
Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | |
Collapse
|
44
|
Kang J, Jeong YJ, Hong J. Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year. J Korean Acad Nurs 2020; 50:787-798. [PMID: 33441526 DOI: 10.4040/jkan.20233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors. METHODS Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios. RESULTS Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively. Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores. CONCLUSION The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.
Collapse
Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, Korea
| | | | - Jiwon Hong
- College of Nursing, Dong-A University, Busan, Korea.
| |
Collapse
|
45
|
Warrillow S, Raper R. The evolving role of intensive care in health care and society. Med J Aust 2019; 211:294-297.e1. [PMID: 31544249 DOI: 10.5694/mja2.50340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Stephen Warrillow
- Austin Heath, Melbourne, VIC.,Australian and New Zealand Intensive Care Society, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Raymond Raper
- College of Intensive Care Medicine of Australia and New Zealand, Melbourne, VIC.,Royal North Shore Hospital, Sydney, NSW
| |
Collapse
|
46
|
Rosa RG, Ferreira GE, Viola TW, Robinson CC, Kochhann R, Berto PP, Biason L, Cardoso PR, Falavigna M, Teixeira C. Effects of post-ICU follow-up on subject outcomes: A systematic review and meta-analysis. J Crit Care 2019; 52:115-125. [DOI: 10.1016/j.jcrc.2019.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/07/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022]
|
47
|
Ahlberg M, Hollman Frisman G, Berterö C, Ågren S. Family Health Conversations create awareness of family functioning. Nurs Crit Care 2019; 25:102-108. [PMID: 31197904 DOI: 10.1111/nicc.12454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The whole family is affected if one family member is critically ill. The Family Health Conversation Intervention may give the family tools that support healthier family functioning. AIMS AND OBJECTIVES The aim of this study was to identify which components of family function are affected when families participate in Family Health Conversations. DESIGN A secondary analysis was performed of existing qualitative interviews. The Family Health Conversation is an intervention where nurses ask the family reflective questions, and reflection is made possible in three conversation sessions. METHODS This study included transcribed data from 13 follow-up interviews from seven families attending Family Health Conversations after three and 12 months. Data were analysed with narrative analysis, focusing on family function. RESULTS Three themes were identified. The families' family functioning had been supported with: improved understanding of each other-there was an understanding of being in the same situation but still having totally different experiences; more concern for each other-they talked about their different experiences and felt they had become closer to each other; and a process of working through-they had experienced working through various experiences, standing by and supporting, and then being able to move on. CONCLUSIONS The Family Health Conversation Intervention is provided to families, accompanied by nurses. The families in this study gained an awareness of their family function that brought the family closer because of improved understanding of each other and the situation. The families experienced openness, and the family members spoke more freely with each other, which facilitated the progress of working through the experience of critical illness and helped to maintain healthy family functioning. RELEVANCE TO CLINICAL PRACTICE It is important to have an overall perspective and to recognize the patient and the family as equally important within the family for awareness of family function.
Collapse
Affiliation(s)
- Mona Ahlberg
- Department of Anaesthesiology and Intensive Care, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunilla Hollman Frisman
- Anaesthetics, Operations and Speciality Surgery Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Carina Berterö
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Susanna Ågren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Cardiothoracic Surgery, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
48
|
Haines KJ, Sevin CM, Hibbert E, Boehm LM, Aparanji K, Bakhru RN, Bastin AJ, Beesley SJ, Butcher BW, Drumright K, Eaton TL, Farley T, Firshman P, Fritschle A, Holdsworth C, Hope AA, Johnson A, Kenes MT, Khan BA, Kloos JA, Kross EK, MacLeod-Smith BJ, Mactavish P, Meyer J, Montgomery-Yates A, Quasim T, Saft HL, Slack A, Stollings J, Weinhouse G, Whitten J, Netzer G, Hopkins RO, Mikkelsen ME, Iwashyna TJ, McPeake J. Key mechanisms by which post-ICU activities can improve in-ICU care: results of the international THRIVE collaboratives. Intensive Care Med 2019; 45:939-947. [PMID: 31165227 PMCID: PMC6611738 DOI: 10.1007/s00134-019-05647-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/24/2019] [Indexed: 12/27/2022]
Abstract
Objective To identify the key mechanisms that clinicians perceive improve care in the intensive care unit (ICU), as a result of their involvement in post-ICU programs. Methods Qualitative inquiry via focus groups and interviews with members of the Society of Critical Care Medicine’s THRIVE collaborative sites (follow-up clinics and peer support). Framework analysis was used to synthesize and interpret the data. Results Five key mechanisms were identified as drivers of improvement back into the ICU: (1) identifying otherwise unseen targets for ICU quality improvement or education programs—new ideas for quality improvement were generated and greater attention paid to detail in clinical care. (2) Creating a new role for survivors in the ICU—former patients and family members adopted an advocacy or peer volunteer role. (3) Inviting critical care providers to the post-ICU program to educate, sensitize, and motivate them—clinician peers and trainees were invited to attend as a helpful learning strategy to gain insights into post-ICU care requirements. (4) Changing clinician’s own understanding of patient experience—there appeared to be a direct individual benefit from working in post-ICU programs. (5) Improving morale and meaningfulness of ICU work—this was achieved by closing the feedback loop to ICU clinicians regarding patient and family outcomes. Conclusions The follow-up of patients and families in post-ICU care settings is perceived to improve care within the ICU via five key mechanisms. Further research is required in this novel area. Electronic supplementary material The online version of this article (10.1007/s00134-019-05647-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Sunshine Hospital, Melbourne, Australia.
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
| | - Carla M Sevin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Krishna Aparanji
- Critical Care Medicine, Springfield Clinic, Springfield, IL, USA
| | - Rita N Bakhru
- Section of Pulmonary, Critical Care, Allergy and Immunology, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Anthony J Bastin
- Department of Peri-operative Medicine, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Sarah J Beesley
- Pulmonary Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
- Pulmonary Division, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Kelly Drumright
- Tennessee Valley Healthcare System VA Medical Center, Nashville, TN, USA
| | - Tammy L Eaton
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Thomas Farley
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, VIC, Australia
| | - Aluko A Hope
- Division of Critical Care Medicine, Albert Einstein College of Medicine of Yeshiva University, New York, USA
| | - Annie Johnson
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Babar A Khan
- Indiana University School of Medicine Research Scientist, Regenstrief Institute Inc., Indianapolis, IN, USA
| | - Janet A Kloos
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Erin K Kross
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | | | - Pamela Mactavish
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Joel Meyer
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ashley Montgomery-Yates
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Kentucky, USA
| | - Tara Quasim
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK
| | - Howard L Saft
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Andrew Slack
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gerald Weinhouse
- Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Whitten
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN, USA
| | - Giora Netzer
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Maryland, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT, USA
- Pulmonary and Critical Care Division, Department of Medicine, Intermountain Medical Center, Murray, UT, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT, USA
| | - Mark E Mikkelsen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Joanne McPeake
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK.
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK.
| |
Collapse
|
49
|
Page P, Simpson A, Reynolds L. Bearing witness and being bounded: The experiences of nurses in adult critical care in relation to the survivorship needs of patients and families. J Clin Nurs 2019; 28:3210-3221. [PMID: 31017337 DOI: 10.1111/jocn.14887] [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: 11/09/2018] [Revised: 03/08/2019] [Accepted: 03/21/2019] [Indexed: 11/27/2022]
Abstract
AIM To discern and understand the responses of nurses to the survivorship needs of patients and family members in adult critical care units. BACKGROUND The critical care environment is a demanding place of work which may limit nurses to immediacy of care, such as the proximity to death and the pressure of work. DESIGN A constructivist grounded theory approach with constant comparative analysis. METHODS As part of a wider study and following ethical approval, eleven critical care nurses working within a general adult critical care unit were interviewed with respect to their experiences in meeting the psychosocial needs of patients and family members. Through the process of constant comparative analysis, an overarching selective code was constructed. EQUATOR guidelines for qualitative research (COREQ) were applied. RESULTS The data illuminated a path of developing expertise permitting integration of physical, psychological and family care with technology and humanity. Gaining such proficiency is demanding, and the data presented reveal the challenges that nurses experience along the way. CONCLUSION The study confirms that working within a critical care environment is an emotionally charged challenge and may incur an emotional cost. Nurses can find themselves bounded by the walls of the critical care unit and experience personal and professional conflicts in their role. Nurses bear witness to the early stages of the survivorship trajectory but are limited in their support of ongoing needs. RELEVANCE TO CLINICAL PRACTICE Critical care nurses can experience personal and professional conflicts when caring for both patients and families. This can lead to moral distress and may contribute to compassion fatigue. Critical care nurses appear bounded to the delivery of physiological and technical care, in the moment, as demanded by the patient's acuity. Consequentially, this limits nurses' ability to support the onward survivorship trajectory. Increased pressure and demands on critical care beds have contributed further to occupational stress in this care setting.
Collapse
Affiliation(s)
- Pamela Page
- Faculty of Health Social Care & Education, School of Nursing & Midwifery, Anglia Ruskin University, Chelmsford, UK
| | - Alan Simpson
- School of Health Sciences, Centre for Mental Health Research, City, University of London, London, UK
| | - Lisa Reynolds
- Nursing Division, School of Health Sciences, City, University of London, London, UK
| |
Collapse
|
50
|
Turnbull AE, Bosslet GT, Kross EK. Aligning use of intensive care with patient values in the USA: past, present, and future. THE LANCET RESPIRATORY MEDICINE 2019; 7:626-638. [PMID: 31122892 DOI: 10.1016/s2213-2600(19)30087-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 10/26/2022]
Abstract
For more than three decades, both medical professionals and the public have worried that many patients receive non-beneficial care in US intensive care units during their final months of life. Some of these patients wish to avoid severe cognitive and physical impairments, and protracted deaths in the hospital setting. Recognising when intensive care will not restore a person's health, and helping patients and families embrace goals related to symptom relief, interpersonal connection, or spiritual fulfilment are central challenges of critical care practice in the USA. We review trials from the past decade of interventions designed to address these challenges, and present reasons why evaluating, comparing, and implementing these interventions have been difficult. Careful scrutiny of the design and interpretation of past trials can show why improving goal concordant care has been so elusive, and suggest new directions for the next generation of research.
Collapse
Affiliation(s)
- Alison E Turnbull
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Department of Epidemiology, Bloomberg School of Public Health, and Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Gabriel T Bosslet
- Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine, and Charles Warren Fairbanks Center for Medical Ethics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Erin K Kross
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|