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Amacher SA, Sahmer C, Becker C, Gross S, Arpagaus A, Urben T, Tisljar K, Emsden C, Sutter R, Marsch S, Hunziker S. Post-intensive care syndrome and health-related quality of life in long-term survivors of cardiac arrest: a prospective cohort study. Sci Rep 2024; 14:10533. [PMID: 38719863 PMCID: PMC11079009 DOI: 10.1038/s41598-024-61146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
Patients discharged from intensive care are at risk for post-intensive care syndrome (PICS), which consists of physical, psychological, and/or neurological impairments. This study aimed to analyze PICS at 24 months follow-up, to identify potential risk factors for PICS, and to assess health-related quality of life in a long-term cohort of adult cardiac arrest survivors. This prospective cohort study included adult cardiac arrest survivors admitted to the intensive care unit of a Swiss tertiary academic medical center. The primary endpoint was the prevalence of PICS at 24 months follow-up, defined as impairments in physical (measured through the European Quality of Life 5-Dimensions-3-Levels instrument [EQ-5D-3L]), neurological (defined as Cerebral Performance Category Score > 2 or Modified Rankin Score > 3), and psychological (based on the Hospital Anxiety and Depression Scale and the Impact of Event Scale-Revised) domains. Among 107 cardiac arrest survivors that completed the 2-year follow-up, 46 patients (43.0%) had symptoms of PICS, with 41 patients (38.7%) experiencing symptoms in the physical domain, 16 patients (15.4%) in the psychological domain, and 3 patients (2.8%) in the neurological domain. Key predictors for PICS in multivariate analyses were female sex (adjusted odds ratio [aOR] 3.17, 95% CI 1.08 to 9.3), duration of no-flow interval during cardiac arrest (minutes) (aOR 1.17, 95% CI 1.02 to 1.33), post-discharge job-loss (aOR 31.25, 95% CI 3.63 to 268.83), need for ongoing psychological support (aOR 3.64, 95% CI 1.29 to 10.29) or psychopharmacologic treatment (aOR 9.49, 95% CI 1.9 to 47.3), and EQ-visual analogue scale (points) (aOR 0.88, 95% CI 0.84 to 0.93). More than one-third of cardiac arrest survivors experience symptoms of PICS 2 years after resuscitation, with the highest impairment observed in the physical and psychological domains. However, long-term survivors of cardiac arrest report intact health-related quality of life when compared to the general population. Future research should focus on appropriate prevention, screening, and treatment strategies for PICS in cardiac arrest patients.
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Affiliation(s)
- Simon A Amacher
- Intensive Care Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
- Emergency Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
| | - Christian Sahmer
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
- Emergency Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Armon Arpagaus
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland
| | - Kai Tisljar
- Intensive Care Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
| | - Christian Emsden
- Intensive Care Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
- Division of Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Stephan Marsch
- Intensive Care Medicine, Department of Acute Medical Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031, Basel, Switzerland.
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland.
- Medical Faculty, University of Basel, Basel, Switzerland.
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2
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Deffner T, Hierundar A, Waydhas C, Riessen R, Münch U. [Relatives after a stay on the intensive care unit: a care gap to be closed]. Med Klin Intensivmed Notfmed 2024; 119:285-290. [PMID: 38564001 DOI: 10.1007/s00063-024-01130-2] [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: 11/22/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024]
Abstract
Structures for the care of relatives after a stay on the intensive care unit are present in principle, but no systematic interfaces between the different types of care and the care sectors exists. Therefore, in a first step, the needs of relatives during intensive care treatment should be continuously assessed and addressed as early as possible. Furthermore, proactive provision of information regarding aftercare services is necessary throughout the entire course of hospitalization and rehabilitation, but also in the phase of general practitioner care. The patient's hospital discharge letter with a detailed social history can serve information transfer at the interfaces.
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Affiliation(s)
- Teresa Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland.
| | - Anke Hierundar
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - Christian Waydhas
- Klinik und Poliklinik für Chirurgie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Deutschland
- Medizinische Fakultät, Universität Duisburg-Essen, Essen, Deutschland
| | - Reimer Riessen
- Abteilung für Innere Medizin - Internistische Intensivstation 93, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Urs Münch
- Klinik für Allgemein‑, Viszeral- und Minimalinvasive Chirurgie, DRK Kliniken Berlin Westend, Berlin, Deutschland
- Pankreaszentrum, DRK Kliniken Berlin Westend, Berlin, Deutschland
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Kang J, Lee MH. Incidence rate and risk factors for post-intensive care syndrome subtypes among critical care survivors three months after discharge: A prospective cohort study. Intensive Crit Care Nurs 2024; 81:103605. [PMID: 38157567 DOI: 10.1016/j.iccn.2023.103605] [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: 08/28/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To investigate the incidence of post-intensive care syndrome subtypes and their risk factors among intensive care unit survivors. RESEARCH METHODOLOGY/DESIGN This prospective observational cohort study assessed post-intensive care syndrome at three months after discharge in 475 survivors (median age of 62 years, 59.4 % male) admitted for more than 24 hours to 19 intensive care units. SETTING 19 intensive care units at four university hospitals in Korea. MAIN OUTCOME MEASURES Three months after discharge, the Hospital Anxiety and Depression Scale, Posttraumatic Diagnosis Scale, Montreal Cognitive Assessment, and Activities of Daily Living were used to evaluate post-intensive care syndrome. RESULTS Participants exhibited eight subtypes of post-intensive care syndrome: post-intensive care syndrome free (50.3 %), impaired in physical (3.4 %), mental (13.5 %), cognitive (12.4 %), physical and mental (7.8 %), physical and cognitive (2.3 %), mental and cognitive (4.0 %) and all three domains (6.3 %). Age, unemployment, education, comorbidities, unplanned admission, longer stay, and place of discharge were risk factors for each domain. Age ≥ 65 years (OR 9.234, p < .001), female gender (OR = 5.143, p = .002), two or more comorbidities (OR = 8.701, p = .002), and discharge to an extended care facility (OR = 36.040, p < .001) were associated with increased probability of impairment in all three domains. CONCLUSION The type with impaired in both mental and physical domains was the most prevalent in cases of co-occurrence. Discharge to an extended care facility was one of the most significant risk factor for the occurrence of each domain and intensity of post-intensive care syndrome. IMPLICATIONS FOR CLINICAL PRACTICE Nurses must promote prevention strategies by proactively evaluating intensive care unit survivors for post-intensive care syndrome risk factors. Additionally, it is necessary to raise healthcare providers' awareness of post-intensive care syndrome evaluation and management in extended care facilities.
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Affiliation(s)
- Jiyeon Kang
- College of Nursing, Dong-A University, Busan, South Korea
| | - Min Hye Lee
- College of Nursing, Dong-A University, Busan, South Korea.
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Potter KM, Dunn H, Krupp A, Mueller M, Newman S, Girard TD, Miller S. Identifying Comorbid Subtypes of Patients With Acute Respiratory Failure. Am J Crit Care 2023; 32:294-301. [PMID: 37391366 DOI: 10.4037/ajcc2023980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Patients with acute respiratory failure have multiple risk factors for disability following their intensive care unit stay. Interventions to facilitate independence at hospital discharge may be more effective if personalized for patient subtypes. OBJECTIVES To identify subtypes of patients with acute respiratory failure requiring mechanical ventilation and compare post-intensive care functional disability and intensive care unit mobility level among subtypes. METHODS Latent class analysis was conducted in a cohort of adult medical intensive care unit patients with acute respiratory failure receiving mechanical ventilation who survived to hospital discharge. Demographic and clinical medical record data were collected early in the stay. Clinical characteristics and outcomes were compared among subtypes by using Kruskal-Wallis tests and χ2 tests of independence. RESULTS In a cohort of 934 patients, the 6-class model provided the optimal fit. Patients in class 4 (obesity and kidney impairment) had worse functional impairment at hospital discharge than patients in classes 1 through 3. Patients in class 3 (alert patients) had the lowest magnitude of functional impairment (P < .001) and achieved the earliest out-of-bed mobility and highest mobility level of all subtypes (P < .001). CONCLUSIONS Acute respiratory failure survivor subtypes identified from clinical data available early in the intensive care unit stay differ in post-intensive care functional disability. Future research should target high-risk patients in early rehabilitation trials in the intensive care unit. Additional investigation of contextual factors and mechanisms of disability is critical to improving quality of life in acute respiratory failure survivors.
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Affiliation(s)
- Kelly M Potter
- Kelly M. Potter was a PhD candidate at the Medical University of South Carolina College of Nursing during the study and is now a research assistant professor at the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pennsylvania
| | - Heather Dunn
- Heather Dunn is a clinical assistant professor at University of Iowa College of Nursing, Iowa City, Iowa
| | - Anna Krupp
- Anna Krupp is an assistant professor at University of Iowa College of Nursing
| | - Martina Mueller
- Martina Mueller is a professor of biostatistics at the Medical University of South Carolina College of Nursing, Charleston, South Carolina
| | - Susan Newman
- Susan Newman is an associate professor and assistant dean at the Medical University of South Carolina College of Nursing
| | - Timothy D Girard
- Timothy D. Girard is an associate professor and director of the CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh
| | - Sarah Miller
- Sarah Miller is an associate professor at the Medical University of South Carolina College of Nursing
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Hiser SL, Fatima A, Ali M, Needham DM. Post-intensive care syndrome (PICS): recent updates. J Intensive Care 2023; 11:23. [PMID: 37221567 DOI: 10.1186/s40560-023-00670-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
An increasing number of patients are surviving critical illness, but some experience new or worsening long-lasting impairments in physical, cognitive and/or mental health, commonly known as post-intensive care syndrome (PICS). The need to better understand and improve PICS has resulted in a growing body of literature exploring its various facets. This narrative review will focus on recent studies evaluating various aspects of PICS, including co-occurrence of specific impairments, subtypes/phenotypes, risk factors/mechanisms, and interventions. In addition, we highlight new aspects of PICS, including long-term fatigue, pain, and unemployment.
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Affiliation(s)
- Stephanie L Hiser
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, 2000 Pennsylvania Ave. NW, Suite 2000, Washington, DC, 20006, USA.
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.
| | - Arooj Fatima
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mazin Ali
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
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Interrelationships among workload, illness severity, and function on return to work following acute respiratory distress syndrome. Aust Crit Care 2023; 36:247-253. [PMID: 35210156 PMCID: PMC9392808 DOI: 10.1016/j.aucc.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 12/28/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inability to return to work (RTW) is common after acute respiratory distress syndrome (ARDS). OBJECTIVES The aim of this study is to examine interrelationships among pre-ARDS workload, illness severity, and post-ARDS cognitive, psychological, interpersonal, and physical function with RTW at 6 and 12 months after ARDS. METHODS We conducted a secondary analysis using the US multicentre ARDS Network Long-Term Outcomes Study. The US Occupational Information Network was used to determine pre-ARDS workload. The Mini-Mental State Examination and SF-36 were used to measure four domains of post-ARDS function. Analyses used structural equation modeling and mediation analyses. RESULTS Among 329 previously employed ARDS survivors, 6- and 12-month RTW rates were 52% and 56%, respectively. Illness severity (standardised coefficients range: -0.51 to -0.54, p < 0.001) had a negative effect on RTW at 6 months, whereas function at 6 months (psychological [0.42, p < 0.001], interpersonal [0.40, p < 0.001], and physical [0.43, p < 0.001]) had a positive effect. Working at 6 months (0.79 to 0.72, P < 0.001) had a positive effect on RTW at 12 months, whereas illness severity (-0.32 to -0.33, p = 0.001) and post-ARDS function (psychological [6 months: 0.44, p < 0.001; 12 months: 0.33, p = 0.002], interpersonal [0.44, p < 0.001; 0.22, p = 0.03], and physical abilities [0.47, p < 0.001; 0.33, p = 0.007]) only had an indirect effect on RTW at 12 months mediated through work at 6 months. CONCLUSIONS RTW at 12 months was associated with patients' illness severity; post-ARDS cognitive, psychological, interpersonal, and physical function; and working at 6 months. Among these factors, working at 6 months and function may be modifiable mediators of 12-month post-ARDS RTW. Improving ARDS survivors' RTW may include optimisation of workload after RTW, along with interventions across the healthcare spectrum to improve patients' physical, psychological, and interpersonal function.
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Gorman EA, O'Kane CM, McAuley DF. Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management. Lancet 2022; 400:1157-1170. [PMID: 36070788 DOI: 10.1016/s0140-6736(22)01439-8] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 12/16/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is characterised by acute hypoxaemic respiratory failure with bilateral infiltrates on chest imaging, which is not fully explained by cardiac failure or fluid overload. ARDS is defined by the Berlin criteria. In this Series paper the diagnosis, management, outcomes, and long-term sequelae of ARDS are reviewed. Potential limitations of the ARDS definition and evidence that could inform future revisions are considered. Guideline recommendations, evidence, and uncertainties in relation to ARDS management are discussed. The future of ARDS strives towards a precision medicine approach, and the framework of treatable traits in ARDS diagnosis and management is explored.
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Affiliation(s)
- Ellen A Gorman
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Cecilia M O'Kane
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.
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Jain S, Hauschildt K, Scheunemann LP. Social determinants of recovery. Curr Opin Crit Care 2022; 28:557-565. [PMID: 35993295 DOI: 10.1097/mcc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine evidence describing the influence of social determinants on recovery following hospitalization with critical illness. In addition, it is meant to provide insight into the several mechanisms through which social factors influence recovery as well as illuminate approaches to addressing these factors at various levels in research, clinical care, and policy. RECENT FINDINGS Social determinants of health, ranging from individual factors like social support and socioeconomic status to contextual ones like neighborhood deprivation, are associated with disability, cognitive impairment, and mental health after critical illness. Furthermore, many social factors are reciprocally related to recovery wherein the consequences of critical illness such as financial toxicity and caregiver burden can put essential social needs under strain turning them into barriers to recovery. SUMMARY Recovery after hospitalization for critical illness may be influenced by many social factors. These factors warrant attention by clinicians, health systems, and policymakers to enhance long-term outcomes of critical illness survivors.
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Potter KM, Scheunemann LP, Girard TD. Health Equity and Critical Care Survivorship: Where Do We Go From Here? Ann Intern Med 2022; 175:749-750. [PMID: 35254881 DOI: 10.7326/m22-0726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Kelly M Potter
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Leslie P Scheunemann
- Division of Geriatric Medicine and Gerontology and Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Timothy D Girard
- The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Hewitt KC, Marra DE, Block C, Cysique LA, Drane DL, Haddad MM, Łojek E, McDonald CR, Reyes A, Eversole K, Bowers D. Central Nervous System Manifestations of COVID-19: A Critical Review and Proposed Research Agenda. J Int Neuropsychol Soc 2022; 28:311-325. [PMID: 33858556 PMCID: PMC10035233 DOI: 10.1017/s1355617721000345] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE On March 11, 2020, the World Health Organization declared an outbreak of a new viral entity, coronavirus 2019 (COVID-19), to be a worldwide pandemic. The characteristics of this virus, as well as its short- and long-term implications, are not yet well understood. The objective of the current paper was to provide a critical review of the emerging literature on COVID-19 and its implications for neurological, neuropsychiatric, and cognitive functioning. METHOD A critical review of recently published empirical research, case studies, and reviews pertaining to central nervous system (CNS) complications of COVID-19 was conducted by searching PubMed, PubMed Central, Google Scholar, and bioRxiv. RESULTS After considering the available literature, areas thought to be most pertinent to clinical and research neuropsychologists, including CNS manifestations, neurologic symptoms/syndromes, neuroimaging, and potential long-term implications of COVID-19 infection, were reviewed. CONCLUSION Once thought to be merely a respiratory virus, the scientific and medical communities have realized COVID-19 to have broader effects on renal, vascular, and neurological body systems. The question of cognitive deficits is not yet well studied, but neuropsychologists will undoubtedly play an important role in the years to come.
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Affiliation(s)
- Kelsey C. Hewitt
- Emory University School of Medicine, Department of Neurology, Atlanta, GA 30329, USA
| | - David E. Marra
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL 32610, USA
| | - Cady Block
- Emory University School of Medicine, Department of Neurology, Atlanta, GA 30329, USA
| | - Lucette A. Cysique
- University of New South Wales, Department of Psychology, The Alfred Hospital, Melbourne, 3004, Australia
- St. Vincent’s Applied Medical Research Centre, Sydney, New South Wales, 2011, Australia
| | - Daniel L. Drane
- Emory University School of Medicine, Department of Neurology, Atlanta, GA 30329, USA
- Emory University, Department of Pediatrics, Atlanta, GA 30322, USA
| | - Michelle M. Haddad
- Emory University, Department of Rehabilitation Medicine, Atlanta, GA 30329, USA
| | - Emilia Łojek
- University of Warsaw, Department of Psychology, Warszawa, 00-183, Poland
| | - Carrie R. McDonald
- University of California-San Diego, Department of Psychiatry, La Jolla, CA 92093, USA
| | - Anny Reyes
- University of California-San Diego, Department of Psychiatry, La Jolla, CA 92093, USA
| | - Kara Eversole
- James Madison University, Department of Graduate Psychology, Harrisonburg, VA 22807, USA
| | - Dawn Bowers
- University of Florida, Department of Clinical and Health Psychology, Gainesville, FL 32610, USA
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Siuba MT, Sadana D, Gadre S, Bruckman D, Duggal A. Acute respiratory distress syndrome readmissions: A nationwide cross-sectional analysis of epidemiology and costs of care. PLoS One 2022; 17:e0263000. [PMID: 35077505 PMCID: PMC8789165 DOI: 10.1371/journal.pone.0263000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background Acute Respiratory Distress Syndrome affects approximately 10% of patients admitted to intensive care units internationally, with as many as 40%-52% of patients reporting re-hospitalization within one year. Research question/aim To describe the epidemiology of patients with acute respiratory distress syndrome who require 30-day readmission, and to describe associated costs. Study design and methods A cross-sectional analysis of the 2016 Healthcare Cost and Utilization Project’s Nationwide Readmission Database, which is a population-based administrative database which includes discharge data from U.S. hospitals. Inclusion criteria: hospital discharge records for adults age > 17 years old, with a diagnosis of ARDS on index admission, with associated procedure codes for endotracheal intubation and/or invasive mechanical ventilation, who were discharged alive. Primary exposure is adult hospitalization for meeting criteria as described. The primary outcome measure is 30-day readmission rate, as well as patient characteristics and time distribution of readmissions. Results Nationally, 25,170 admissions meeting criteria were identified. Index admission mortality rate was 37.5% (95% confidence interval [CI], 36.2–38.8). 15,730 records of those surviving hospitalization had complete discharge information. 30-day readmission rate was 18.4%, with 14% of total readmissions occurring within 2 calendar days of discharge; these early readmissions had higher mortality risk (odds ratio 1.82, 95% CI 1.05–6.56) compared with readmission in subsequent days. For the closest all-cause readmission within 30 days, the mean cost was $26,971, with a total national cost of over $75.6 million. Interpretation Thirty-day readmission occurred in 18.4% of patients with acute respiratory distress syndrome in this sample, and early readmission is strongly associated with increased mortality compared to late readmission. Further research is needed to clarify whether the rehospitalizations or associated mortalities are preventable.
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Affiliation(s)
- Matthew T. Siuba
- Department of Critical Care Medicine, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, United States of America
- * E-mail:
| | - Divyajot Sadana
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shruti Gadre
- Department of Critical Care Medicine, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, United States of America
| | - David Bruckman
- Department of Quantitative Health Sciences, Cleveland Clinic, Center for Populations Health Research, Lerner Research Institute, Cleveland, Ohio, United States of America
| | - Abhijit Duggal
- Department of Critical Care Medicine, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, United States of America
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Sudarsanam T, Thomas R, Turaka V, Peter J, Christopher DJ, Balamugesh T, Mahasampath G, Mathuram A, Sadiq M, Ramya I, George T, Chandireseharan V, George T. Good survival rate, moderate overall and good respirator quality of life, near normal pulmonary functions, and good return to work despite catastrophic economic costs 6 months following recovery from Acute Respiratory Distress Syndrome. Lung India 2022; 39:169-173. [PMID: 35259800 PMCID: PMC9053934 DOI: 10.4103/lungindia.lungindia_6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Long-term quality of life, return to work, economic consequences following Acute Respiratory Distress Syndrome (ARDS) are not well described in India. This study was aimed to address the question. Methods: A prospective cohort study of 109 ARDS survivors were followed up for a minimum of 6 months following discharge. Quality of life was assessed using the SF-36 questionnaire. Respiratory quality was assessed using the St Georges Respiratory Questionnaire. Time to return to work was documented. Costs-direct medical, as well as indirect were documented up to 6 months. Results: At 6 months, 6/109 (5.5%) had expired. Low energy/vitality and general heath were noted in the SF-36 scores at 6 months; overall a moderate quality of life. Pulmonary function tests had mostly normalized. Six-min walk distance was 77% of predicted. Respiratory quality of life was good. It took at the median of 111 days to go back Interquartile range (55–193.5) to work with 88% of previously employed going back to work. There were no significant differences in the severity of ARDS and any of these outcomes at 6 months. The average total cost from the societal perspective was 231,450 (standard deviation 146,430 -, 387,300). There was a significant difference between the 3-ARDS severity groups and costs (P < 0.01). There were no independent predictors of return to work. Conclusion: ARDS survivors have low 6-month mortality. Pulmonary physiology and exercise capacity was mostly normal. Overall, quality of life is average was moderate, while respiratory quality of life was good. Return to work was excellent, while cost of care falls under a catastrophic heath expense.
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Hashem MD, Hopkins RO, Colantuoni E, Dinglas VD, Sinha P, Aronson Friedman L, Morris PE, Jackson JC, Hough CL, Calfee CS, Needham DM. Six-month and 12-month patient outcomes based on inflammatory subphenotypes in sepsis-associated ARDS: secondary analysis of SAILS-ALTOS trial. Thorax 2022; 77:22-30. [PMID: 34112703 PMCID: PMC8660939 DOI: 10.1136/thoraxjnl-2020-216613] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Prior acute respiratory distress syndrome (ARDS) trials have identified hypoinflammatory and hyperinflammatory subphenotypes, with distinct differences in short-term outcomes. It is unknown if such differences extend beyond 90 days or are associated with physical, mental health or cognitive outcomes. METHODS 568 patients in the multicentre Statins for Acutely Injured Lungs from Sepsis trial of rosuvastatin versus placebo were included and assigned a subphenotype. Among 6-month and 12-month survivors (N=232 and 219, respectively, representing 243 unique survivors), subphenotype status was evaluated for association with a range of patient-reported outcomes (eg, mental health symptoms, quality of life). Patient subsets also were evaluated with performance-based tests of physical function (eg, 6 min walk test) and cognition. FINDINGS The hyperinflammatory versus hypoinflammatory subphenotype had lower overall 12-month cumulative survival (58% vs 72%, p<0.01); however, there was no significant difference in survival beyond 90 days (86% vs 89%, p=0.70). Most survivors had impairment across the range of outcomes, with little difference between subphenotypes at 6-month and 12-month assessments. For instance, at 6 months, in comparing the hypoinflammatory versus hyperinflammatory subphenotypes, respectively, the median (IQR) patient-reported SF-36 mental health domain score was 47 (33-56) vs 44 (35-56) (p=0.99), and the per cent predicted 6 min walk distance was 66% (48%, 80%) vs 66% (49%, 79%) (p=0.76). INTERPRETATION Comparing the hyperinflammatory versus hypoinflammatory ARDS subphenotype, there was no significant difference in survival beyond 90 days and no consistent findings of important differences in 6-month or 12-month physical, cognitive and mental health outcomes. These findings, when considered with prior results, suggest that inflammatory subphenotypes largely reflect the acute phase of illness and its short-term impact.
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Affiliation(s)
- Mohamed D Hashem
- Department of Medicine, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins University - Bloomberg School of Public Health, Baltimore, Maryland, USA
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
| | - Victor D Dinglas
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pratik Sinha
- Division of Critical Care, Department of Anesthesia, Washington University in St Louis, Saint Louis, Missouri, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Peter E Morris
- Division of Pulmonary, Critical Care & Sleep Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - James C Jackson
- Center for Critical Illness, Brain Dysfunction, and Survivorship (CIBS Center), Nashville, Tennessee, USA
- Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Carolyn S Calfee
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco Department of Medicine, San Francisco, California, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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15
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Evans RA, McAuley H, Harrison EM, Shikotra A, Singapuri A, Sereno M, Elneima O, Docherty AB, Lone NI, Leavy OC, Daines L, Baillie JK, Brown JS, Chalder T, De Soyza A, Diar Bakerly N, Easom N, Geddes JR, Greening NJ, Hart N, Heaney LG, Heller S, Howard L, Hurst JR, Jacob J, Jenkins RG, Jolley C, Kerr S, Kon OM, Lewis K, Lord JM, McCann GP, Neubauer S, Openshaw PJM, Parekh D, Pfeffer P, Rahman NM, Raman B, Richardson M, Rowland M, Semple MG, Shah AM, Singh SJ, Sheikh A, Thomas D, Toshner M, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Wain LV, Brightling CE. Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study. THE LANCET. RESPIRATORY MEDICINE 2021; 9:1275-1287. [PMID: 34627560 PMCID: PMC8497028 DOI: 10.1016/s2213-2600(21)00383-0] [Citation(s) in RCA: 327] [Impact Index Per Article: 109.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/30/2021] [Accepted: 08/18/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9-6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40-59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. INTERPRETATION We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. FUNDING UK Research and Innovation and National Institute for Health Research.
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Affiliation(s)
- Rachael A Evans
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Hamish McAuley
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Aarti Shikotra
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Marco Sereno
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Olivia C Leavy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J Kenneth Baillie
- Roslin Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Jeremy S Brown
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony De Soyza
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Teaching Hospitals Trust, Newcastle upon Tyne, UK
| | - Nawar Diar Bakerly
- Manchester Metropolitan University, Manchester, UK; Salford Royal NHS Foundation Trust, Manchester, UK
| | - Nicholas Easom
- Infection Research Group, Hull University Teaching Hospitals, Hull, UK
| | - John R Geddes
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Neil J Greening
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Nick Hart
- Lane Fox Respiratory Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Belfast Health & Social Care Trust, Belfast, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Luke Howard
- Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, Department of Medicine, University College London, London, UK
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK; Lungs for Living Research Centre, University College London, London, UK
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Caroline Jolley
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Steven Kerr
- Roslin Institute, University of Edinburgh, Edinburgh, UK
| | - Onn M Kon
- Imperial College Healthcare NHS Trust, London, UK, University College London, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Keir Lewis
- Hywel Dda University Health Board, Wales, UK; University of Swansea, Swansea, UK; Respiratory Innovation Wales, Llanelli, UK
| | - Janet M Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Stefan Neubauer
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | | | - Dhruv Parekh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK; Department of Acute Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Paul Pfeffer
- Barts Health NHS Trust, London, UK; Queen Mary University of London, London, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Matthew Richardson
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Matthew Rowland
- Kadoorie Centre for Critical Care Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Malcolm G Semple
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, UK; Respiratory Medicine, Alder Hey Children's Hospital, Liverpool, UK
| | - Ajay M Shah
- King's College London British Heart Foundation Centre and King's College Hospital NHS Foundation Trust, London, UK
| | - Sally J Singh
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Thomas
- Immunology and Inflammation, Imperial College London, London, UK
| | - Mark Toshner
- Cambridge NIHR Biomedical Research Centre, Cambridge, UK; NIHR Cambridge Clinical Research Facility, Cambridge, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK
| | - Alex Horsley
- Division of Infection, Immunity & Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK
| | | | - Louise V Wain
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK
| | - Christopher E Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
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16
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Rasulo FA, Piva S, Latronico N. Long-term complications of COVID-19 in ICU survivors: what do we know? Minerva Anestesiol 2021; 88:72-79. [PMID: 34709019 DOI: 10.23736/s0375-9393.21.16032-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has caused more than 175 million persons infected and 3.8 million deaths so far and is having a devastating impact on both low and high-income countries, in particular on hospitals and intensive care units (ICU). The ICU mortality during the first pandemic wave ranged from 40% to 85% during the busiest ICU period for admissions around the peak of the surge, and those surviving are frequently faced with impairments affecting physical, cognitive, and mental health status, complicating the post-acute phase of COVID-19, which in the pre-COVID period, were defined collectively as post-intensive care syndrome (PICS). Long COVID is defined as four weeks of persisting symptoms after the acute illness, and post-COVID syndrome and chronic COVID-19 are the proposed terms to describe continued symptomatology for more than 12 weeks. Overall, 50% of ICU survivors suffer from new physical, mental, and/or cognitive problems at 1 year after ICU discharge. The prevalence, severity, and duration of the various impairments in ICU survivors are poorly defined, with substantial variations among published series, and may reflect differences in the timing of assessment, the outcome measured, the instruments utilized, and thresholds adopted to establish the diagnosis, the qualification of personnel delivering the tests, the resource availability as well diversity in patients' case-mix. Future longitudinal studies of adequate sample size with repeated assessments of validated outcomes and comparison with non-COVID-19 ICU patients are needed to fully explore the long-term outcome of ICU patients with COVID-19. In this article, we focus on chronic COVID-19 in ICU survivors and present state of the art data regarding long-term complications related to critical illness and the treatments and organ support received.
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Affiliation(s)
- Frank A Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy - .,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy - .,Alessandra Bono Interdepartmental Research Center for LOng-Term Outcome (LOTO) in survivors of critical Illness, University of Brescia, Brescia, Italy -
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.,Alessandra Bono Interdepartmental Research Center for LOng-Term Outcome (LOTO) in survivors of critical Illness, University of Brescia, Brescia, Italy
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17
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Shah FA, Meyer NJ, Angus DC, Awdish R, Azoulay É, Calfee CS, Clermont G, Gordon AC, Kwizera A, Leligdowicz A, Marshall JC, Mikacenic C, Sinha P, Venkatesh B, Wong HR, Zampieri FG, Yende S. A Research Agenda for Precision Medicine in Sepsis and Acute Respiratory Distress Syndrome: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:891-901. [PMID: 34652268 PMCID: PMC8534611 DOI: 10.1164/rccm.202108-1908st] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Precision medicine focuses on the identification of therapeutic strategies that are effective for a group of patients based on similar unifying characteristics. The recent success of precision medicine in non-critical care settings has resulted from the confluence of large clinical and biospecimen repositories, innovative bioinformatics, and novel trial designs. Similar advances for precision medicine in sepsis and in the acute respiratory distress syndrome (ARDS) are possible but will require further investigation and significant investment in infrastructure. Methods: This project was funded by the American Thoracic Society Board of Directors. A multidisciplinary and diverse working group reviewed the available literature, established a conceptual framework, and iteratively developed recommendations for the Precision Medicine Research Agenda for Sepsis and ARDS. Results: The following six priority recommendations were developed by the working group: 1) the creation of large richly phenotyped and harmonized knowledge networks of clinical, imaging, and multianalyte molecular data for sepsis and ARDS; 2) the implementation of novel trial designs, including adaptive designs, and embedding trial procedures in the electronic health record; 3) continued innovation in the data science and engineering methods required to identify heterogeneity of treatment effect; 4) further development of the tools necessary for the real-time application of precision medicine approaches; 5) work to ensure that precision medicine strategies are applicable and available to a broad range of patients varying across differing racial, ethnic, socioeconomic, and demographic groups; and 6) the securement and maintenance of adequate and sustainable funding for precision medicine efforts. Conclusions: Precision medicine approaches that incorporate variability in genomic, biologic, and environmental factors may provide a path forward for better individualizing the delivery of therapies and improving care for patients with sepsis and ARDS.
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18
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Palakshappa JA, Krall JTW, Belfield LT, Files DC. Long-Term Outcomes in Acute Respiratory Distress Syndrome: Epidemiology, Mechanisms, and Patient Evaluation. Crit Care Clin 2021; 37:895-911. [PMID: 34548140 PMCID: PMC8157317 DOI: 10.1016/j.ccc.2021.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Survivors of acute respiratory distress syndrome (ARDS) experience challenges that persist well beyond the time of hospital discharge. Impairment in physical function, cognitive function, and mental health are common and may last for years. The current coronavirus disease 2019 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. Evaluation of the ARDS survivor should be comprehensive, and common domains of impairment that have emerged from long-term outcomes research over the past 2 decades should be systematically evaluated.
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Affiliation(s)
- Jessica A Palakshappa
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jennifer T W Krall
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Lanazha T Belfield
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - D Clark Files
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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19
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Vickory F, Ridgeway K, Falvey J, Houwer B, Gunlikson J, Payne K, Niehaus W. Safety, Feasibility, and Outcomes of Frequent, Long-Duration Rehabilitation in an Inpatient Rehabilitation Facility After Prolonged Hospitalization for Severe COVID-19: An Observational Study. Phys Ther 2021; 101:6365140. [PMID: 34499165 PMCID: PMC8499953 DOI: 10.1093/ptj/pzab208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
OBJECTIVE he objective of this study was to evaluate safety, feasibility, and outcomes of 30 patients within an inpatient rehabilitation facility following hospitalization for severe Coronavirus Disease 19 (COVID-19) infection. METHODS This was an observational study of 30 patients (ages 26-80 years) within a large, metropolitan, academic hospital following hospitalization for complications from severe COVID-19. Ninety percent of the participants required critical care, and 83% required mechanical ventilation during their hospitalization. Within an inpatient rehabilitation facility and model of care, frequent, long-duration rehabilitation was provided by occupational therapists, physical therapists, and speech language pathologists. RESULTS The average inpatient rehabilitation facility length of stay was 11 days (ranging from 4-22 days). Patients averaged 165 min/d (ranging from 140-205 minutes) total of physical therapy, occupational therapy, and speech therapy. Twenty-eight of the 30 patients (93%) were discharged to the community. One patient required readmission from an inpatient rehabilitation facility to an acute hospital. All 30 patients improved their functional status with inpatient rehabilitation. CONCLUSION In this cohort of 30 patients, inpatient rehabilitation after severe COVID-19 was safe and feasible. Patients were able to participate in frequent, long-duration rehabilitation with nearly all patients discharging to the community. Clinically, inpatient rehabilitation should be considered for patients with functional limitations following severe COVID-19. Given 90% of our cohort required critical care, future studies should investigate the efficacy and effectiveness of inpatient rehabilitation following hospitalization for critical illness. Frequent, long-duration rehabilitation shows promising potential to address functional impairments following hospitalization for severe COVID-19. IMPACT Inpatient rehabilitation facilities should be considered as a discharge location for hospitalized survivors of COVID-19, especially severe COVID-19, with functional limitations precluding community discharge. Clinicians and administrators should consider inpatient rehabilitation and inpatient rehabilitation facilities to address the rehabilitation needs of COVID-19 and critical illness survivors.
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Affiliation(s)
- Frank Vickory
- Address all correspondence to Dr. Frank Vickory at: Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave. Aurora, CO 80045. (850) 509-0112,
| | - Kyle Ridgeway
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave, Aurora, CO 80045. Physical Therapy Program, University of Colorado Anschutz Medical Campus: School of Medicine, Department of Physical Medicine and Rehabilitation
| | - Jason Falvey
- Department of Physical Therapy and Rehabilitation Science, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 100 Penn St. Baltimore, MD 21201
| | - Beth Houwer
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave, Aurora, CO 80045
| | - Jennifer Gunlikson
- Inpatient Rehabilitation Therapy Department, University of Colorado Hospital, 12605 E 16 Ave, Aurora, CO 80045
| | - Katherine Payne
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, University of Colorado Hospital. 12631 E 17 Ave, Mail Stop F493 Aurora, CO 80045
| | - William Niehaus
- University of Colorado School of Medicine, Department of Physical Medicine and Rehabilitation, University of Colorado Hospital. 12631 E 17 Ave, Mail Stop F493 Aurora, CO 80045
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20
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Geense WW, Zegers M, Peters MAA, Ewalds E, Simons KS, Vermeulen H, van der Hoeven JG, van den Boogaard M. New Physical, Mental, and Cognitive Problems 1 Year after ICU Admission: A Prospective Multicenter Study. Am J Respir Crit Care Med 2021; 203:1512-1521. [PMID: 33526001 DOI: 10.1164/rccm.202009-3381oc] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rationale: Comprehensive studies addressing the incidence of physical, mental, and cognitive problems after ICU admission are lacking. With an increasing number of ICU survivors, an improved understanding of post-ICU problems is necessary. Objectives: To determine the occurrence and cooccurrence of new physical, mental, and cognitive problems among ICU survivors 1 year after ICU admission, their impact on daily functioning, and risk factors associated with 1-year outcomes. Methods: Prospective multicenter cohort study, including ICU patients ⩾16 years of age, admitted for ⩾12 hours between July 2016 and June 2019. Patients, or proxies, rated their health status before and 1 year after ICU admission using questionnaires. Measurements and Main Results: Validated questionnaires were used to measure frailty, fatigue, new physical symptoms, anxiety and depression, post-traumatic stress disorder, cognitive impairment, and quality of life. Of the 4,793 patients included, 2,345 completed the questionnaires both before and 1 year after ICU admission. New physical, mental, and/or cognitive problems 1 year after ICU admission were experienced by 58% of the medical patients, 64% of the urgent surgical patients, and 43% of the elective surgical patients. Urgent surgical patients experienced a significant deterioration in their physical and mental functioning, whereas elective surgical patients experienced a significant improvement. Medical patients experienced an increase in symptoms of depression. A significant decline in cognitive functioning was experienced by all types of patients. Pre-ICU health status was strongly associated with post-ICU health problems. Conclusions: Overall, 50% of ICU survivors suffer from new physical, mental, and/or cognitive problems. An improved insight into the specific health problems of ICU survivors would enable more personalized post-ICU care.
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Affiliation(s)
| | | | - Marco A A Peters
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Esther Ewalds
- Department of Intensive Care Medicine, Bernhoven Hospital, Uden, the Netherlands
| | - Koen S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands; and
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
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21
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Maddux AB, Sevick C, Cox-Martin M, Bennett TD. Novel Claims-Based Outcome Phenotypes in Survivors of Pediatric Traumatic Brain Injury. J Head Trauma Rehabil 2021; 36:242-252. [PMID: 33656469 PMCID: PMC8249306 DOI: 10.1097/htr.0000000000000646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE For children hospitalized with acute traumatic brain injury (TBI), to use postdischarge insurance claims to identify: (1) healthcare utilization patterns representative of functional outcome phenotypes and (2) patient and hospitalization characteristics that predict outcome phenotype. SETTING Two pediatric trauma centers and a state-level insurance claim aggregator. PATIENTS A total of 289 children, who survived a hospitalization after TBI between 2009 and 2014, were in the hospital trauma registry, and had postdischarge insurance eligibility. DESIGN Retrospective cohort study. MAIN MEASURES Unsupervised machine learning to identify phenotypes based on postdischarge insurance claims. Regression analyses to identify predictors of phenotype. RESULTS Median age 5 years (interquartile range 2-12), 29% (84/289) female. TBI severity: 30% severe, 14% moderate, and 60% mild. We identified 4 functional outcome phenotypes. Phenotypes 3 and 4 were the highest utilizers of resources. Morbidity burden was highest during the first 4 postdischarge months and subsequently decreased in all domains except respiratory. Severity and mechanism of injury, intracranial pressure monitor placement, seizures, and hospital and intensive care unit lengths of stay were phenotype predictors. CONCLUSIONS Unsupervised machine learning identified postdischarge phenotypes at high risk for morbidities. Most phenotype predictors are available early in the hospitalization and can be used for prognostic enrichment of clinical trials targeting mitigation or treatment of domain-specific morbidities.
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Affiliation(s)
- Aline B. Maddux
- Assistant Professor of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO
| | - Carter Sevick
- Data Analyst, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Matthew Cox-Martin
- Data Analyst, Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado
| | - Tellen D. Bennett
- Associate Professor and Section Head, Section of Informatics and Data Science, Department of Pediatrics, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO
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22
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Laake JH, Buanes EA, Småstuen MC, Kvåle R, Olsen BF, Rustøen T, Strand K, Sørensen V, Hofsø K. Characteristics, management and survival of ICU patients with coronavirus disease-19 in Norway, March-June 2020. A prospective observational study. Acta Anaesthesiol Scand 2021; 65:618-628. [PMID: 33501998 PMCID: PMC8014826 DOI: 10.1111/aas.13785] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Norwegian hospitals have operated within capacity during the COVID-19 pandemic. We present patient and management characteristics, and outcomes for the entire cohort of adult (>18 years) COVID-19 patients admitted to Norwegian intensive care units (ICU) from 10 March to 19 June 2020. METHODS Data were collected from The Norwegian intensive care and pandemic registry (NIPaR). Demographics, co-morbidities, management characteristics and outcomes are described. ICU length of stay (LOS) was analysed with linear regression, and associations between risk factors and mortality were quantified using Cox regression. RESULTS In total, 217 patients were included. The male to female ratio was 3:1 and the median age was 63 years. A majority (70%) had one or more co-morbidities, most frequently cardiovascular disease (39%), chronic lung disease (22%), diabetes mellitus (20%), and obesity (17%). Most patients were admitted for acute hypoxaemic respiratory failure (AHRF) (91%) and invasive mechanical ventilation (MV) was used in 86%, prone ventilation in 38% and 25% of patients received a tracheostomy. Vasoactive drugs were used in 79% and renal replacement therapy in 15%. Median ICU LOS and time of MV was 14.0 and 12.0 days. At end of follow-up 45 patients (21%) were dead. Age, co-morbidities and severity of illness at admission were predictive of death. Severity of AHRF and male gender were associated with LOS. CONCLUSIONS In this national cohort of COVID-19 patients, mortality was low and attributable to known risk factors. Importantly, prolonged length-of-stay must be taken into account when planning for resource allocation for any next surge.
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Affiliation(s)
- Jon H. Laake
- Department of Anaesthesiology Division of Emergencies and Critical Care Rikshospitalet Medical Centre Oslo University Hospital Oslo Norway
- Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
| | - Eirik A. Buanes
- Department of Intensive Care Haukeland University Hospital Bergen Norway
- Norwegian Intensive Care and Pandemic Registry Haukeland University Hospital Bergen Norway
| | | | - Reidar Kvåle
- Department of Intensive Care Haukeland University Hospital Bergen Norway
- Norwegian Intensive Care and Pandemic Registry Haukeland University Hospital Bergen Norway
- University of Bergen Bergen Norway
| | - Brita F. Olsen
- Intensive and Postoperative Unit Østfold Hospital Trust Grålum Norway
- Faculty of Health and Welfare Østfold University College Halden Norway
| | - Tone Rustøen
- Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
- Institute of Health and Society Faculty of Medicine University of Oslo Oslo Norway
| | - Kristian Strand
- Department of Intensive Care Stavanger University Hospital Stavanger Norway
| | | | - Kristin Hofsø
- Department of Research and Development Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway
- Lovisenberg Diaconal University College Oslo Norway
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23
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Hosey MM, Needham DM, Kudchadkar SR. Fatigue in critical care survivors: multidisciplinary and self-management strategies. Anaesthesia 2021; 76:1163-1166. [PMID: 33878209 DOI: 10.1111/anae.15474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 12/14/2022]
Affiliation(s)
- M M Hosey
- Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery Research Group Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D M Needham
- Division of Pulmonary and Critical Care Medicine, Outcomes After Critical Illness and Surgery Research Group Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Department of Pediatrics, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery Research Group Johns Hopkins University School of Medicine, Baltimore, MD, USA
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24
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Spontaneous Versus Controlled Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:85-91. [PMID: 33679255 PMCID: PMC7925253 DOI: 10.1007/s40140-021-00443-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 01/06/2023]
Abstract
Purpose of Review To review clinical evidence on whether or not to allow mechanically ventilated patients with acute respiratory distress syndrome (ARDS) to breathe spontaneously. Recent Findings Observational data (LUNG SAFE study) indicate that mechanical ventilation allowing for spontaneous breathing (SB) is associated with more ventilator-free days and a shorter stay in the intensive care unit without any effect on hospital mortality. A paediatric trial, comparing airway pressure release ventilation (APRV) and low-tidal volume ventilation, showed an increase in mortality in the APRV group. Conversely, in an unpublished trial comparing SB and controlled ventilation (NCT01862016), the authors concluded that SB is feasible but did not improve outcomes in ARDS patients. Summary A paucity of clinical trial data continues to prevent firm guidance on if or when to allow SB during mechanical ventilation in patients with ARDS. No published large randomised controlled trial exists to inform practice about the benefits and harms of either mode.
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25
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Mandora E, Comini L, Olivares A, Fracassi M, Cadei MG, Paneroni M, Marchina L, Suruniuc A, Luisa A, Scalvini S, Corica G, Vitacca M. Patients recovering from COVID-19 pneumonia in sub-acute care exhibit severe frailty: Role of the nurse assessment. J Clin Nurs 2021; 30:952-960. [PMID: 33434372 PMCID: PMC8014482 DOI: 10.1111/jocn.15637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/10/2020] [Accepted: 12/31/2020] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To document the level of frailty in sub-acute COVID-19 patients recovering from acute respiratory failure and investigate the associations between frailty, assessed by the nurse using the Blaylock Risk Assessment Screening Score (BRASS), and clinical and functional patient characteristics during hospitalisation. BACKGROUND Frailty is a major problem in patients discharged from acute care, but no data are available on the frailty risk in survivors of COVID-19 infection. DESIGN A descriptive cross-sectional study (STROBE checklist). METHODS At admission to sub-acute care in 2020, 236 COVID-19 patients (median age 77 years - interquartile range 68-83) were administered BRASS and classified into 3 levels of frailty risk. The Short Physical Performance Battery (SPPB) was also administered to measure physical function and disability. Differences between BRASS levels and associations between BRASS index and clinical parameters were analysed. RESULTS The median BRASS index was 14.0 (interquartile range 9.0-20.0) denoting intermediate frailty (32.2%, 41.1%, 26.7% of patients exhibited low, intermediate and high frailty, respectively). Significant differences emerged between the BRASS frailty classes regards to sex, comorbidities, history of cognitive deficits, previous mechanical ventilation support and SPPB score. Patients with no comorbidities (14%) exhibited low frailty (BRASS: median 5.5, interquartile range 3.0-12.0). Age ≥65 years, presence of comorbidities, cognitive deficit and SPPB % predicted <50% were significant predictors of high frailty. CONCLUSIONS Most COVID-19 survivors exhibit substantial frailty and require continuing care after discharge from acute care. RELEVANCE TO CLINICAL PRACTICE The BRASS index is a valuable tool for nurses to identify those patients most at risk of frailty, who require a programme of rehabilitation and community reintegration.
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Affiliation(s)
- Elena Mandora
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Adriana Olivares
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Brescia, Italy
| | - Michela Fracassi
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Maria Grazia Cadei
- Istituti Clinici Scientifici Maugeri IRCCS, Health Direction of the Institute of Lumezzane, Brescia, Italy
| | - Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Lucia Marchina
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Adrian Suruniuc
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Alberto Luisa
- Istituti Clinici Scientifici Maugeri IRCCS, Neurological Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Giacomo Corica
- Istituti Clinici Scientifici Maugeri IRCCS, Health Direction of the Institute of Lumezzane, Brescia, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
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26
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Paneroni M, Vogiatzis I, Bertacchini L, Simonelli C, Vitacca M. Predictors of Low Physical Function in Patients With COVID-19 With Acute Respiratory Failure Admitted to a Subacute Unit. Arch Phys Med Rehabil 2021; 102:1228-1231. [PMID: 33529611 PMCID: PMC7846883 DOI: 10.1016/j.apmr.2020.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
Objective To document the level of physical function in patients with coronavirus disease 2019 (COVID-19) recovering from acute respiratory failure and investigate which patient clinical characteristics could predict physical function assessed by the Short Physical Performance Battery (SPPB) test. Design Cross-sectional study. Setting Subacute unit of a Rehabilitation Institute. Participants Patients with COVID-19 (N=184; aged 18 years or older) who were admitted to a subacute unit to stabilize their condition and recover from acute respiratory failure due to COVID-19. Interventions Not applicable. Main Outcome Measures At admission patients underwent the SPPB test, represented by the sum of 3 functional tests, standing balance, 4-meter gait speed, and 5-repetition sit-to-stand motion. Comparisons between 2 SPPB score groups were performed by an unpaired t test; multivariate stepwise linear regression analysis was employed to detect predictors of the SPPB score considering several clinical parameters. Results Participants were 74±12 years old, 52% were men and with more than 2 comorbidities in 43% of cases. SPPB score was 3.02±3.87 denoting patients’ profound physical dysfunction. Normal physical function was detected in only 12% of patients, whereas low, intermediate, and severe impairment was found in 65%, 13%, and 10%, respectively. Age, both invasive and noninvasive ventilation use, and the presence of previous disability were significant predictors of SPPB. Patients without any comorbidities (8%) also exhibited low function (SPPB: 5.67±1.12). Conclusions The majority of survivors after COVID-19 experienced acute respiratory failure due to pneumonia and exhibited substantial physical dysfunction influenced by age, mechanical ventilation need, and previous disability. Further studies are needed to evaluate the role of rehabilitation to promote recovery and community reintegration in this population.
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Affiliation(s)
- Mara Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Ioannis Vogiatzis
- Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Northumbria University Newcastle, Newcastle, United Kingdom
| | - Laura Bertacchini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Carla Simonelli
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
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27
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Pfortmueller CA, Spinetti T, Urman RD, Luedi MM, Schefold JC. COVID-19-associated acute respiratory distress syndrome (CARDS): Current knowledge on pathophysiology and ICU treatment - A narrative review. Best Pract Res Clin Anaesthesiol 2020; 35:351-368. [PMID: 34511224 PMCID: PMC7831801 DOI: 10.1016/j.bpa.2020.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic “waves,” intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS “atypical.” Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.
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Affiliation(s)
- Carmen A Pfortmueller
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern, University Hospital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
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28
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Ámundadóttir ÓR, Jónasdóttir RJ, Sigvaldason K, Jónsdóttir H, Möller AD, Dean E, Sveinsson T, Sigurðsson GH. Predictive variables for poor long-term physical recovery after intensive care unit stay: An exploratory study. Acta Anaesthesiol Scand 2020; 64:1477-1490. [PMID: 32813915 DOI: 10.1111/aas.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/22/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Elucidating factors that influence physical recovery of survivors after an intensive care unit (ICU) stay is paramount in maximizing long-term functional outcomes. We examined potential predictors for poor long-term physical recovery in ICU survivors. METHODS Based on secondary analysis of a trial of 50 ICU patients who underwent mobilization in the ICU and were followed for one year, linear regression analysis examined the associations of exposure variables (baseline characteristics, severity of illness variables, ICU-related variables, and lengths of ICU and hospital stay), with physical recovery variables (muscle strength, exercise capacity, and self-reported physical function), measured one year after ICU discharge. RESULTS When the data were adjusted for age, female gender was associated with reduced muscle strength (P = .003), exercise capacity (P < .0001), and self-reported physical function (P = .01). Older age, when adjusted for gender, was associated with reduced exercise capacity (P < .001). After adjusting for gender and age, an association was observed between a lower score on one or two physical recovery variables and exposure variables, specifically, high body mass index, low functional independence, comorbidity and low self-reported physical function at baseline, muscle weakness at ICU discharge, and longer hospital stay. No adjustment was made for cumulative type I error rate due to small number of participants. CONCLUSION Elucidating risk factors for poor long-term physical recovery after ICU stay, including gender, may be critical if mobilization and exercise are to be prescribed expediently during and after ICU stay, to ensure maximal long-term recovery.
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Affiliation(s)
- Ólöf R. Ámundadóttir
- Department of Physiotherapy Landspitali – The National University Hospital of Iceland Reykjavik Iceland
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
| | - Rannveig J. Jónasdóttir
- Faculty of Nursing School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Anaesthesiology and Intensive Care Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Kristinn Sigvaldason
- Department of Anaesthesiology and Intensive Care Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
| | - Helga Jónsdóttir
- Faculty of Nursing School of Health Sciences University of Iceland Reykjavik Iceland
| | | | - Elizabeth Dean
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Physical Therapy Faculty of Medicine The University of British Columbia Vancouver Canada
| | - Thorarinn Sveinsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
| | - Gísli H. Sigurðsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Department of Anaesthesiology and Intensive Care Medicine Landspitali – The National University Hospital of Iceland Reykjavik Iceland
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29
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Parker AM, Nelliot A, Chessare CM, Malik AM, Koneru M, Hosey MM, Ozok AA, Lyons KD, Needham DM. Usability and acceptability of a mobile application prototype for a combined behavioural activation and physical rehabilitation intervention in acute respiratory failure survivors. Aust Crit Care 2020; 33:511-517. [PMID: 32340769 DOI: 10.1016/j.aucc.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Acute respiratory failure survivors experience depression symptoms and new impairments in physical function. Behavioural activation, an evidence-based nonpharmacological treatment for depression, combined with physical rehabilitation, is a promising intervention. Notably, mHealth applications (Apps) are potentially effective methods of delivering home-based interventions. OBJECTIVES The objective of this study was to evaluate the usability and acceptability of a prototype App to deliver a combined, home-based behavioural activation and rehabilitation intervention to acute respiratory failure survivors. METHODS A prospective user-preference study was conducted with acute respiratory failure survivors and self-designated care partners. Survivors were adults with at least mild depression symptoms before hospital discharge who received mechanical ventilation in the intensive care unit for ≥24 h. Survivors and care partners reviewed the App during a single in-person home visit and completed the System Usability Scale (range: 0-100; score >73 considered "good") and a semistructured interview. RESULTS Ten patient/care partner dyads completed study. The median [interquartile range] patient age was 50 [40-64] years, and 50% were female. The median System Usability Scale scores among patients and care partners were 76 [68-83] and 88 [75-94], respectively. Qualitative feedback supported usability and acceptability of the App, with three themes reported: (1) stigma associated with depression, (2) App as a motivator for recovery, and (3) App providing multidisciplinary support for survivor and care partner. CONCLUSIONS A mobile App prototype designed to deliver a combined behavioural activation and rehabilitation intervention was usable and acceptable to survivors of acute respiratory failure and their care partners. Given the reported stigma associated with depression, the self-directed App may be particularly valuable for motivation and multidisciplinary support.
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Affiliation(s)
- Ann M Parker
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Archana Nelliot
- Department of Pediatrics, Hershey Medical Center, Hershey, PA, USA
| | - Caroline M Chessare
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albahi M Malik
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mounica Koneru
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan M Hosey
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Ant Ozok
- Department of Information Systems, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Kathleen D Lyons
- Department of Psychiatry Research, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Dartmouth College, Hanover, NH, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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30
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Puthucheary ZA, Gensichen JS, Cakiroglu AS, Cashmore R, Edbrooke L, Heintze C, Neumann K, Wollersheim T, Denehy L, Schmidt KFR. Implications for post critical illness trial design: sub-phenotyping trajectories of functional recovery among sepsis survivors. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:577. [PMID: 32977833 PMCID: PMC7517819 DOI: 10.1186/s13054-020-03275-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients who survive critical illness suffer from a significant physical disability. The impact of rehabilitation strategies on health-related quality of life is inconsistent, with population heterogeneity cited as one potential confounder. This secondary analysis aimed to (1) examine trajectories of functional recovery in critically ill patients to delineate sub-phenotypes and (2) to assess differences between these cohorts in both clinical characteristics and clinimetric properties of physical function assessment tools. METHODS Two hundred ninety-one adult sepsis survivors were followed-up for 24 months by telephone interviews. Physical function was assessed using the Physical Component Score (PCS) of the Short Form-36 Questionnaire (SF-36) and Activities of Daily Living and the Extra Short Musculoskeletal Function Assessment (XSFMA-F/B). Longitudinal trajectories were clustered by factor analysis. Logistical regression analyses were applied to patient characteristics potentially determining cluster allocation. Responsiveness, floor and ceiling effects and concurrent validity were assessed within clusters. RESULTS One hundred fifty-nine patients completed 24 months of follow-up, presenting overall low PCS scores. Two distinct sub-cohorts were identified, exhibiting complete recovery or persistent impairment. A third sub-cohort could not be classified into either trajectory. Age, education level and number of co-morbidities were independent determinants of poor recovery (AUROC 0.743 ((95%CI 0.659-0.826), p < 0.001). Those with complete recovery trajectories demonstrated high levels of ceiling effects in physical function (PF) (15%), role physical (RP) (45%) and body pain (BP) (57%) domains of the SF-36. Those with persistent impairment demonstrated high levels of floor effects in the same domains: PF (21%), RP (71%) and BP (12%). The PF domain demonstrated high responsiveness between ICU discharge and at 6 months and was predictive of a persistent impairment trajectory (AUROC 0.859 (95%CI 0.804-0.914), p < 0.001). CONCLUSIONS Within sepsis survivors, two distinct recovery trajectories of physical recovery were demonstrated. Older patients with more co-morbidities and lower educational achievements were more likely to have a persistent physical impairment trajectory. In regard to trajectory prediction, the PF score of the SF-36 was more responsive than the PCS and could be considered for primary outcomes. Future trials should consider adaptive trial designs that can deal with non-responders or sub-cohort specific outcome measures more effectively.
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Affiliation(s)
- Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK. .,Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK.
| | - Jochen S Gensichen
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Institute of Family Medicine, University Hospital of the Ludwig Maximilian University, Munich, Germany.,Center of Sepsis Care and Control, Jena University Hospital, Jena, Germany
| | | | - Richard Cashmore
- Critical Care and Perioperative Medicine Research Group, Adult Critical Care Unit, Royal London Hospital, London, E1 1BB, UK
| | - Lara Edbrooke
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia.,Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine Berlin, Berlin, Germany
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine, Charité University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Melbourne, Australia.,Allied Health Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.,Center of Sepsis Care and Control, Jena University Hospital, Jena, Germany.,Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany
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Chuchalin AG, Gusev EI, Martynov MY, Kim TG, Shogenova LV. [Pulmonary insufficiency in acute stroke: risk factors and mechanisms of development]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:7-16. [PMID: 32790970 DOI: 10.17116/jnevro20201200717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Various degrees of pulmonary insufficiency (PI) (PaO2 ≤60 mm Hg, SaO2 ≤90%) are diagnosed in most of patients with severe acute stroke (AS). Frequency and severity of PI positively correlates with the severity of AS. PI worsens patient's condition, prolongs the hospitalization period, and increases the probability of fatal outcome. Early clinical signs of PI may be undiagnosed due to the severity of stroke and thus not treated. The initiating pathogenic mechanism of PI is stress-related activation of sympathetic nervous system (SNS) and systemic immunosuppression. In severe stroke with mass effect, the rapid and significant increase in intracranial pressure may additionally activate the SNS. Risk factors of PI include older age, previous pulmonary disease, prolonged supine position, respiratory muscle dysfunction, apnea, and concomitant somatic diseases. Decompensation of somatic diseases leads to multiple stage reactions with facilitation of functional and morphologic changes in the pulmonary system, hypoxemia and hypoxia, promotes infectious complications and multiple organ failure and worsens neurological outcome. Diagnosis and treatment of PI in AS decreases mortality and improves rehabilitation prognosis.
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Affiliation(s)
- A G Chuchalin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E I Gusev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M Yu Martynov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - T G Kim
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Shogenova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Cox CE, Olsen MK, Gallis JA, Porter LS, Greeson JM, Gremore T, Frear A, Ungar A, McKeehan J, McDowell B, McDaniel H, Moss M, Hough CL. Optimizing a self-directed mobile mindfulness intervention for improving cardiorespiratory failure survivors' psychological distress (LIFT2): Design and rationale of a randomized factorial experimental clinical trial. Contemp Clin Trials 2020; 96:106119. [PMID: 32805434 PMCID: PMC7428440 DOI: 10.1016/j.cct.2020.106119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although as many as 75% of the >2 million annual intensive care unit (ICU) survivors experience symptoms of psychological distress that persist for months to years, few therapies exist that target their symptoms and accommodate their unique needs. In response, we developed LIFT, a mobile app-based mindfulness intervention. LIFT reduced distress symptoms more than either a telephone-based mindfulness program or education control in a pilot randomized clinical trial (LIFT1). OBJECTIVE To describe the methods of a factorial experimental clinical trial (LIFT2) being conducted to aid in the development and implementation of the version of the LIFT intervention that is optimized across domains of effect, feasibility, scalability, and costs. METHODS AND ANALYSIS The LIFT2 study is an optimization trial conceptualized as a component of a larger multiphase optimization strategy (MOST) project. The goal of LIFT2 is to use a 2 × 2 × 2 factorial experimental trial involving 152 patients to determine the ideal components of the LIFT mobile mindfulness program for ICU survivors across factors including (1) study introduction by call from a therapist vs. app only, (2) response to persistent or worsening symptoms over time by therapist vs. app only, and (3) high dose vs. low dose. The primary trial outcome is change in depression symptoms 1 month from randomization measured by the PHQ-9 instrument. Secondary outcomes include anxiety, post-traumatic stress disorder, and physical symptoms; measures of feasibility, acceptability, and usability; as well as themes assessed through qualitative analysis of semi-structured interviews with study participants conducted after follow up completion. We will use general linear models to compare outcomes across the main effects and interactions of the factors.
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Affiliation(s)
- Christopher E Cox
- Department of Medicine, Division of Pulmonary & Critical Care Medicine and the Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, United States of America.
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, NC, United States of America.
| | - John A Gallis
- Department of Biostatistics & Bioinformatics, Duke Global Health Institute, Duke University, Durham, NC, United States of America.
| | - Laura S Porter
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, United States of America.
| | - Jeffrey M Greeson
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ, United States of America.
| | - Tina Gremore
- Department of Psychology, College of Science and Mathematics, Rowan University, Glassboro, NJ, United States of America.
| | - Allie Frear
- Department of Medicine, Division of Pulmonary & Critical Care Medicine and the Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, United States of America.
| | - Anna Ungar
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA, United States of America.
| | - Jeffrey McKeehan
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Colorado, Denver, CO, United States of America.
| | - Brittany McDowell
- Department of Medicine, Division of Pulmonary & Critical Care Medicine and the Program to Support People and Enhance Recovery (ProSPER), Duke University, Durham, NC, United States of America.
| | - Hannah McDaniel
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Colorado, Denver, CO, United States of America.
| | - Marc Moss
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Colorado, Denver, CO, United States of America.
| | - Catherine L Hough
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Washington, Seattle, WA, United States of America.
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Robba C, Asgari S, Gupta A, Badenes R, Sekhon M, Bequiri E, Hutchinson PJ, Pelosi P, Gupta A. Lung Injury Is a Predictor of Cerebral Hypoxia and Mortality in Traumatic Brain Injury. Front Neurol 2020; 11:771. [PMID: 32849225 PMCID: PMC7426476 DOI: 10.3389/fneur.2020.00771] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/23/2020] [Indexed: 12/19/2022] Open
Abstract
Background: A major contributor to unfavorable outcome after traumatic brain injury (TBI) is secondary brain injury. Low brain tissue oxygen tension (PbtO2) has shown to be an independent predictor of unfavorable outcome. Although PbtO2 provides clinicians with an understanding of the ischemic and non-ischemic derangements of brain physiology, its value does not take into consideration systemic oxygenation that can influence patients' outcomes. This study analyses brain and systemic oxygenation and a number of related indices in TBI patients: PbtO2, partial arterial oxygenation pressure (PaO2), PbtO2/PaO2, ratio of PbtO2 to fraction of inspired oxygen (FiO2), and PaO2/FiO2. The primary aim of this study was to identify independent risk factors for cerebral hypoxia. Secondary goal was to determine whether any of these indices are predictors of mortality outcome in TBI patients. Materials and Methods: A single-centre retrospective cohort study of 70 TBI patients admitted to the Neurocritical Care Unit (NCCU) at Cambridge University Hospital in 2014-2018 and undergoing advanced neuromonitoring including invasive PbtO2 was conducted. Three hundred and three simultaneous measurements of PbtO2, PaO2, PbtO2/PaO2, PbtO2/FiO2, PaO2/FiO2 were collected and mortality at discharge from NCCU was considered as outcome. Generalized estimating equations were used to analyse the longitudinal data. Results: Our results showed PbtO2 of 28 mmHg as threshold to define cerebral hypoxia. PaO2/FiO2 found to be a strong and independent risk factor for cerebral hypoxia when adjusting for confounding factor of intracranial pressure (ICP) with adjusted odds ratio of 1.78, 95% confidence interval of (1.10-2.87) and p-value = 0.019. With respect to TBI outcome, compromised values of PbtO2, PbtO2/PaO2, PbtO2/FiO2, and PaO2/FiO2 were all independent predictors of mortality while considered individually and adjusting for confounding factors of ICP, age, gender, and cerebral perfusion pressure (CPP). However, when considering all the compromised values together, only PaO2/FiO2 became an independent predictor of mortality with adjusted odds ratio of 3.47 (1.20-10.04) and p-value = 0.022. Conclusions: Brain and Lung interaction in TBI patients is a complex interrelationship. PaO2/FiO2 seems to be a major determinant of cerebral hypoxia and mortality. These results confirm the importance of employing ventilator strategies to prevent cerebral hypoxia and improve the outcome in TBI patients.
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Affiliation(s)
- Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy
| | - Shadnaz Asgari
- Biomedical Engineering Department, California State University, Long Beach, CA, United States.,Computer Engineering and Computer Science Department, California State University, Long Beach, CA, United States
| | - Amit Gupta
- Emergency Department, Broomfield Hospital, Mid-Essex Hospital Trust, Essex, United Kingdom
| | - Rafael Badenes
- Department of Surgery, University of Valencia, Valencia, Spain
| | - Mypinder Sekhon
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Erta Bequiri
- Department of Neurosurgery, Addenbrooke's Hospital, Hills University of Cambridge, Cambridge, United Kingdom.,Department of Physiology and Transplantation, Milan University, Milan, Italy
| | - Peter J Hutchinson
- Department of Neurosurgery, Addenbrooke's Hospital, Hills University of Cambridge, Cambridge, United Kingdom
| | - Paolo Pelosi
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università Degli Studi di Genova, Genoa, Italy
| | - Arun Gupta
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, United Kingdom
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Oliveira RPD, Teixeira C, Rosa RG. Acute respiratory distress syndrome: how do patients fare after the intensive care unit? Rev Bras Ter Intensiva 2020; 31:555-560. [PMID: 31967232 PMCID: PMC7008991 DOI: 10.5935/0103-507x.20190074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022] Open
Abstract
Patients with acute respiratory distress syndrome require ventilation strategies that have been shown to be important for reducing short-term mortality, such as protective ventilation and prone position ventilation. However, patients who survive have a prolonged stay in both the intensive care unit and the hospital, and they experience a reduction in overall satisfaction with life (independence, acceptance and positive outlook) as well as decreased mental health (including anxiety, depression and posttraumatic stress disorder symptoms), physical health (impaired physical state and activities of daily living; fatigue and muscle weakness), social health and the ability to participate in social activities (including relationships with friends and family, hobbies and social gatherings).
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Affiliation(s)
- Roselaine Pinheiro de Oliveira
- Unidade de Terapia Intensiva, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil.,Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil
| | - Cassiano Teixeira
- Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Programa de Pós-Graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil.,Unidade de Terapia Intensiva, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Régis Goulart Rosa
- Unidade de Terapia Intensiva, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil
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Aslam TN, Klitgaard TL, Møller MH, Perner A, Hofsø K, Skrubbeltrang C, Flaatten HI, Rasmussen BS, Laake JH. Spontaneous versus controlled mechanical ventilation in patients with acute respiratory distress syndrome - Protocol for a scoping review. Acta Anaesthesiol Scand 2020; 64:857-860. [PMID: 32157683 DOI: 10.1111/aas.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND In caring for mechanically ventilated adults with acute respiratory distress syndrome (ARDS), clinicians are faced with an uncertain choice between controlled or spontaneous breathing modes. Observational data indicate considerable practice variation which may be driven by differences in sedation and mobilisation practices. The benefits and harms of either strategy are largely unknown. METHODS A scoping review will be prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We will review the clinical literature on controlled vs spontaneous breathing in mechanically ventilated patients with ARDS of any severity. Studies reporting on qualitative and/or quantitative data from any world region will be considered. For inclusion, studies must include data on mechanically ventilated patients with ARDS who are allowed spontaneous (triggered ventilation). Searches will be conducted in four electronic databases without any limitation on publication date and language. We will assess the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, where appropriate. CONCLUSION We will perform a scoping review of the clinical literature on controlled vs spontaneously breathing in mechanically ventilated patients who fulfil ARDS criteria (including acute lung injury). This is to elucidate if a pragmatic clinical trial comparing controlled and spontaneous mechanical ventilation is warranted and will allow us to formulate relevant research questions.
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Affiliation(s)
- Tayyba N. Aslam
- Department of Critical Care and Emergencies Rikshospitalet Medical Centre Oslo University Hospital Oslo Norway
| | - Thomas L. Klitgaard
- Department of Anaesthesia Intensive Care Medicine Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Morten H. Møller
- Department of Intensive Care 4131 Centre for Research in Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care 4131 Centre for Research in Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Kristin Hofsø
- Department of Critical Care and Emergencies Rikshospitalet Medical Centre Oslo University Hospital Oslo Norway
- Lovisenberg Diaconal University College Oslo Norway
| | | | | | - Bodil S. Rasmussen
- Department of Anaesthesia Intensive Care Medicine Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Jon H. Laake
- Department of Critical Care and Emergencies Rikshospitalet Medical Centre Oslo University Hospital Oslo Norway
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Abstract
RATIONALE Survivorship from critical illness has improved; however, factors mediating the functional recovery of persons experiencing a critical illness remain incompletely understood. OBJECTIVES To identify groups of acute respiratory failure (ARF) survivors with similar patterns of physical function recovery after discharge and to determine the characteristics associated with group membership in each physical function trajectory group. METHODS We performed a secondary analysis of a randomized controlled trial, using group-based trajectory modeling to identify distinct subgroups of patients with similar physical function recovery patterns after ARF. Chi-square tests and one-way analysis of variance were used to determine which variables were associated with trajectory membership. A multinomial logistic regression analysis was performed to identify variables jointly associated with trajectory group membership. RESULTS A total of 260 patients enrolled in a trial evaluating standardized rehabilitation therapy in patients with ARF and discharged alive (NCT00976833) were included in this analysis. Physical function was quantified using the Short Physical Performance Battery at hospital discharge and 2, 4, and 6 months after enrollment. Latent class analysis of the Short Physical Performance Battery scores identified four trajectory groups. These groups differ in both the degree and rate of physical function recovery. A multinomial logistic regression analysis was performed using covariates that have been previously identified in the literature as influencing recovery after critical illness. By multinomial logistic regression, age (P < 0.001), female sex (P = 0.001), intensive care unit (ICU) length of stay (LOS) (P = 0.003), and continuous intravenous sedation days (P = 0.004) were the variables that jointly influenced trajectory group membership. Participants in the trajectory demonstrating most rapid and complete functional recovery consisted of younger females with fewer continuous sedation days and a shorter LOS. The participant trajectory that failed to functionally recover consisted of older patients with greater sedation time and the longest LOS. CONCLUSIONS We identified distinct trajectories of physical function recovery after critical illness. Age, sex, continuous sedation time, and ICU length of stay impact the trajectory of functional recovery after critical illness. Further examination of these groups may assist in clinical trial design to tailor interventions to specific subgroups.
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Understanding Cognitive Outcome Trajectories After Critical Illness. Crit Care Med 2020; 47:1164-1166. [PMID: 31305305 DOI: 10.1097/ccm.0000000000003871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Introduction: Acute respiratory distress syndrome (ARDS) is a severe form of acute lung injury common in critically ill patients and characterized by significant morbidity and mortality. It frequently manifests long-lasting effects beyond hospitalization, from cognitive impairment to physical weakness.Areas covered: Several complications of ARDS have been identified in patients after hospital discharge. The authors conducted literature searches to identify observational studies, randomized clinical trials, systematic reviews, and guidelines. A summary of is presented here to outline the sequelae of ARDS and their risk factors with a focus on the limited but growing research into possible therapies. Long term sequelae of ARDS commonly identified in the literature include long-term cognitive impairment, psychological morbidities, neuromuscular weakness, pulmonary dysfunction, and ongoing healthcare utilization with reduced quality of life.Expert opinion: Given the public health significance of long-term complications following ARDS, the development of new therapies for prevention and treatment is of vital importance. Furthering knowledge of the pathophysiology of these impairments will provide a framework to develop new therapeutic targets to fuel future clinical trials in this area of critical care medicine.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Defining patient-centered recovery after critical illness - A qualitative study. J Crit Care 2020; 57:84-90. [PMID: 32062290 DOI: 10.1016/j.jcrc.2020.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/10/2020] [Accepted: 01/31/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore perspectives of adult critical illness survivors and identify important aspects to care and recovery. MATERIALS AND METHODS A descriptive, qualitative study of adult survivors of prolonged critical illness, six-months after Intensive Care Unit (ICU) discharge, using semi-structured interviews and thematic analysis. The study was undertaken in an academic, tertiary, regional hospital in Victoria, Australia. RESULTS Thirty-five patients participated in the study. Most were male (69%) with median age 64 years. Admissions were predominantly medical (51%), followed by cardiothoracic (26%) and general surgical (23%). Median ICU and hospital length of stay were 5 and 17 days respectively. Qualitative analysis revealed two key theme categories, recovery status and care experience. Three recovery states were identified based on physical and neuropsychological recovery. Care experiences varied across recovery states, including care encounters, communication, support and impact on family and friends, and use of community health services. CONCLUSION Critical illness survivors frame their recovery in terms of recovery status and care experience, reflecting existing qualitative domains of physical health, psychological health, cognitive function, social health and life satisfaction. Theme content varied with recovery status, raising the possibility that modifying care experiences or patient perceptions could change recovery outcomes.
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Hua M. Psychological Outcomes after Critical Illness. Is It Time to Rethink Our Paradigm? Am J Respir Crit Care Med 2019; 197:6-7. [PMID: 28968149 DOI: 10.1164/rccm.201709-1885ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- May Hua
- 1 Department of Anesthesiology Columbia University New York, New York
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41
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Ko RE, Lee H, Jung JH, Lee HO, Sohn I, Yoo H, Ko JY, Suh GY, Chung CR. Simple functional assessment at hospital discharge can predict long-term outcomes of ICU survivors. PLoS One 2019; 14:e0214602. [PMID: 30947283 PMCID: PMC6448871 DOI: 10.1371/journal.pone.0214602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/17/2019] [Indexed: 11/29/2022] Open
Abstract
Recent studies showed that physical and/or neuropsychiatric impairments significantly affect long-term mortality of ICU survivors. We conducted this study to investigate that simplified measurement of physical function and level of consciousness at hospital discharge by attending nurses could predict long-term outcomes after hospital discharge. A retrospective analysis of prospectively and retrospectively collected data of 246 patients who received medical ICU treatment was conducted. We grouped patients according to physical function and level of consciousness measured by the simplified method at hospital discharge as follow; group A included patients with alert mental and capable of walking or moving by wheel chairs; group B included those with alert mental and bed-ridden status; and Group C included those with confused mental and bed-ridden status. The two-year survival rate after hospital discharge was compared. Of 246 patients, 157 patients were included in the analysis and there were 103 survivors after two-year follow up. Compared to non-survivors, survivors were more likely to be younger (P = 0.026) and have higher body mass index (P = 0.019) and no malignant disease (P = 0.001). There were no statistically significant differences in treatment modalities including medication, use of medical devices, and physical therapy between the survivors and non-survivors. The analysis showed significant differences in survival between the groups classified by physical function (P < 0.001) and level of consciousness (P < 0.01). Multivariate analysis showed that survival rate was significantly lower among the patients in group C than in those in group B or group A (P < 0.001). Simplified method to assess physical function and level of consciousness at hospital discharge can predict long-term outcomes of medical ICU survivors.
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Affiliation(s)
- Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jin Hee Jung
- Advanced Practice Nurse, Department of Nursing, Samsung Medical Center, Seoul, South Korea
| | - Hee Og Lee
- Advanced Practice Nurse, Department of Nursing, Samsung Medical Center, Seoul, South Korea
| | - Insuk Sohn
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Heejin Yoo
- Statistics and Data Center, Samsung Medical Center, Seoul, South Korea
| | - Jin Yeong Ko
- Department of pharmaceutical services, Samsung Medical Center, Seoul, South Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Division of Pulmonology and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Sex susceptibility to ventilator-induced lung injury. Intensive Care Med Exp 2019; 7:7. [PMID: 30635805 PMCID: PMC6329690 DOI: 10.1186/s40635-019-0222-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/02/2019] [Indexed: 01/20/2023] Open
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Wang D, Ing C, Blinderman CD, Hua M. Latent Class Analysis of Specialized Palliative Care Needs in Adult Intensive Care Units From a Single Academic Medical Center. J Pain Symptom Manage 2019; 57:73-78. [PMID: 30315914 PMCID: PMC6310624 DOI: 10.1016/j.jpainsymman.2018.10.270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 02/02/2023]
Abstract
CONTEXT In the intensive care unit (ICU), 14% of patients meet criteria for specialized palliative care, but whether subgroups of patients differ in their palliative care needs is unknown. OBJECTIVES The objective of this study was to use latent class analysis to separate ICU patients into different classes of palliative care needs and determine if such classes differ in their palliative care resource requirements. METHODS We conducted a retrospective cohort study of ICU patients who received specialized palliative care, August 2013 to August 2015. Reason(s) for consultation were extracted from the initial note and entered into a latent class analysis model to generate mutually exclusive patient classes. Differences in "high use" of palliative care (defined as having five or more palliative care visits) between classes were assessed using logistic regression, adjusting for age, race, Charlson Comorbidity Index, and length of stay. RESULTS In a sample of 689 patients, a four-class model provided the most meaningful groupings: 1) Pain and Symptom Management (n = 218, 31.6%), 2) Goals of Care and Advance Directives (GCAD) (n = 131, 19.0%), 3) All Needs (n = 112, 16.3%), and 4) Supportive Care (n = 228, 33.1%). In comparison to GCAD patients, all other classes were more likely to require "high use" of palliative care (adjusted odds ratio [aOR] 2.61 [1.41-4.83] for "All Needs," aOR 2.01 [1.16-3.50] for "Pain and Symptom Management," aOR 1.94 [1.12-3.34] for "Supportive Care"). CONCLUSION Based on the initial reason for consultation, we identified four classes of palliative care needs among critically ill patients, and GCAD patients were least likely to be high utilizers. These findings may help inform allocation of palliative care resources for this population.
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Affiliation(s)
- David Wang
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Caleb Ing
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
| | | | - May Hua
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, New York, USA; Department of Epidemiology, Mailman School of Public Health, New York, New York, USA.
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Pediatric Acute Respiratory Distress Syndrome Survivors—What Happens After the PICU?*. Crit Care Med 2018; 46:1866-1867. [DOI: 10.1097/ccm.0000000000003375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Parker AM, Malik A, Hosey M. Process evaluation and the development of behavioural interventions to improve psychological distress among survivors of critical illness. Thorax 2018; 74:7-10. [PMID: 30337416 DOI: 10.1136/thoraxjnl-2018-211989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/14/2018] [Accepted: 09/24/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Ann M Parker
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Albahi Malik
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Megan Hosey
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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47
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Patroniti N, Bonatti G, Senussi T, Robba C. Mechanical ventilation and respiratory monitoring during extracorporeal membrane oxygenation for respiratory support. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:386. [PMID: 30460260 DOI: 10.21037/atm.2018.10.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Over the past decade, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for respiratory support has widely expanded as a treatment strategy for patients with acute respiratory distress syndrome (ARDS). Despite considerable attention has been given to the indications, the timing and the management of patients undergoing ECMO for refractory respiratory hypoxemic failure, little is known regarding the management of mechanical ventilation (MV) in this group of patients. ECMO enables to minimize ventilatory induced lung injury (VILI) and it has been successfully used as rescue therapy in patients with ARDS when conventional ventilator strategies have failed. However, literature is lacking regarding the best strategies and MV settings, including positive end expiratory pressure (PEEP), tidal volume (VT), respiratory rate (RR) and plateau pressure (PPLAT). The aim of this review is to summarize current evidence, the rationale and provide recommendations about the best ventilator strategy to adopt in patients with ARDS undergoing VV-ECMO support.
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Affiliation(s)
- Nicolò Patroniti
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Giulia Bonatti
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Tarek Senussi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy
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Su YX, Xu L, Gao XJ, Wang ZY, Lu X, Yin CF. Long-term quality of life after sepsis and predictors of quality of life in survivors with sepsis. Chin J Traumatol 2018; 21:216-223. [PMID: 30017545 PMCID: PMC6085193 DOI: 10.1016/j.cjtee.2018.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/29/2018] [Accepted: 05/07/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To evaluate the quality of life among survivors after sepsis in 2 years, comparing with critical patients without sepsis and the general people, analyze the changes and the predictors of quality of life among septic survivors. METHODS This prospective case-control study screened the intensive care unit (ICU) patients in Tianjin Third Central Hospital from January 2014 to October 2017, and the Chinese general population in the previous studies was also included. According to inclusion criteria and exclusion criteria, 306 patients with sepsis were enrolled as the observation group, and another 306 patients without sepsis in ICU during the same period, whose ages, gender and Charlson Comorbidity Index matched with observation group, were enrolled as the control group. At 3 mo, 12 mo, and 24 mo after discharge, the Mos 36-item Short Form Health Survey (SF-36), the Euroqol-5 dimension (EQ-5D), and the activities of daily living (ADL) were evaluated in face-to-face for the quality of life among survivors. RESULTS There were 210 (68.6%) septic patients and 236 (77.1%) non-septic critically ill patients surviving. At 3 months after discharge, the observation and control groups had the similar demographic characteristics (age: 58.8 ± 18.1years vs. 57.5 ± 17.6 years, p = 0.542; male: 52.0% vs. 51.4%, p = 0.926). However, the observation group had higher acute physiology and chronic health evaluation II (APACHEII) scores, higher sequential organ failure assessment (SOFA) scores, longer hospital stay, and longer ICU stay than the control group did (p < 0.05). There were no significant differences in the eight dimensions of the SF36 scale, the EQ-5D health utility scores, and the activities of daily life scores between septic survivors and non-septic survivors (p > 0.05). In addition, compared with the quality of life of the Chinese general population (aged 55-64 years), the quality of life of septic patients were significantly lower at 3 months after discharge (p < 0.05). Comparing the quality of life of the ill patients who had been discharged at 3 mo and 24 mo, the general health improved statistically (p = 0.000) and clinically (score improvement > 5 points). Older age (OR, 1.050; 95% CI, 1.022-1.078, p = 0.000), female (OR, 3.375; 95% CI, 1.434-7.941, p = 0.005) and longer mechanical ventilation time (OR, 3.412; 95% CI, 1.413, 8.244, p = 0.006) were the risk factors for the quality of life of septic survivors. CONCLUSION The long-term quality of life of septic survivors was similar to that of non-sepsis critically ill survivors. After discharge, the general health of sepsis improved overtime. Age, female and mechanical ventilation time (>5 days) were the predictors of the quality of life after sepsis.
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Affiliation(s)
- Ya-Xiao Su
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Lei Xu
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China,Corresponding author. Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China.
| | - Xin-Jing Gao
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Zhi-Yong Wang
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Xing Lu
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Cheng-Fen Yin
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, 300170, China,Tianjin Key Laboratory of Artificial Cell, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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49
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Should ICU clinicians follow patients after ICU discharge? Yes. Intensive Care Med 2018; 44:1539-1541. [DOI: 10.1007/s00134-018-5260-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/01/2018] [Indexed: 01/20/2023]
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50
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Cox CE, Hough CL, Jones DM, Ungar A, Reagan W, Key MD, Gremore T, Olsen MK, Sanders L, Greeson JM, Porter LS. Effects of mindfulness training programmes delivered by a self-directed mobile app and by telephone compared with an education programme for survivors of critical illness: a pilot randomised clinical trial. Thorax 2018; 74:33-42. [PMID: 29793970 DOI: 10.1136/thoraxjnl-2017-211264] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients who are sick enough to be admitted to an intensive care unit (ICU) commonly experience symptoms of psychological distress after discharge, yet few effective therapies have been applied to meet their needs. METHODS Pilot randomised clinical trial with 3-month follow-up conducted at two academic medical centres. Adult (≥18 years) ICU patients treated for cardiorespiratory failure were randomised after discharge home to 1 of 3 month-long interventions: a self-directed mobile app-based mindfulness programme; a therapist-led telephone-based mindfulness programme; or a web-based critical illness education programme. RESULTS Among 80 patients allocated to mobile mindfulness (n=31), telephone mindfulness (n=31) or education (n=18), 66 (83%) completed the study. For the primary outcomes, target benchmarks were exceeded by observed rates for all participants for feasibility (consent 74%, randomisation 91%, retention 83%), acceptability (mean Client Satisfaction Questionnaire 27.6 (SD 3.8)) and usability (mean Systems Usability Score 89.1 (SD 11.5)). For secondary outcomes, mean values (and 95% CIs) reflected clinically significant group-based changes on the Patient Health Questionnaire depression scale (mobile (-4.8 (-6.6, -2.9)), telephone (-3.9 (-5.6, -2.2)), education (-3.0 (-5.3, 0.8)); the Generalized Anxiety Disorder scale (mobile -2.1 (-3.7, -0.5), telephone -1.6 (-3.0, -0.1), education -0.6 (-2.5, 1.3)); the Post-Traumatic Stress Scale (mobile -2.6 (-6.3, 1.2), telephone -2.2 (-5.6, 1.2), education -3.5 (-8.0, 1.0)); and the Patient Health Questionnaire physical symptom scale (mobile -5.3 (-7.0, -3.7), telephone -3.7 (-5.2, 2.2), education -4.8 (-6.8, 2.7)). CONCLUSIONS Among ICU patients, a mobile mindfulness app initiated after hospital discharge demonstrated evidence of feasibility, acceptability and usability and had a similar impact on psychological distress and physical symptoms as a therapist-led programme. A larger trial is warranted to formally test the efficacy of this approach. TRIAL REGISTRATION NUMBER Results, NCT02701361.
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Affiliation(s)
- Christopher E Cox
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.,Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina, USA
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Derek M Jones
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.,Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina, USA
| | - Anna Ungar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Wen Reagan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.,Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina, USA
| | - Mary D Key
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.,Program to Support People and Enhance Recovery, Duke University, Durham, North Carolina, USA
| | - Tina Gremore
- Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina, USA
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, North Carolina, USA.,Department of Biostatistics, Duke University, Durham, North Carolina, USA
| | - Linda Sanders
- Division of General Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Jeffrey M Greeson
- Department of Psychology, Rowan University, Glassboro, New Jersey, USA.,Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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