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Affiliation(s)
- Margaret S Herridge
- From Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto; and Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris
| | - Élie Azoulay
- From Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto; and Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris
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Ben Hadj Salem O. Neurocritical care for neurological incapacitated patients. Rev Neurol (Paris) 2021; 178:105-110. [PMID: 34563374 DOI: 10.1016/j.neurol.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/29/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
Admission to ICU for patients with long-term disease is always the result of a reflection for short and long term benefit. When the disease is about functional or cognitive autonomy, we have to think with ethical considerations to allow the patient to find acceptable quality of life after Intensive Care Unit (ICU). ICU complications through the prism of neurological incapacitated patients will be described. As neurodegenerative disorder like Parkinson's disease shares common points with delirium or sepsis associated encephalopathy (SAE), there is a theoretic link to think that ICU could worsen cognitive function among patients with neurodegenerative disorder (ND). However, clinical data are still very poor. Regarding long term sequelae after ICU stay and probable synergy between ICU and incapacitated patients to worsen their handicap, different angles should be considered when those patients are referred to ICU.
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Affiliation(s)
- O Ben Hadj Salem
- Intensive Care Unit, Centre Hospitalier Intercommunal Meulan - Les Mureaux, 1, rue du Fort, 78250 Meulan en Yvelines, France.
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Ramadori G. Albumin Infusion in Critically Ill COVID-19 Patients: Hemodilution and Anticoagulation. Int J Mol Sci 2021; 22:ijms22137126. [PMID: 34281177 PMCID: PMC8268290 DOI: 10.3390/ijms22137126] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023] Open
Abstract
Hypercoagulation is one of the major risk factors for ICU treatment, mechanical ventilation, and death in critically ill patients infected with SARS-CoV-2. At the same time, hypoalbuminemia is one risk factor in such patients, independent of age and comorbidities. Especially in patients with severe SARS-CoV-2-infection, albumin infusion may be essential to improve hemodynamics and to reduce the plasma level of the main marker of thromboembolism, namely, the D-dimer plasma level, as suggested by a recent report. Albumin is responsible for 80% of the oncotic pressure in the vessels. This is necessary to keep enough water within the systemic circulatory system and for the maintenance of sufficient blood pressure, as well as for sufficient blood supply for vital organs like the brain, lungs, heart, and kidney. The liver reacts to a decrease in oncotic pressure with an increase in albumin synthesis. This is normally possible through the use of amino acids from the proteins introduced with the nutrients reaching the portal blood. If these are not sufficiently provided with the diet, amino acids are delivered to the liver from muscular proteins by systemic circulation. The liver is also the source of coagulation proteins, such as fibrinogen, fibronectin, and most of the v WF VIII, which are physiological components of the extracellular matrix of the vessel wall. While albumin is the main negative acute-phase protein, fibrinogen, fibronectin, and v WF VIII are positive acute-phase proteins. Acute illnesses cause the activation of defense mechanisms (acute-phase reaction) that may lead to an increase of fibrinolysis and an increase of plasma level of fibrinogen breakdown products, mainly fibrin and D-dimer. The measurement of the plasma level of the D-dimer has been used as a marker for venous thromboembolism, where a fourfold increase of the D-dimer plasma level was used as a negative prognostic marker in critically ill SARS-CoV-2 hospitalized patients. Increased fibrinolysis can take place in ischemic peripheral sites, where the mentioned coagulation proteins can become part of the provisional clot (e.g., in the lungs). Although critically ill SARS-CoV-2-infected patients are considered septic shock patients, albumin infusions have not been considered for hemodynamic resuscitation and as anticoagulants. The role of coagulation factors as provisional components of the extracellular matrix in case of generalized peripheral ischemia due to hypoalbuminemia and hypovolemia is discussed in this review.
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Affiliation(s)
- Giuliano Ramadori
- Internal Medicine University Clinic, University of Göttingen, Göttingen, Germany Robert-Koch-Strasse 40, 37075 Göttingen, Germany
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The Association Between Endotracheal Tube Size and Aspiration (During Flexible Endoscopic Evaluation of Swallowing) in Acute Respiratory Failure Survivors. Crit Care Med 2021; 48:1604-1611. [PMID: 32804785 DOI: 10.1097/ccm.0000000000004554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine whether a modifiable risk factor, endotracheal tube size, is associated with the diagnosis of postextubation aspiration in survivors of acute respiratory failure. DESIGN Prospective cohort study. SETTING ICUs at four academic tertiary care medical centers. PATIENTS Two hundred ten patients who were at least 18 years old, admitted to an ICU, and mechanically ventilated with an endotracheal tube for longer than 48 hours were enrolled. INTERVENTIONS Within 72 hours of extubation, all patients received a flexible endoscopic evaluation of swallowing examination that entailed administration of ice, thin liquid, thick liquid, puree, and cracker boluses. Patient demographics, treatment variables, and hospital outcomes were abstracted from the patient's medical records. Endotracheal tube size was independently selected by the patient's treating physicians. MEASUREMENTS AND MAIN RESULTS For each flexible endoscopic evaluation of swallowing examination, laryngeal pathology was evaluated, and for each bolus, a Penetration Aspiration Scale score was assigned. Aspiration (Penetration Aspiration Scale score ≥ 6) was further categorized into nonsilent aspiration (Penetration Aspiration Scale score = 6 or 7) and silent aspiration (Penetration Aspiration Scale score = 8). One third of patients (n = 68) aspirated (Penetration Aspiration Scale score ≥ 6) on at least one bolus, 13.6% (n = 29) exhibited silent aspiration, and 23.8% (n = 50) exhibited nonsilent aspiration. In a multivariable analysis, endotracheal tube size (≤ 7.5 vs ≥ 8.0) was significantly associated with patients exhibiting any aspiration (Penetration Aspiration Scale score ≥ 6) (p = 0.016; odds ratio = 2.17; 95% CI 1.14-4.13) and with risk of developing laryngeal granulation tissue (p = 0.02). CONCLUSIONS Larger endotracheal tube size was associated with increased risk of aspiration and laryngeal granulation tissue. Using smaller endotracheal tubes may reduce the risk of postextubation aspiration.
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Post-Discharge Health Status and Symptoms in Patients with Severe COVID-19. J Gen Intern Med 2021; 36:738-745. [PMID: 33443703 PMCID: PMC7808113 DOI: 10.1007/s11606-020-06338-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Little is known about long-term recovery from severe COVID-19 disease. Here, we characterize overall health, physical health, and mental health of patients 1 month after discharge for severe COVID-19. METHODS This was a prospective single health system observational cohort study of patients ≥ 18 years hospitalized with laboratory-confirmed COVID-19 disease who required at least 6 l of oxygen during admission, had intact baseline cognitive and functional status, and were discharged alive. Participants were enrolled between 30 and 40 days after discharge. Outcomes were elicited through validated survey instruments: the PROMIS® Dyspnea Characteristics and PROMIS® Global Health-10. RESULTS A total of 161 patients (40.6% of eligible) were enrolled; 152 (38.3%) completed the survey. Median age was 62 years (interquartile range [IQR], 50-67); 57 (37%) were female. Overall, 113/152 (74%) participants reported shortness of breath within the prior week (median score 3 out of 10 [IQR 0-5]), vs 47/152 (31%) pre-COVID-19 infection (0, IQR 0-1), p < 0.001. Participants also rated their physical health and mental health as worse in their post-COVID state (43.8, standard deviation 9.3; mental health 47.3, SD 9.3) compared to their pre-COVID state, (54.3, SD 9.3; 54.3, SD 7.8, respectively), both p < 0.001. Physical and mental health means in the general US population are 50 (SD 10). A total of 52/148 (35.1%) patients without pre-COVID oxygen requirements needed home oxygen after hospital discharge; 20/148 (13.5%) reported still using oxygen at time of survey. CONCLUSIONS Patients with severe COVID-19 disease typically experience sequelae affecting their respiratory status, physical health, and mental health for at least several weeks after hospital discharge.
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Plapler PG, de Souza DR, Kaziyama HHS, Battistella LR, de Barros-Filho TEP. Relationship between the coronavirus disease 2019 pandemic and immobilization syndrome. Clinics (Sao Paulo) 2021; 76:e2652. [PMID: 33567050 PMCID: PMC7847256 DOI: 10.6061/clinics/2021/e2652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
- Pérola Grinberg Plapler
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Daniel Rubio de Souza
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Instituto de Medicina de Reabilitacao (IMRea), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Helena Hideko Seguchi Kaziyama
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Linamara Rizzo Battistella
- Instituto de Medicina de Reabilitacao (IMRea), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail: /
| | - Tarcisio Eloy Pessoa de Barros-Filho
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Weerahandi H, Hochman KA, Simon E, Blaum C, Chodosh J, Duan E, Garry K, Kahan T, Karmen-Tuohy S, Karpel HC, Mendoza F, Prete AM, Quintana L, Rutishauser J, Martinez LS, Shah K, Sharma S, Simon E, Stirniman A, Horwitz LI. Post-discharge health status and symptoms in patients with severe COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.08.11.20172742. [PMID: 32817973 PMCID: PMC7430618 DOI: 10.1101/2020.08.11.20172742] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about long-term recovery from severe COVID-19 disease. Here, we characterize overall health, physical health and mental health of patients one month after discharge for severe COVID-19. METHODS This was a prospective single health system observational cohort study of patients ≥18 years hospitalized with laboratory-confirmed COVID-19 disease who required at least 6 liters of oxygen during admission, had intact baseline cognitive and functional status and were discharged alive. Participants were enrolled between 30 and 40 days after discharge. Outcomes were elicited through validated survey instruments: the PROMIS Dyspnea Characteristics and PROMIS Global Health-10. RESULTS A total of 161 patients (40.6% of eligible) were enrolled; 152 (38.3%) completed the survey. Median age was 62 years (interquartile range [IQR], 50-67); 57 (37%) were female. Overall, 113/152 (74%) participants reported shortness of breath within the prior week (median score 3 out of 10 [IQR 0-5]), vs. 47/152 (31%) pre-COVID-19 infection (0, IQR 0-1), p<0.001. Participants also rated their physical health and mental health as worse in their post-COVID state (43.8, standard deviation 9.3; mental health 47.3, SD 9.3) compared to their pre-COVID state, (54.3, SD 9.3; 54.3, SD 7.8, respectively), both p <0.001. A total of 52/148 (35.1%) patients without pre-COVID oxygen requirements needed home oxygen after hospital discharge; 20/148 (13.5%) reported still using oxygen at time of survey. CONCLUSIONS Patients with severe COVID-19 disease typically experience sequelae affecting their respiratory status, physical health and mental health for at least several weeks after hospital discharge.
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Affiliation(s)
- Himali Weerahandi
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY
| | - Katherine A. Hochman
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY
| | - Emma Simon
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY
| | - Caroline Blaum
- Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, NY
| | - Joshua Chodosh
- Division of Geriatric Medicine and Palliative Care, NYU Grossman School of Medicine, New York, NY
| | - Emily Duan
- NYU Grossman School of Medicine, New York, NY
| | - Kira Garry
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY
| | | | | | | | - Felicia Mendoza
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY
| | | | | | | | - Leticia Santos Martinez
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY
| | - Kanan Shah
- NYU Grossman School of Medicine, New York, NY
| | | | - Elias Simon
- NYU Grossman School of Medicine, New York, NY
| | | | - Leora I. Horwitz
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, New York, NY
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY
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Iannaccone S, Castellazzi P, Tettamanti A, Houdayer E, Brugliera L, de Blasio F, Cimino P, Ripa M, Meloni C, Alemanno F, Scarpellini P. Role of Rehabilitation Department for Adult Individuals With COVID-19: The Experience of the San Raffaele Hospital of Milan. Arch Phys Med Rehabil 2020; 101:1656-1661. [PMID: 32505489 PMCID: PMC7272153 DOI: 10.1016/j.apmr.2020.05.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 01/27/2023]
Abstract
The rapid evolution of the health emergency linked to the spread of severe acute respiratory syndrome coronavirus 2 requires specifications for the rehabilitative management of patients with coronavirus disease 2019 (COVID-19). The symptomatic evolution of patients with COVID-19 is characterized by 2 phases: an acute phase in which respiratory symptoms prevail and a postacute phase in which patients can show symptoms related to prolonged immobilization, to previous and current respiratory dysfunctions, and to cognitive and emotional disorders. Thus, there is the need for specialized rehabilitative care for these patients. This communication reports the experience of the San Raffaele Hospital of Milan and recommends the setup of specialized clinical pathways for the rehabilitation of patients with COVID-19. In this hospital, between February 1 and March 2, 2020, about 50 patients were admitted every day with COVID-19 symptoms. In those days, about 400 acute care beds were created (intensive care/infectious diseases). In the following 30 days, from March 2 to mid-April, despite the presence of 60 daily arrivals to the emergency department, the organization of patient flow between different wards was modified, and several different units were created based on a more accurate integration of patients' needs. According to this new organization, patients were admitted first to acute care COVID-19 units and then to COVID-19 rehabilitation units, post-COVID-19 rehabilitation units, and/or quarantine/observation units. After hospital discharge, telemedicine was used to follow-up with patients at home. Such clinical pathways should each involve dedicated multidisciplinary teams composed of pulmonologists, physiatrists, neurologists, cardiologists, physiotherapists, neuropsychologists, occupational therapists, speech therapists, and nutritionists.
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Affiliation(s)
- Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Castellazzi
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Tettamanti
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elise Houdayer
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Luigia Brugliera
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco de Blasio
- Respiratory Medicine and Pulmonary Rehabilitation Section, Clinic Center S.p.A. Private Hospital, Naples, Italy
| | - Paolo Cimino
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Ripa
- Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Meloni
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Alemanno
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Scarpellini
- Department of Infectious Disease, IRCCS San Raffaele Hospital, Milan, Italy
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Agha MA, El-Habashy MM, Abdelshafy MS. Postintensive care syndrome in mechanically ventilated patients secondary to respiratory disorders. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_58_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hamimy W, Zaghloul A, Abdelaal A. The application of a new regimen for short term sedation in the ICU (ketofol) – Case series. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2012.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- W. Hamimy
- Anesthesia Department, Faculty of Medicine , Cairo University , Egypt
| | - A. Zaghloul
- Anesthesia Department, Faculty of Medicine , Cairo University , Egypt
| | - A. Abdelaal
- Anesthesia Department, Faculty of Medicine , Beni Suef University , Egypt
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Battle CE, Lynch C, Thorpe C, Biggs S, Grobbelaar K, Morgan A, Roberts S, Thornton E, Hobrok M, Pugh R. Incidence and risk factors for alopecia in survivors of critical illness: A multi-centre observational study. J Crit Care 2018; 50:31-35. [PMID: 30471558 DOI: 10.1016/j.jcrc.2018.11.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/03/2018] [Accepted: 11/14/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the incidence, nature and risk factors for patient-reported alopecia in survivors of critical illness. MATERIALS AND METHODS A multi-centre, mixed methods observational study in the intensive care units (ICU) of ten hospitals in Wales. All patients with an ICU stay of 5 days or more, able to give consent were included. Demographic variables and risk factors were collected. A pre-designed survey was completed at three months post-ICU discharge. Statistical analysis included numbers and percentages (categorical variables) and medians and interquartile ranges (continuous variables). Comparisons between patients with and without alopecia were made using Fisher's Exact test (categorical variables) and Mann Whitney U test (continuous variables). Multivariate logistic regression analysis was used to determine the risk factors for alopecia. RESULTS The survey was completed by 123 patients with alopecia reported in 44 (36%) patients. The only risk factor for alopecia on analysis was sepsis / septic shock (p < .001; OR: 5.1, 95%CI: 2.1-12.4). CONCLUSIONS Limited research exists examining the incidence, nature and risk factors for patient-reported alopecia in adult survivors of critical illness. The results of this study highlight the need to discuss the potential for alopecia with survivors of critical illness, who had sepsis / septic shock.
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Affiliation(s)
- C E Battle
- Ed Major Critical Care Unit, Morriston Hospital, Swansea, SA6 6NL Wales, UK.
| | - C Lynch
- Intensive Care Unit, Royal Glamorgan Hospital, Llantrisant, UK.
| | - C Thorpe
- Department of Anaesthetics and Intensive Care Medicine, Ysbyty Gwynedd, Bangor, UK.
| | - S Biggs
- Physiotherapy Dept, Royal Gwent Hospital, Newport, UK.
| | - K Grobbelaar
- Physiotherapy Dept, Nevill Hall Hospital, Abergavenny, UK.
| | - A Morgan
- Physiotherapy Dept, Glangwili General Hospital, Carmarthen, UK.
| | - S Roberts
- Physiotherapy Dept, Princess of Wales Hospital, Bridgend, UK.
| | - E Thornton
- Physiotherapy Dept, University Hospital Wales, Cardiff, UK.
| | - M Hobrok
- Intensive Care Unit, Bronglais General Hospital, Aberystwyth, UK.
| | - R Pugh
- Department of Anaesthetics, Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK..
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Langerud AK, Rustøen T, Småstuen MC, Kongsgaard U, Stubhaug A. Health-related quality of life in intensive care survivors: Associations with social support, comorbidity, and pain interference. PLoS One 2018; 13:e0199656. [PMID: 29940026 PMCID: PMC6016908 DOI: 10.1371/journal.pone.0199656] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/12/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Experiences during a stay in the intensive care unit (ICU), including pain, delirium, physical deterioration, and the critical illness itself, may all influence survivors' health-related quality of life (HRQOL). However, few studies have examined the influence of social support, comorbidity, and pain interference on ICU survivors' HRQOL. OBJECTIVES To investigate possible associations between social support, number of comorbidities, and pain interference on HRQOL in ICU survivors. METHODS ICU survivors responded to a survey 3 months (n = 118) and 1 year (n = 89) after ICU discharge. HRQOL was measured using the Short Form Health Survey-12 (v1), social support using the revised Social Provision Scale, pain interference using the Brief Pain Inventory-Short Form, and comorbidities using the Self-Administered Comorbidity Questionnaire. RESULTS Physical and mental HRQOL were reduced at both 3 months and 1 year in ICU survivors compared with the general population. This reduction was more pronounced at 3 months for physical HRQOL, while a small reduction in mental HRQOL was not clinically relevant. Social support was statistical significantly positively associated with mental HRQOL at 3 months, while number of comorbidities was statistical significantly associated with a reduction in physical HRQOL at 3 months and 1 year and mental HRQOL at 1 year. Lastly pain interference was significantly associated with a reduction in physical HRQOL at 3 months and 1 year. CONCLUSIONS ICU survivors primarily report reduced physical HRQOL. Social support was positively associated with mental HRQOL, while number of comorbidities, and pain interference were all significantly associated with a reduction in HRQOL. Pain interference was associated with the largest reduction in HRQOL.
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Affiliation(s)
- Anne Kathrine Langerud
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Post-operative and Critical Care, Division of Emergencies and Critical Care Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Department of Nursing science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Ulf Kongsgaard
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Audun Stubhaug
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Wintermann GB, Rosendahl J, Weidner K, Strauß B, Hinz A, Petrowski K. Self-reported fatigue following intensive care of chronically critically ill patients: a prospective cohort study. J Intensive Care 2018; 6:27. [PMID: 29744108 PMCID: PMC5930426 DOI: 10.1186/s40560-018-0295-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
Background Protracted treatment on intensive care unit (ICU) sets the patients at increased risk for the development of chronic critical illness (CCI). Muscular and cardio-respiratory deconditioning are common long-term sequelae, going along with a state of chronic fatigue. At present, findings regarding the frequency, long-term course, and associated factors of self-reported fatigue following ICU treatment of CCI patients are lacking. Methods CCI patients with the diagnosis of critical illness polyneuropathy/myopathy (CIP/CIM) were assessed at three time points. Four weeks following the discharge from ICU at acute care hospital (t1), eligibility for study participation was asserted. Self-reported fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20) via telephone contact at 3 (t2, n = 113) and 6 months (t3, n = 91) following discharge from ICU at acute care hospital. Results At both 3 and 6 months, nearly every second CCI patient showed clinically relevant fatigue symptoms (t2/t3: n = 53/n = 51, point prevalence rates: 46.9%/45.1%). While total fatigue scores remained stable in the whole sample, female patients showed a decrease from 3 to 6 months. The presence of a coronary heart disease, the perceived fear of dying at acute care ICU, a diagnosis of major depression, and the perceived social support were confirmed as significant correlates of fatigue at 3 months. At 6 months, male gender, the number of medical comorbidities, a diagnosis of major depression, and a prior history of anxiety disorder could be identified. A negative impact of fatigue on the perceived health-related quality of life could be ascertained. Conclusions Nearly every second CCI patient showed fatigue symptoms up to 6 months post-ICU. Patients at risk should be informed about fatigue, and appropriate treatment options should be offered to them. Trial registration The present study was registered retrospectively at the German Clinical Trials Register (date of registration: 13th of December 2011; registration number: DRKS00003386). Date of enrolment of the first participant to the present trial: 09th of November 2011.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- 1Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden Fetscherstraße 74, 01307 Dresden, Germany
| | - Jenny Rosendahl
- Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.,Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- 1Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden Fetscherstraße 74, 01307 Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Andreas Hinz
- 4Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Katja Petrowski
- 1Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden Fetscherstraße 74, 01307 Dresden, Germany
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15
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Jamsahar M, Navab E, Yekaninejad MS, Navidhamidi M. The effect of provision of information on serum cortisol in patients transferred from the coronary care unit to the general ward: A randomised controlled trial. Intensive Crit Care Nurs 2018; 46:38-43. [PMID: 29625869 DOI: 10.1016/j.iccn.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Patients' transfer from coronary care units to general wards is a main source of anxiety for patients. Transfer anxiety is due to either lack of patients' knowledge or inadequacy of transfer-related information to patients. This study aimed to evaluate the effect of provision of information on the serum cortisol level, as an indicator of anxiety, in patients transferred from the coronary care unit to the general ward. METHODS This pretest-posttest randomised clinical trial was conducted on fifty patients transferred from coronary care units to general wards. Patients were selected using a purposeful sampling method and randomly were allocated to control and intervention groups. After taking blood samples for a baseline cortisol measurement, the patients in the control group received routine verbal transfer-related information. The patients in the intervention group were provided with an educational pamphlet consisting of textual and visual data about patients' transfer, continuity of care and the target general ward. The second and the third blood samples were taken for a cortisol measurement half an hour after informing the patients about the transfer order and half an hour after entrance to the general ward, respectively. Descriptive and inferential statistics via the SPSS software v. 21 was used for data analysis. RESULTS No statistically significant differences were reported between the groups in terms of demographic characteristics (p > 0.05). The serum levels of cortisol in the intervention group decreased from 40.16 (microgram per decilitre) at the baseline to 36.52 and 34.34 at the second and the third measurement time points, respectively. Conversely, the serum levels of cortisol in the control group increased from 37.48 at the baseline to 40.52 and 41.52 at the second- and the third-time points, respectively. While no statistically significant difference was reported between the groups in the baseline serum level of cortisol, between-group differences were statistically significant at the second- and the third-time points (p < 0.05). CONCLUSION Provision of transfer-related information can reduce transfer anxiety among patients, that should be transferred from coronary care units to general wards.
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Affiliation(s)
- Maryam Jamsahar
- Department of Medical-Surgical, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Navab
- Department of Critical Care and Geriatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojdeh Navidhamidi
- Department of Medical-Surgical Nursing and Medical Basic Sciences, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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16
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Jesus FSD, Paim DDM, Brito JDO, Barros IDA, Nogueira TB, Martinez BP, Pires TQ. Mobility decline in patients hospitalized in an intensive care unit. Rev Bras Ter Intensiva 2017; 28:114-9. [PMID: 27410406 PMCID: PMC4943048 DOI: 10.5935/0103-507x.20160025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 03/21/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the variation in mobility during hospitalization in an intensive
care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion
criteria included patients admitted with an independence score of ≥ 4
for both bed-chair transfer and locomotion, with the score based on the
Functional Independence Measure. Patients with cardiac arrest and/or those
who died during hospitalization were excluded. To measure the loss of
mobility, the value obtained at discharge was calculated and subtracted from
the value obtained on admission, which was then divided by the admission
score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility
during hospitalization was 14.3% (p < 0.001). Loss of mobility was
greater in patients hospitalized for more than 48 hours in the intensive
care unit (p < 0.02) and in patients who used vasopressor drugs (p =
0.041). However, the comparison between subjects aged 60 years or older and
those younger than 60 years indicated no significant differences in the loss
of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3
score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital
mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit.
This loss was greater in patients who were hospitalized for more than 48
hours and in those who used vasopressors; however, the causal and prognostic
factors associated with this decline need to be elucidated.
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17
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Herridge MS, Chu LM, Matte A, Tomlinson G, Chan L, Thomas C, Friedrich JO, Mehta S, Lamontagne F, Levasseur M, Ferguson ND, Adhikari NKJ, Rudkowski JC, Meggison H, Skrobik Y, Flannery J, Bayley M, Batt J, Santos CD, Abbey SE, Tan A, Lo V, Mathur S, Parotto M, Morris D, Flockhart L, Fan E, Lee CM, Wilcox ME, Ayas N, Choong K, Fowler R, Scales DC, Sinuff T, Cuthbertson BH, Rose L, Robles P, Burns S, Cypel M, Singer L, Chaparro C, Chow CW, Keshavjee S, Brochard L, Hebert P, Slutsky AS, Marshall JC, Cook D, Cameron JI. The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation. Am J Respir Crit Care Med 2016; 194:831-844. [PMID: 26974173 DOI: 10.1164/rccm.201512-2343oc] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Disability risk groups and 1-year outcome after greater than or equal to 7 days of mechanical ventilation (MV) in medical/surgical intensive care unit (ICU) patients are unknown and may inform education, prognostication, rehabilitation, and study design. OBJECTIVES To stratify patients for post-ICU disability and recovery to 1 year after critical illness. METHODS We evaluated a multicenter cohort of 391 medical/surgical ICU patients who received greater than or equal to 1 week of MV at 7 days and 3, 6, and 12 months after ICU discharge. Disability risk groups were identified using recursive partitioning modeling. MEASUREMENTS AND MAIN RESULTS The 7-day post-ICU Functional Independence Measure (FIM) determined the recovery trajectory to 1-year after ICU discharge and was an independent risk factor for 1-year mortality. The 7-day post-ICU FIM was predicted by age and ICU length of stay. By 2 weeks of MV, ICU patients could be stratified into four disability groups characterized by increasing risk for post ICU disability, ICU and post-ICU healthcare use, and disposition. Patients less than 42 years with ICU length of stay less than 2 weeks had the best function and fewest deaths at 1 year compared with patients greater than 66 years with ICU length of stay greater than 2 weeks who sustained the worst disability and 40% 1-year mortality. Depressive symptoms (17%) and post-traumatic stress disorder (18%) persisted at 1 year. CONCLUSIONS ICU survivors of greater than or equal to 1 week of MV may be stratified into four disability groups based on age and ICU length of stay. These groups determine 1-year recovery and healthcare use and are independent of admitting diagnosis and illness severity. Clinical trial registered with www.clinicaltrials.gov (NCT 00896220).
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Affiliation(s)
- Margaret S Herridge
- 1 Department of Medicine.,2 Medical-Surgical Intensive Care.,4 Institute of Medical Science.,5 Toronto General Research Institute.,3 Interdepartmental Division of Critical Care Medicine
| | | | | | - George Tomlinson
- 1 Department of Medicine.,6 Institute of Health Policy, Management and Evaluation.,7 Dalla Lana School of Public Health.,8 Department of Medicine
| | | | | | - Jan O Friedrich
- 3 Interdepartmental Division of Critical Care Medicine.,9 Department of Medicine.,10 Division of Critical Care Medicine, and.,11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Sangeeta Mehta
- 3 Interdepartmental Division of Critical Care Medicine.,12 Department of Medicine and Anesthesia, Mount Sinai Hospital, Toronto, Canada
| | - Francois Lamontagne
- 13 Centre de Recherche du CHU de Sherbrooke, Sherbrooke, Canada.,14 Ecole de Réadaptation, Institut Universitaire de Gériatrie de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Melanie Levasseur
- 14 Ecole de Réadaptation, Institut Universitaire de Gériatrie de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Niall D Ferguson
- 1 Department of Medicine.,2 Medical-Surgical Intensive Care.,4 Institute of Medical Science.,5 Toronto General Research Institute.,3 Interdepartmental Division of Critical Care Medicine
| | - Neill K J Adhikari
- 3 Interdepartmental Division of Critical Care Medicine.,15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jill C Rudkowski
- 16 Department of General Internal Medicine and.,17 Department of Critical Care, St. Joseph's Healthcare
| | - Hilary Meggison
- 18 Department of Critical Care, University of Ottawa, Ottawa, Canada
| | - Yoanna Skrobik
- 19 Department of Medicine and.,20 Division of Critical Care, Maisonneuve Rosemont Hospital, University of Montreal, Montreal, Canada
| | - John Flannery
- 21 Toronto Rehabilitation Institute.,22 Interdepartmental Division of Physiatry
| | - Mark Bayley
- 21 Toronto Rehabilitation Institute.,22 Interdepartmental Division of Physiatry
| | - Jane Batt
- 9 Department of Medicine.,11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Claudia Dos Santos
- 3 Interdepartmental Division of Critical Care Medicine.,9 Department of Medicine.,10 Division of Critical Care Medicine, and.,11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Susan E Abbey
- 1 Department of Medicine.,23 Department of Psychiatry, and
| | - Adrienne Tan
- 1 Department of Medicine.,23 Department of Psychiatry, and
| | - Vincent Lo
- 2 Medical-Surgical Intensive Care.,24 Department of Physical Therapy
| | - Sunita Mathur
- 24 Department of Physical Therapy.,25 Rehabilitation Science Institution, and
| | - Matteo Parotto
- 1 Department of Medicine.,2 Medical-Surgical Intensive Care.,3 Interdepartmental Division of Critical Care Medicine
| | | | | | - Eddy Fan
- 1 Department of Medicine.,2 Medical-Surgical Intensive Care.,4 Institute of Medical Science.,5 Toronto General Research Institute.,3 Interdepartmental Division of Critical Care Medicine
| | - Christie M Lee
- 3 Interdepartmental Division of Critical Care Medicine.,12 Department of Medicine and Anesthesia, Mount Sinai Hospital, Toronto, Canada
| | - M Elizabeth Wilcox
- 1 Department of Medicine.,2 Medical-Surgical Intensive Care.,3 Interdepartmental Division of Critical Care Medicine
| | - Najib Ayas
- 26 Department of Medicine, St. Paul's Hospital, British Columbia, Vancouver, Canada
| | - Karen Choong
- 27 Department of Clinical Epidemiology and Biostatistics, and
| | - Robert Fowler
- 3 Interdepartmental Division of Critical Care Medicine.,6 Institute of Health Policy, Management and Evaluation.,7 Dalla Lana School of Public Health.,15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Damon C Scales
- 3 Interdepartmental Division of Critical Care Medicine.,15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Tasnim Sinuff
- 3 Interdepartmental Division of Critical Care Medicine.,15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Brian H Cuthbertson
- 3 Interdepartmental Division of Critical Care Medicine.,15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Louise Rose
- 15 Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Priscila Robles
- 5 Toronto General Research Institute.,24 Department of Physical Therapy.,25 Rehabilitation Science Institution, and
| | | | - Marcelo Cypel
- 4 Institute of Medical Science.,5 Toronto General Research Institute.,28 Division of Thoracic Surgery and Lung Transplant, University Health Network, Toronto, Canada
| | - Lianne Singer
- 1 Department of Medicine.,4 Institute of Medical Science.,5 Toronto General Research Institute
| | - Cecelia Chaparro
- 1 Department of Medicine.,4 Institute of Medical Science.,5 Toronto General Research Institute.,28 Division of Thoracic Surgery and Lung Transplant, University Health Network, Toronto, Canada
| | - Chung-Wai Chow
- 1 Department of Medicine.,4 Institute of Medical Science.,5 Toronto General Research Institute
| | - Shaf Keshavjee
- 1 Department of Medicine.,4 Institute of Medical Science.,5 Toronto General Research Institute.,28 Division of Thoracic Surgery and Lung Transplant, University Health Network, Toronto, Canada
| | - Laurent Brochard
- 3 Interdepartmental Division of Critical Care Medicine.,9 Department of Medicine.,10 Division of Critical Care Medicine, and.,11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Paul Hebert
- 29 Centre de recherche du Centre hospitalier de l'Université de Montreal, Montreal, Canada; and.,30 Department of Medicine of the Université de Montréal, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Arthur S Slutsky
- 3 Interdepartmental Division of Critical Care Medicine.,9 Department of Medicine.,10 Division of Critical Care Medicine, and.,11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - John C Marshall
- 3 Interdepartmental Division of Critical Care Medicine.,9 Department of Medicine.,10 Division of Critical Care Medicine, and.,11 Keenan Research Center at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Deborah Cook
- 27 Department of Clinical Epidemiology and Biostatistics, and.,31 Department of Medicine and Pediatrics, McMaster University, Hamilton, Canada
| | - Jill I Cameron
- 32 Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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18
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Miura A, Hino H, Uchida K, Inoue S, Tateda T. Peripheral nerve conduction abnormalities precede morphological alterations in an experimental rat model of sepsis. J Anesth 2016; 30:961-969. [PMID: 27612852 DOI: 10.1007/s00540-016-2247-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The pathological mechanisms of critical illness polyneuropathy (CIP), an acute neuromuscular disorder, remain unknown. In this study, we evaluated nerve and vascular properties that might account for electrophysiological abnormalities, including reduced nerve conduction amplitude, in the early phase of CIP. METHODS Rats were administered intravenous saline (C-group; n = 31) or lipopolysaccharide (3 mg/kg/day; L-group; n = 30) for 48 h. Subsequently, tracheotomy was performed and sciatic nerves exposed bilaterally. A catheter was inserted into the left internal carotid artery to measure the mean arterial pressure (MAP). Nerve conduction velocity (NCV), nerve blood flow (NBF), evoked amplitudes, chronaxie, rheobase, and the absolute refractory period (ARP) were measured from the sciatic nerves. Degeneration, myelination, and neutrophil infiltration were examined in the sciatic nerves using histology and electron microscopy. RESULTS The NBF (C-group 25 ± 3 ml/100 g/min, L-group 13 ± 3 ml/100 g/min, p < 0.001) was lower in the L-group, but the MAP was similar between groups (C-group 119 ± 17 mmHg, L-group 115 ± 18 mmHg, p = 0.773). LPS also caused a severe reduction in amplitude (C-group 0.9 ± 0.2 mV, L-group 0.2 ± 0.1 mV, p < 0.001), while latency and NCV were not affected. Of note, response amplitudes partially recovered with an increase in stimulus intensity. LPS treatment increased the rheobase and decreased the chronaxie (rheobase: C vs L-group; 0.35 ± 0.07 vs 1.29 ± 0.66 mA, p < 0.001; chronaxie 171 ± 24 vs 42 ± 20 µs, p < 0.001), while ARP was unchanged. No primary axonal degeneration or inflammatory infiltration was observed. CONCLUSIONS Our findings suggest that primary electrophysiological deterioration is due to threshold alterations rather than morphological alterations after 48 h of LPS treatment.
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Affiliation(s)
- Arisa Miura
- Department of Anesthesia, Kanazawabunko Hospital, Kanagawa, Japan
| | - Hirofumi Hino
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1, Sugao Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan.
| | - Kazuhide Uchida
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1, Sugao Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Soichiro Inoue
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1, Sugao Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
| | - Takeshi Tateda
- Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1, Sugao Miyamae-ku, Kawasaki-shi, Kanagawa, 216-8511, Japan
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19
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Bahrami Gorji F, Amri P, Shokri J, Alereza H, Bijani A. Sedative and Analgesic Effects of Propofol-Fentanyl Versus Propofol-Ketamine During Endoscopic Retrograde Cholangiopancreatography: A Double-Blind Randomized Clinical Trial. Anesth Pain Med 2016; 6:e39835. [PMID: 27853681 PMCID: PMC5106556 DOI: 10.5812/aapm.39835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/31/2016] [Accepted: 08/10/2016] [Indexed: 12/20/2022] Open
Abstract
Background Endoscopic retrograde cholangiopancreatography (ERCP) is a painful procedure that requires analgesia and sedation. Objectives In this study, we compared the analgesic and sedative effects of propofol-ketamine versus propofol-fentanyl in patients undergoing ERCP. Methods In this clinical trial, 72 patients, aged 30 - 70 years old, who were candidates for ERCP were randomly divided into two groups. Before the start of ERCP, both groups received midazolam 0.5 - 1 mg. The intervention group (PK) received ketamine 0.5 mg/kg, and the control group (PF) received fentanyl 50 - 100 micrograms. All patients received propofol 0.5 mg/kg in a loading dose followed by 75 mcg/kg/minute in an infusion. The patients, the anesthesiologist, and the endoscopist were unaware of the medication regimen. Sedation and analgesia quality (based on a VAS), blood pressure, respiratory rate, heart rate, arterial oxygen saturation, recovery time (based on Aldrete scores), and endoscopist and patient satisfation were recorded. Results The sedative effects were equal in the two groups (P > 0.05), but the analgesic effects were higher in the PF group than in the PK group (P < 0.05). The PK group had higher blood pressure levels in the eighth minute. Respiratory rate, heart rate, and arterial oxygen saturation showed no significant differences between the groups (P > 0.05). Endoscopist satisfaction, patient satisfaction, and recovery time showed no significant differences between the two groups (P > 0.05). Conclusions The results showed that the sedative effect of propofol-ketamine was equal to the propofol-fentanyl combination during ERCP. To prevent respiratory and hemodynamic complications during ERCP, the propofol-ketamine combination should be used in patients with underlying disease.
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Affiliation(s)
- Fakhroddin Bahrami Gorji
- Student Committee Research, The Clinical Research Development Unit of Roohani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Parviz Amri
- Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran
- Corresponding author: Parviz Amri, Department of Intensive Care, Babol University of Medical Sciences, Babol, Iran. Tel: +98-1112238301, E-mail:
| | - Javad Shokri
- Department of Gastroenterology, Babol University of Medical Sciences, Babol, Iran
| | - Hakimeh Alereza
- Vice Chancellor, Babol University of Medical Sciences, Babol, Iran
| | - Ali Bijani
- Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
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20
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Lim WC, Black N, Lamping D, Rowan K, Mays N. Conceptualizing and measuring health-related quality of life in critical care. J Crit Care 2016; 31:183-93. [DOI: 10.1016/j.jcrc.2015.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/30/2015] [Accepted: 10/27/2015] [Indexed: 02/06/2023]
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21
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Tilburgs B, Nijkamp MD, Bakker EC, van der Hoeven H. The influence of social support on patients’ quality of life after an intensive care unit discharge: A cross-sectional survey. Intensive Crit Care Nurs 2015; 31:336-42. [DOI: 10.1016/j.iccn.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
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22
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23
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Merriweather JL, Salisbury LG, Walsh TS, Smith P. Nutritional care after critical illness: a qualitative study of patients' experiences. J Hum Nutr Diet 2014; 29:127-36. [PMID: 25522771 DOI: 10.1111/jhn.12287] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present qualitative study aimed to explore the factors influencing nutritional recovery in patients after critical illness and to develop a model of care to improve current management of nutrition for this patient group. METHODS Patients were recruited into the study on discharge from a general intensive care unit (ICU) of a large teaching hospital in central Scotland. Semi-structured interviews were carried out after discharge from the ICU, weekly for the duration of their ward stay, and at 3 months post ICU discharge. Observations of ward practice were undertaken thrice weekly for the duration of the ward stay. RESULTS Seventeen patients were recruited into the study and, using a grounded theory approach, 'inter-related system breakdowns during the nutritional recovery process' emerged as the overarching core category that influenced patients' experiences of eating after critical illness. This encompassed the categories, 'experiencing a dysfunctional body', 'experiencing socio-cultural changes in relation to eating' and 'encountering nutritional care delivery failures'. CONCLUSIONS The findings from the present study provide a unique contribution to knowledge by offering important insights into patients' experiences of eating after critical illness. The study has identified numerous nutritional problems and raises questions about the efficacy of current nutritional management in this patient group. Adopting a more individualised approach to nutritional care could ameliorate the nutritional issues experienced by post ICU patients. This will be evaluated in future work.
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Affiliation(s)
- J L Merriweather
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - L G Salisbury
- Royal Infirmary of Edinburgh, Edinburgh, UK.,School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - T S Walsh
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The University of Edinburgh, Edinburgh, UK
| | - P Smith
- Royal Infirmary of Edinburgh, Edinburgh, UK.,School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
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24
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Ewens BA, Hendricks JM, Sundin D. The use, prevalence and potential benefits of a diary as a therapeutic intervention/tool to aid recovery following critical illness in intensive care: a literature review. J Clin Nurs 2014; 24:1406-25. [PMID: 25488139 DOI: 10.1111/jocn.12736] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES To critically appraise the available literature and summarise the evidence related to the use, prevalence, purpose and potential therapeutic benefits of intensive care unit diaries following survivors' discharge from hospital and identify areas for future exploration. BACKGROUND Intensive care unit survivorship is increasing as are associated physical and psychological complications. These complications can impact on the quality of life of survivors and their families. Rehabilitation services for survivors have been sporadically implemented and lack an evidence base. Patient diaries in intensive care have been implemented in Scandinavia and Europe with the intention of filling memory gaps, enable survivors to set realistic recovery goals and cement their experiences in reality. DESIGN A review of original research articles. METHODS The review used key terms and Boolean operators across a 34-year time frame in: CIHAHL, Medline, Scopus, Proquest, Informit and Google Scholar for research reports pertaining to the area of enquiry. Twenty-two original research articles met the inclusion criteria for this review. RESULTS The review concluded that diaries are prevalent in Scandinavia and parts of Europe but not elsewhere. The implementation and ongoing use of diaries is disparate and international guidelines to clarify this have been proposed. Evidence which demonstrates the potential of diaries in the reduction of the psychological complications following intensive care has recently emerged. Results from this review will inform future research in this area. CONCLUSIONS Further investigation is warranted to explore the potential benefits of diaries for survivors and improve the evidence base which is currently insufficient to inform practice. The exploration of prospective diarising in the recovery period for survivors is also justified. RELEVANCE TO CLINICAL PRACTICE Intensive care diaries are a cost effective intervention which may yield significant benefits to survivors.
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25
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Bench S, Day T, Griffiths P. Effectiveness of critical care discharge information in supporting early recovery from critical illness. Crit Care Nurse 2014; 33:41-52. [PMID: 23727851 DOI: 10.4037/ccn2013134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Providing patients with information can alleviate or reduce relocation stress, but how best to provide information to patients being discharged from critical care units is unclear. This narrative critical review describes (1) the current evidence base on the use of discharge information for adult critical care patients and (2) the extent of involvement of service users in the design and evaluation of such information. Seven publications reported data from 121 patients, 252 relatives, and 33 nurses. Overall evidence was of low quality but use of individualized information was associated with beneficial physical effects for patients and increased knowledge and satisfaction for their relatives. Findings highlight the significant gaps in our knowledge and understanding. The consequences of such findings for the future development of information that meets service users' needs are discussed. Results should inform the design of future studies on this topic.
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Affiliation(s)
- Suzanne Bench
- Florence Nightingale School of Nursing and Midwifery, King’s College, 57 Waterloo Road, London, UK.
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26
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Scott T, Davies M, Dutton C, Cummings I, Burden B, England K, Wood P. Intensive Care Follow-up in UK Military Casualties: A One-Year Pilot. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Military casualties requiring intensive care were reviewed in a pilot follow-up clinic at approximately three to six months post discharge. All patients reviewed had suffered traumatic injuries in Afghanistan with a median New Injury Severity Score (NISS) of 41. Approximately 50% of casualties reviewed reported hallucinations while on ICU which were often intense and unpleasant. The predominant sedative agents used were morphine and midazolam. Occipital alopecia and pressure sores were reported as an unexpected finding in 35% of casualties. This appears to be permanent in 25% of cases and has required surgery in a small number of cases. Personality changes and anger are common and this cohort of patients can be sensitive to perceived stigmatising concerns regarding referral to psychiatric support services. Patient diaries, which were begun on intensive care in Afghanistan and continued through until discharge in the UK, were found to be very helpful. A significant proportion of clinic attendees thought the pilot clinic was helpful with a quarter of survey responders finding it very helpful. However, this was commonly based on the perception that they were helping the defence medical services improve delivery of care.
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Affiliation(s)
- Timothy Scott
- Surgeon Commander, Anaesthetic Department, John Radcliffe Hospital, Oxford
| | - Matthew Davies
- Wing Commander, Anaesthetic Department, Peterborough City Hospital, Peterborough
| | - Clare Dutton
- Major, Deputy OC Nursing, Defence Medical Rehabilitation Centre, Headley Court, Surrey
| | - Iain Cummings
- Squadron Leader, Department of Anaesthesia, Royal Victoria Infirmary, Newcastle-Upon-Tyne
| | - Bev Burden
- Captain, Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham
| | - Kaye England
- Consultant Intensive Care Physician, Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham
| | - Paul Wood
- Consultant Anaesthetist, Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham
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Ramsay P, Salisbury LG, Merriweather JL, Huby G, Rattray JE, Hull AM, Brett SJ, Mackenzie SJ, Murray GD, Forbes JF, Walsh TS. A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial. Trials 2014; 15:38. [PMID: 24476530 PMCID: PMC4016544 DOI: 10.1186/1745-6215-15-38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 01/08/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause ongoing disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). METHODS The intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. RESULTS The final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. CONCLUSIONS The MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.
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Affiliation(s)
| | - Lisa G Salisbury
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Chancellors Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK.
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Abstract
OBJECTIVES Patients hospitalized in the ICU can frequently develop swallowing disorders, resulting in an inability to effectively transfer food, liquids, and pills from their mouth to stomach. The complications of these disorders can be devastating, including aspiration, reintubation, pneumonia, and a prolonged hospital length of stay. As a result, critical care practitioners should understand the optimal diagnostic strategies, proposed mechanisms, and downstream complications of these ICU-acquired swallowing disorders. DATA SOURCES Database searches and a review of the relevant medical literature. DATA SYNTHESIS A significant portion of the estimated 400,000 patients who annually develop acute respiratory failure, require endotracheal intubation, and survive to be extubated are determined to have dysfunctional swallowing. This group of swallowing disorders has multiple etiologies, including local effects of endotracheal tubes, neuromuscular weakness, and an altered sensorium. The diagnosis of dysfunctional swallowing is usually made by a speech-language pathologist using a bedside swallowing evaluation. Major complications of swallowing disorders in hospitalized patients include aspiration, reintubation, pneumonia, and increased hospitalization. The national yearly cost of swallowing disorders in hospitalized patients is estimated to be over $500 million. Treatment modalities focus on changing the consistency of food, changing mealtime position, and/or placing feeding tubes to prevent aspiration. CONCLUSIONS Swallowing disorders are costly and clinically important in a large population of ICU patients. The development of effective screening strategies and national diagnostic standards will enable further studies aimed at understanding the precise mechanisms for these disorders. Further research should also concentrate on identifying modifiable risk factors and developing novel treatments aimed at reducing the significant burden of swallowing dysfunction in critical illness survivors.
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Via Clavero G, Sanjuán Naváis M, Menéndez Albuixech M, Corral Ansa L, Martínez Estalella G, Díaz-Prieto-Huidobro A. [Evolution in muscle strength in critical patients with invasive mechanical ventilation]. ENFERMERIA INTENSIVA 2013; 24:155-66. [PMID: 24183829 DOI: 10.1016/j.enfi.2013.09.001] [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: 06/26/2013] [Accepted: 09/15/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the evolution of muscle strength in critically ill patients with mechanical ventilation (MV) from withdrawal of sedatives to hospital discharge. MATERIAL AND METHOD A cohort study was conducted in two intensive care units in the Hospital Universitari de Bellvitge from November 2011 to March 2012. INCLUSION CRITERIA Consecutive patients with MV > 72h. Dependent outcome: Muscle strength measured with the Medical Research Council (MRC) scale beginning on the first day the patient was able to answer 3 out of 5 simple orders (day 1), every week, at ICU discharge and at hospital discharge or at day 60 Independent outcomes: factors associated with muscle strength loss, ventilator-free days, ICU length of stay and hospital length of stay. The patients were distributed into two groups (MRC< 48, MRC ≥ 48) after the first measurement. RESULTS Thirty-four patients were assessed. Independent outcomes associated with muscle strength weakness were: days with cardiovascular SOFA >2 (P<.001) and days with costicosteroids (P<.001). Initial MRC in MRC<48 group was 38 (27-43), and 52 (50-54) in MRC ≥ 48. The largest muscle strength gain was obtained the first week (31% versus 52%). A MRC < 48 value was associated with more MV days (P<.007) and a longer ICU stay. (P<.003). CONCLUSION The greatest muscle strength gain after withdrawing of the sedatives was achieved in the first week. Muscle strength loss was associated with a cardiovascular SOFA > 2 and costicosteroids. Patients with a MRC < 48 required more days with MV and a longer ICU stay.
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Affiliation(s)
- G Via Clavero
- Unidad de Cuidados Intensivos, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Departamento Enfermería Fundamental y Médico-Quirúrgica, Escuela Universitaria de Enfermería, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España.
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Cullinane JP, Plowright CI. Patients' and relatives' experiences of transfer from intensive care unit to wards. Nurs Crit Care 2013; 18:289-96. [PMID: 24165070 DOI: 10.1111/nicc.12047] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/31/2013] [Accepted: 07/17/2013] [Indexed: 11/28/2022]
Abstract
AIMS This literature review looks at the evidence around transferring patients from intensive care units (ICU) to wards. The literature informs us that patients and their families experience problems when being transferred from an ICU environment and that this increases overall anxiety. BACKGROUND The effects of surviving critical illness often have a profound psychological impact on patients and families This study examines the experiences of adult patients, and their families, following their transfer from the ICU to the ward. FINDINGS Five themes emerged from this literature review: physical responses, psychological responses, information and communication, safety and security, and the needs of relatives. CONCLUSIONS This review reminds us that these problems can be reduced if information and communication around time of transfers were improved. RELEVANCE TO CLINICAL PRACTICE As critical care nurses it is essential that we prepare patients and families for transfer to wards.
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Affiliation(s)
- James P Cullinane
- J P Cullinane, Intensive Care Unit, Anaesthetics Department, Medway NHS Foundation Trust, Gillingham, Kent, UK
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Kowalczyk M, Nestorowicz A, Fijałkowska A, Kwiatosz-Muc M. Emotional sequelae among survivors of critical illness: a long-term retrospective study. Eur J Anaesthesiol 2013; 30:111-8. [PMID: 23358098 DOI: 10.1097/eja.0b013e32835dcc45] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Treatment in an ICU can be stressful and traumatic for patients, and can lead to various physical, psychological and cognitive sequelae. OBJECTIVES The aim of the study was to assess the influence of the social, economic and working status of individuals in regard to long-term anxiety and depression among ICU convalescents. DESIGN Retrospective, cross-sectional, 5-year survey between 2005 and 2009. SETTING The general ICUs of two hospitals in Lublin (Poland): the Teaching Hospital, Medical University of Lublin and the District Hospital. PATIENTS All adults surviving an ICU stay of more than 24 h were eligible. In December 2010, 533 questionnaires were sent to discharged ICU survivors, and 195 (36.6%) were returned. One hundred and eighty-six patients were enrolled in the study. Patients with brain injuries were excluded. MAIN OUTCOME MEASURES The questionnaire consisted of the Hospital Anxiety and Depression Scale (HADS); questions defining social, economic and working status before and after intensive care stay, health status before intensive care stay, as well as questions about memories and readmissions to intensive care were included. RESULTS According to HADS, 34.4% patients had an anxiety disorder and 27.4% were depressed. There was a strong positive correlation between anxiety and depression (r = +0.726, P<0.001). Better material and housing conditions correlated with lower anxiety and depression rates. Acute Physiology and Chronic Health Evaluation II scores on admission positively correlated with both anxiety (r =+0.187; P=0.011) and depression (r = +0.239; P=0.001). A negative correlation between health status before intensive care admission and HADS scores was observed (anxiety rs = -0.193; P=0.008; depression rs = -0.227; P=0.002); better health resulted in less anxiety and depression disorders. CONCLUSION Adverse social and economic status is associated with higher rates of anxiety and depression following ICU stay.
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Affiliation(s)
- Michał Kowalczyk
- 1st Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Lublin, Poland.
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Egerod I, Risom SS, Thomsen T, Storli SL, Eskerud RS, Holme AN, Samuelson KA. ICU-recovery in Scandinavia: A comparative study of intensive care follow-up in Denmark, Norway and Sweden. Intensive Crit Care Nurs 2013; 29:103-11. [DOI: 10.1016/j.iccn.2012.10.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 10/12/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
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Developing a mobility protocol for early mobilization of patients in a surgical/trauma ICU. Crit Care Res Pract 2012; 2012:964547. [PMID: 23320154 PMCID: PMC3539434 DOI: 10.1155/2012/964547] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/27/2012] [Accepted: 07/11/2012] [Indexed: 11/18/2022] Open
Abstract
As technology and medications have improved and increased, survival rates are also increasing in intensive care units (ICUs), so it is now important to focus on improving the patient outcomes and recovery. To do this, ICU patients need to be assessed and started on an early mobility program, if stable. While the early mobilization of the ICU patients is not without risk, the current literature has demonstrated that patients can be safely and feasibly mobilized, even while requiring mechanical ventilation. These patients are at a high risk for muscle deconditioning due to limited mobility from numerous monitoring equipment and multiple medical conditions. Frequently, a critically ill patient only receives movement from nurses; such as, being turned side to side, pulled up in bed, or transferred from bed to a stretcher for a test. The implementation of an early mobility protocol that can be used by critical care nurses is important for positive patient outcomes minimizing the functional decline due to an ICU stay. This paper describes a pilot study to evaluate an early mobilization protocol to test the safety and feasibility for mechanically ventilated patients in a surgical trauma ICU in conjunction with the current unit standards.
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Brooke J, Hasan N, Slark J, Sharma P. Efficacy of information interventions in reducing transfer anxiety from a critical care setting to a general ward: a systematic review and meta-analysis. J Crit Care 2012; 27:425.e9-15. [PMID: 22824085 DOI: 10.1016/j.jcrc.2012.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/16/2012] [Accepted: 01/22/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE Our aim was to undertake a comprehensive systematic review on the efficacy of information interventions on reducing anxiety in patients and family members on transfer from a critical care setting to a general ward. MATERIALS AND METHODS MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Google Scholar databases from 1990 to January 1, 2011, were searched. Bibliographies of identified articles were reviewed. Only high-quality randomized controlled trials comparing an intervention to reduce transfer anxiety with standard care, where transfer anxiety is measured by the validated State Trait Anxiety Inventory, were included. Data were extracted to estimate standard mean differences (SMDs), pooled odds ratios (ORs), and 95% confidence intervals (CIs) using both fixed and random effects model. RESULTS Of 266 studies identified in the primary search, 5 studies enrolling 629 participants met the inclusion criteria, family members' transfer anxiety was significantly reduced in the intervention arm of information provision (OR, 1.70; 95% CI, 1.15-2.52; P = .01) compared with those who received standard care (OR, 0.42; 95% CI; 0.276-0.625; P < .001), and patients' transfer anxiety was significantly reduced in one study. CONCLUSIONS Providing information to understand a future ward environment can significantly reduce patients' and family members' transfer anxiety from the critical care setting when compared with standard care.
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Affiliation(s)
- Joanne Brooke
- University of Greenwich, G308, Southwood Site, Avery Hill Road, Eltham, London, UK.
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Akerman E, Fridlund B, Samuelson K, Baigi A, Ersson A. Psychometric evaluation of 3-set 4P questionnaire. Intensive Crit Care Nurs 2012; 29:40-7. [PMID: 22835992 DOI: 10.1016/j.iccn.2012.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 06/11/2012] [Accepted: 06/16/2012] [Indexed: 11/24/2022]
Abstract
This is a further development of a specific questionnaire, the 3-set 4P, to be used for measuring former ICU patients' physical and psychosocial problems after intensive care and the need for follow-up. The aim was to psychometrically test and evaluate the 3-set 4P questionnaire in a larger population. The questionnaire consists of three sets: "physical", "psychosocial" and "follow-up". The questionnaires were sent by mail to all patients with more than 24-hour length of stay on four ICUs in Sweden. Construct validity was measured with exploratory factor analysis with Varimax rotation. This resulted in three factors for the "physical set", five factors for the "psychosocial set" and four factors for the "follow-up set" with strong factor loadings and a total explained variance of 62-77.5%. Thirteen questions in the SF-36 were used for concurrent validity showing Spearman's r(s) 0.3-0.6 in eight questions and less than 0.2 in five. Test-retest was used for stability reliability. In set follow-up the correlation was strong to moderate and in physical and psychosocial sets the correlations were moderate to fair. This may have been because the physical and psychosocial status changed rapidly during the test period. All three sets had good homogeneity. In conclusion, the 3-set 4P showed overall acceptable results, but it has to be further modified in different cultures before being considered a fully operational instrument for use in clinical practice.
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Affiliation(s)
- Eva Akerman
- School of Health Sciences, Jönköping University, Jönköping, Sweden.
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Abstract
PURPOSE OF REVIEW Recovery and rehabilitation after critical illness is a vital part of intensive care management. The role of feeding and nutritional intervention is the subject of many recent studies. The gastric hormone ghrelin has effects on appetite and food intake and on immunomodulatory functions. Here we review the interactions between critical illness, appetite regulation, nutrition and ghrelin. RECENT FINDINGS Critical illness results in significant loss of lean body mass; strategies to prevent this have so far proven unsuccessful. Ghrelin has been shown to reduce catabolic protein loss in animal models of critical illness and improve body composition in chronic cachectic illnesses in humans. SUMMARY Enhancing recovery from critical illness will improve both short-term and long-term outcomes. Ghrelin may offer an important means of improving appetite, muscle mass and rehabilitation in the period after critical illness, although studies are needed to see whether this potential is realized.
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Health-related quality of life: implications for critical care interventional studies and why we need to collaborate with patients. Curr Opin Crit Care 2012; 17:510-4. [PMID: 21900770 DOI: 10.1097/mcc.0b013e32834a4bd4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Health-related quality of life (HRQoL) is an important patient-reported outcome measure following critical illness. 'Validated' and professionally endorsed generic measures are widely used to evaluate critical care intervention and guide practice, policy and research. Although recognizing that they are 'here to stay', leading QoL researchers are beginning to question their 'fitness for purpose'. It is therefore timely to review critiques of their limitations in the wider healthcare and social science literatures and to examine the implications for critical care research including, in particular, emerging interventional studies in which HRQoL is the primary outcome of interest. RECENT FINDINGS Generic HRQoL measures have provided important yet limited insights into HRQoL among survivors of critical illness. They are rarely developed or validated in collaboration with patients and cannot therefore be assumed to reflect their experiences and perspectives. SUMMARY Collaboration with patients is advocated in order to improve the interpretation and utility of such data. Failure to do so may result in important study effects being overlooked and the dismissal of potentially useful interventions.
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Bench SD, Day TL, Griffiths P. Developing user centred critical care discharge information to support early critical illness rehabilitation using the Medical Research Council's complex interventions framework. Intensive Crit Care Nurs 2012; 28:123-31. [DOI: 10.1016/j.iccn.2012.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 02/03/2012] [Accepted: 02/07/2012] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW As incidence of acute lung injury (ALI) increases and case fatality decreases, long-term care of survivors is of public health importance. Previous studies demonstrate that these survivors are at risk for impairment in physical, cognitive and mental health. In this review, we will discuss recent studies that add to our knowledge of long-term outcomes after ALI and critical illness. RECENT FINDINGS New studies show that persisting impairment in physical and cognitive function continues 5 years after recovery from critical illness. Glucose dysregulation may play a role in development of both depression and cognitive impairment. Premorbid impairment appears to be an important risk factor, but critical illness is an independent risk factor of physical and cognitive functional decline. Recent randomized controlled trials emphasize that post-ICU interventions may not be enough to improve health-related quality of life after ALI. Interventions delivered early in critical illness, such as physical and occupational therapy and creation of ICU diaries, may be key in improving late outcomes after ALI. SUMMARY Physical, cognitive and mental health impairments after ALI are common, persistent and expensive. Future research is needed to improve prediction, prevention and treatment of these important sequelae.
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Deacon KS. Re-building life after ICU: a qualitative study of the patients' perspective. Intensive Crit Care Nurs 2012; 28:114-22. [PMID: 22390918 DOI: 10.1016/j.iccn.2011.11.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 11/02/2011] [Accepted: 11/15/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore former ICU patients' views on what the key components of a post ICU rehabilitation programme should be. RESEARCH METHODOLOGY Thirty five participants completed an online questionnaire accessed via a link to the study from two support groups' websites. Adults (>18 years) who had been patients in ICU were invited to take part. Participants were asked open questions about their ICU experience and their views on ICU rehabilitation. Participants were: aged from 22 to 70 years; from the USA (22), the UK (8), Canada (2), Australia (1) and other (2); 30 female and five male. Findings were analysed using a thematic approach. FINDINGS Three themes were identified: 'Information and education', 'Personal support' and 'Assessment and therapy'. Analysis suggested that for participants the aspects of rehabilitation covered by each of the themes were of equal importance. CONCLUSION Healthcare professionals in ICU, acute ward and community settings need to be aware of the broad array of physical and psychological challenges faced by patients who have been critically ill. Healthcare professionals need to ensure a holistic approach is implemented to coordinate and facilitate rehabilitation, to address identified patients' needs.
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Affiliation(s)
- Kate S Deacon
- Burton-upon-Trent School of Health and Wellbeing Centre, Burton Hospitals NHS Trust, Burton-upon-Trent, Staffordshire, United Kingdom.
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Physical function, disability and rehabilitation in the elderly critically ill. RÉFÉRENCES EN RÉANIMATION. COLLECTION DE LA SRLF 2012. [DOI: 10.1007/978-2-8178-0287-9_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Walsh TS, Salisbury LG, Boyd J, Ramsay P, Merriweather J, Huby G, Forbes J, Rattray JZ, Griffith DM, Mackenzie SJ, Hull A, Lewis S, Murray GD. A randomised controlled trial evaluating a rehabilitation complex intervention for patients following intensive care discharge: the RECOVER study. BMJ Open 2012; 2:bmjopen-2012-001475. [PMID: 22761291 PMCID: PMC3391367 DOI: 10.1136/bmjopen-2012-001475] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patients who survive an intensive care unit admission frequently suffer physical and psychological morbidity for many months after discharge. Current rehabilitation pathways are often fragmented and little is known about the optimum method of promoting recovery. Many patients suffer reduced quality of life. METHODS AND ANALYSIS The authors plan a multicentre randomised parallel group complex intervention trial with concealment of group allocation from outcome assessors. Patients who required more than 48 h of mechanical ventilation and are deemed fit for intensive care unit discharge will be eligible. Patients with primary neurological diagnoses will be excluded. Participants will be randomised into one of the two groups: the intervention group will receive standard ward-based care delivered by the NHS service with additional treatment by a specifically trained generic rehabilitation assistant during ward stay and via telephone contact after hospital discharge and the control group will receive standard ward-based care delivered by the current NHS service. The intervention group will also receive additional information about their critical illness and access to a critical care physician. The total duration of the intervention will be from randomisation to 3 months postrandomisation. The total duration of follow-up will be 12 months from randomisation for both groups. The primary outcome will be the Rivermead Mobility Index at 3 months. Secondary outcomes will include measures of physical and psychological morbidity and function, quality of life and survival over a 12-month period. A health economic evaluation will also be undertaken. Groups will be compared in relation to primary and secondary outcomes; quantitative analyses will be supplemented by focus groups with patients, carers and healthcare workers. ETHICS AND DISSEMINATION Consent will be obtained from patients and relatives according to patient capacity. Data will be analysed according to a predefined analysis plan. TRIAL REGISTRATION The trial is registered as ISRCTN09412438 and funded by the Chief Scientist Office, Scotland.
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Affiliation(s)
- Timothy Simon Walsh
- Centre for Inflammation Research, Queens Medical Research Institute, Edinburgh, UK
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Edinburgh, UK
| | - Lisa G Salisbury
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Edinburgh, UK
- Interdisciplinary Social Science in Health/Nursing Studies, University of Edinburgh, Edinburgh, UK
| | - Julia Boyd
- Edinburgh Clinical Trials Unit, Edinburgh University, Edinburgh, UK
| | - Pamela Ramsay
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Edinburgh, UK
- Interdisciplinary Social Science in Health/Nursing Studies, University of Edinburgh, Edinburgh, UK
- Lothian University Hospitals Division, Edinburgh, UK
| | - Judith Merriweather
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Edinburgh, UK
- Interdisciplinary Social Science in Health/Nursing Studies, University of Edinburgh, Edinburgh, UK
- Lothian University Hospitals Division, Edinburgh, UK
| | - Guro Huby
- Interdisciplinary Social Science in Health/Nursing Studies, University of Edinburgh, Edinburgh, UK
| | - John Forbes
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Janice Z Rattray
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
| | - David M Griffith
- Edinburgh Critical Care Research group, Edinburgh University and NHS Lothian, Edinburgh, UK
- Lothian University Hospitals Division, Edinburgh, UK
| | | | | | - Steff Lewis
- Edinburgh Clinical Trials Unit, Edinburgh University, Edinburgh, UK
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Gordon D Murray
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Ramsay P, Huby G, Rattray J, Salisbury LG, Walsh TS, Kean S. A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol. BMJ Open 2012; 2:bmjopen-2012-001507. [PMID: 22802422 PMCID: PMC3400070 DOI: 10.1136/bmjopen-2012-001507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND BACKGROUND Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. METHODS AND ANALYSIS The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients' needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the 'Timing it Right' framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. ETHICS AND DISSEMINATION The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.
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Affiliation(s)
- Pam Ramsay
- Department of Anaesthesia and Critical Care (Research), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Guro Huby
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Janice Rattray
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
| | - Lisa G Salisbury
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Timothy Simon Walsh
- Critical Care Medicine, Centre for Inflammation Research, Edinburgh University, Edinburgh, UK
| | - Susanne Kean
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Herridge MS. The challenge of designing a post-critical illness rehabilitation intervention. Crit Care 2011; 15:1002. [PMID: 22047913 PMCID: PMC3334736 DOI: 10.1186/cc10362] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Post-ICU morbidity is an important issue for patients, families, and the health-care system. Elliott and colleagues outlined the results from their novel report of the very first home-based physiotherapy program to be tested in survivors of critical illness. The authors described an explicit intervention, which included a self-instruction exercise manual, trainer visits, and telephone follow-up, with excellent internal validity and yet no difference in outcome measures at 26-week follow-up. These results are discussed in the context of risk stratification/individual tailoring of post-ICU programs to patient and family needs and suggest that the collection of multiple simultaneous outcome measures across functional, neuropsychological, caregiver, and health-care utilization domains may offer additional insight into the benefits of post-rehabilitation programs.
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Affiliation(s)
- Margaret S Herridge
- Interdepartmental Division of Critical Care, University of Toronto, University Health Network, 585 University Avenue, 11C-1180, Toronto, ON M5G 2C4, Canada.
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Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364:1293-304. [PMID: 21470008 DOI: 10.1056/nejmoa1011802] [Citation(s) in RCA: 1843] [Impact Index Per Article: 141.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There have been few detailed, in-person interviews and examinations to obtain follow-up data on 5-year outcomes among survivors of the acute respiratory distress syndrome (ARDS). METHODS We evaluated 109 survivors of ARDS at 3, 6, and 12 months and at 2, 3, 4, and 5 years after discharge from the intensive care unit. At each visit, patients were interviewed and examined; underwent pulmonary-function tests, the 6-minute walk test, resting and exercise oximetry, chest imaging, and a quality-of-life evaluation; and reported their use of health care services. RESULTS At 5 years, the median 6-minute walk distance was 436 m (76% of predicted distance) and the Physical Component Score on the Medical Outcomes Study 36-Item Short-Form Health Survey was 41 (mean norm score matched for age and sex, 50). With respect to this score, younger patients had a greater rate of recovery than older patients, but neither group returned to normal predicted levels of physical function at 5 years. Pulmonary function was normal to near-normal. A constellation of other physical and psychological problems developed or persisted in patients and family caregivers for up to 5 years. Patients with more coexisting illnesses incurred greater 5-year costs. CONCLUSIONS Exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of health care services are important legacies of severe lung injury.
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Affiliation(s)
- Margaret S Herridge
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
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Doherty N, Steen CD. Critical illness polyneuromyopathy (CIPNM); rehabilitation during critical illness. Therapeutic options in nursing to promote recovery: a review of the literature. Intensive Crit Care Nurs 2011; 26:353-62. [PMID: 20971010 DOI: 10.1016/j.iccn.2010.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 07/17/2010] [Accepted: 08/24/2010] [Indexed: 12/13/2022]
Abstract
Following critical illness requiring prolonged mechanical ventilation and sedation, intensive care patients often present with neuromuscular weakness. This results from critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). A lack of diagnostic criteria for each syndrome complicates prevention and treatment. Consequently the term critical illness polyneuromyopathy (CIPNM) has emerged and is characterised by severe weakness, reduced or absent limb reflexes and marked muscle wasting. Although clinical trials report a high incidence of CIPNM, in clinical practice it often remains undetected. The pathophysiological mechanisms that lead to neuromuscular weakness are not entirely clear, however several risk factors have been identified and will be discussed. To date, there are no specific treatments or interventions available to reduce the onset or impact of CIPNM. This paper will review the strategies employed that are supportive and aimed at controlling the associated risk factors.
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Affiliation(s)
- Nicola Doherty
- Critical Care Sister, Lancashire Teaching Trust, Preston, United Kingdom.
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van Aswegen H, Myezwa H, Mudzi W, Becker P. Health-related quality of life of survivors of penetrating trunk trauma in Johannesburg, South Africa. Eur J Trauma Emerg Surg 2011; 37:419-26. [PMID: 26815279 DOI: 10.1007/s00068-010-0071-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/20/2010] [Indexed: 12/17/2022]
Abstract
PURPOSE To study how the health-related quality of life (HRQOL) of survivors of penetrating trunk trauma (PTT) changes from pre-morbid status to 6 months after hospital discharge and to determine differences in the HRQOL between subjects ventilated for short and prolonged periods of time. To determine how the HRQOL of PTT survivors compares with that of a healthy control group in order to identify limitations imposed by critical illness. METHODS Retrospective and observational prospective assessment of the quality of life (QoL) of PTT survivors with the Medical Outcomes Short Form-36 (SF-36) UK English version questionnaire. Cross-sectional assessment of the QoL of a healthy control group with the SF-36. RESULTS The physical component summary (PCS) score was significantly reduced for the short mechanical ventilation (MV) group (n = 13) at 1 and 3 months compared to pre-admission status (p = 0.00, respectively). The mental component summary (MCS) score was significantly reduced at 1, 3 and 6 months (p = 0.00, respectively). The PCS and MCS were significantly reduced for the long MV group (n = 29) at all three assessments compared to the pre-admission HRQOL (p = 0.00-0.01). The short MV group reported HRQOL comparable to that of the healthy group (n = 40) at 6 months after discharge. The long MV group had a significant reduction in the PCS at 1, 3 and 6 months compared to the healthy group (p = 0.00, respectively). The long MV group had significantly reduced PCS at 3 and 6 months compared to the short MV group (p = 0.01 and 0.00, respectively). CONCLUSIONS Subjects who had higher morbidity and prolonged MV suffered from reduced HRQOL related to physical health for up to 6 months after discharge.
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Affiliation(s)
- H van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, 2050, South Africa.
| | - H Myezwa
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, 2050, South Africa
| | - W Mudzi
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, 2050, South Africa
| | - P Becker
- Biostatistics Unit, Medical Research Council, Private Bag X385, Pretoria, 0001, South Africa
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Guérin C. La mobilisation précoce du patient — Intérêts et risques. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Skeletal muscle dysfunction in critical care: Wasting, weakness, and rehabilitation strategies. Crit Care Med 2010; 38:S676-82. [DOI: 10.1097/ccm.0b013e3181f2458d] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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