1
|
Rhodes A, Wilson C, Zelenkov D, Adams K, Poyant JO, Han X, Faugno A, Montalvo C. "The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist". J Intensive Care Med 2024:8850666241275582. [PMID: 39169853 DOI: 10.1177/08850666241275582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.
Collapse
Affiliation(s)
- Allison Rhodes
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | | | | | - Kathryne Adams
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | | | - Xuan Han
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | - Anthony Faugno
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | - Cristina Montalvo
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| |
Collapse
|
2
|
Boutry C, Patel P, Holmes J, Radford K, Bolton CE, Evangelou N, das Nair R, Morriss R. Returning to work with long covid in the UK during lockdown and other COVID-19 restrictions: A qualitative study. PLoS One 2024; 19:e0307062. [PMID: 39133715 PMCID: PMC11318866 DOI: 10.1371/journal.pone.0307062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/30/2024] [Indexed: 08/15/2024] Open
Abstract
Few previous studies have considered the experiences of people with long covid returning to work beyond symptoms in terms of employer and other support factors. The aim of this research was to understand the experience of returning to work for those with long covid symptoms in contrast to the non-long covid group who had not experienced COVID-19 during the time restrictions were imposed to limit the spread of COVID-19 infection. Twenty-one participants with long covid and 13 participants who had not had COVID-19 were interviewed. Themes were identified from transcripts using framework analysis. Participants with long covid experienced difficulties returning to work, particularly from fatigue, cognitive symptoms and breathlessness. Symptoms were heterogeneous and fluctuated in severity over time. A lack of understanding from colleagues and managers sometimes led to a premature return to work without adequate support, associated with further long covid relapse. Outside-of-work, support was salient for a successful return to work. The standard phased return offered by employers may be too short and rigid for some people with long covid. They may benefit from a tailored intervention to support a return to work that targets symptom management, and engages with work colleagues, managers, and family members.
Collapse
Affiliation(s)
- Clement Boutry
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
- National Institute for Health and Care Research, Applied Research Collaboration East Midland, University of Nottingham, Nottinghamshire, United Kingdom
| | - Priya Patel
- National Institute for Health and Care Research, Applied Research Collaboration East Midland, University of Nottingham, Nottinghamshire, United Kingdom
| | - Jain Holmes
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - Kathryn Radford
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - Charlotte E. Bolton
- NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Nikos Evangelou
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
| | - Roshan das Nair
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
- Health Division, SINTEF, Trondheim, Norway
| | - Richard Morriss
- School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| |
Collapse
|
3
|
McIlveen EC, Edwards J, Vella M, McKinlay L, Hancock C, Quasim T, Moug SJ. Patient-reported impact of emergency laparotomy on employment and health status 1 year after surgery. Langenbecks Arch Surg 2023; 408:378. [PMID: 37749405 DOI: 10.1007/s00423-023-03104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 09/09/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Whilst there has been significant improvement in mortality outcomes after emergency laparotomy, there is little information on longer term outcomes in the year after discharge. The main aim of the study was to assess the impact that an emergency laparotomy has on patients' and employment and health status 1 year after surgery. METHODS This study was a questionnaire study conducted in a single centre district general hospital of patients who had undergone an emergency laparotomy between October 2015 and December 2016. Patients were included according to the National Emergency Laparotomy Audit criteria. At screening, patients who were alive at 1 year and had the capacity to consent were approached between January and December 2017. Patients underwent a researcher-led telephone interview using a semi-structured questionnaire to assess the impact of emergency laparotomy on overall, general and physical health (Glasgow Benefit Inventory) as well as employment status. The symptoms that patients experienced and their impact were also recorded. RESULTS Forty-two patients responded to and completed the questionnaire. Just over one-third of patients experienced a deterioration in their general or physical health and 21% of patients experienced a change in employment. Factors which significantly impacted on health status were stoma issues, postoperative morbidity and a change in employment (p < 0.05). The main symptoms which patients identified as being troublesome were altered bowel habit and stoma issues with a resultant social and psychological impact. CONCLUSIONS One-third of patients experienced a deterioration in their psychosocial and physical health status as well as a change in employment during the first-year postsurgery. Larger research studies are required to define the impact of emergency laparotomy on patients in the longer term and more research is needed to improve perioperative rehabilitation in the postoperative period to ensure optimal functional gain after technically successful surgery.
Collapse
Affiliation(s)
- Erin C McIlveen
- Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK.
| | - Jennifer Edwards
- Department of Anaesthetics, Royal Alexandra Hospital, Paisley, UK
| | - Mark Vella
- Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK
| | - Laura McKinlay
- Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK
| | - Claire Hancock
- Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK
| | - Tara Quasim
- University Department of Anaesthetics and Critical Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Susan J Moug
- Department of General Surgery, Royal Alexandra Hospital, Corsebar Road, Paisley, PA2 9PN, UK
| |
Collapse
|
4
|
Mattioni MF, Dietrich C, Sganzerla D, Rosa RG, Teixeira C. Return to work after discharge from the intensive care unit: a Brazilian multicenter cohort. Rev Bras Ter Intensiva 2022; 34:492-498. [PMID: 36888830 PMCID: PMC9987004 DOI: 10.5935/0103-507x.20220169-pt] [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: 05/12/2022] [Accepted: 09/27/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To describe the rate and factors related to nonreturn to work in the third month after discharge from the intensive care unit and the impact of unemployment, loss of income and health care expenses for survivors. METHODS This was a prospective multicenter cohort study that included survivors of severe acute illness who were hospitalized between 2015 and 2018, previously employed, and who stayed more than 72 hours in the intensive care unit. Outcomes were assessed by telephone interview in the third month after discharge. RESULTS Of the 316 patients included in the study who had previously worked, 193 (61.1%) did not return to work within 3 months after discharge from the intensive care unit. The following factors were associated with nonreturn to work: low educational level (prevalence ratio 1.39; 95%CI 1.10 - 1.74; p = 0.006), previous employment relationship (prevalence ratio 1.32; 95%CI 1 10 - 1.58; p = 0.003), need for mechanical ventilation (prevalence ratio 1.20; 95%CI 1.01 - 1.42; p = 0.04) and physical dependence in the third month after discharge (prevalence ratio 1.27; 95%CI 1.08 - 1.48; p = 0.003). Survivors who were unable to return to work more often had reduced family income (49.7% versus 33.3%; p = 0.008) and increased health expenditures (66.9% versus 48.3%; p = 0.002). compared to those who returned to work in the third month after discharge from the intensive care unit. CONCLUSION Intensive care unit survivors often do not return to work until the third month after discharge from the intensive care unit. Low educational level, formal job, need for ventilatory support and physical dependence in the third month after discharge were related to nonreturn to work. Failure to return to work was also associated with reduced family income and increased health care costs after discharge.
Collapse
Affiliation(s)
- Mariana F Mattioni
- Postgraduate Program in Rehabilitation Sciences, Universidade
Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brazil
- Intensive Care Unit, Hospital Moinhos de Vento - Porto Alegre (RS),
Brasil
| | - Camila Dietrich
- Research Projects Office, Hospital Moinhos de Vento - Porto Alegre
(RS), Brazil
| | - Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento - Porto Alegre
(RS), Brazil
| | - Régis Goulart Rosa
- Research Projects Office, Hospital Moinhos de Vento - Porto Alegre
(RS), Brazil
| | - Cassiano Teixeira
- Postgraduate Program in Rehabilitation Sciences, Universidade
Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brazil
| |
Collapse
|
5
|
Jawa NA, Holden RM, Silver SA, Scott SH, Day AG, Norman PA, Kwan BYM, Maslove DM, Muscedere J, Boyd JG. Identifying neurocognitive outcomes and cerebral oxygenation in critically ill adults on acute kidney replacement therapy in the intensive care unit: the INCOGNITO-AKI study protocol. BMJ Open 2021; 11:e049250. [PMID: 34404711 PMCID: PMC8372874 DOI: 10.1136/bmjopen-2021-049250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Initiation of acute kidney replacement therapy (KRT) is common in critically ill adults admitted to the intensive care unit (ICU), and associated with increased morbidity and mortality. KRT has been linked to poor neurocognitive outcomes, leading to reduced quality of life and increased utilisation of healthcare resources. Adults on dialysis in the ICU may be particularly at risk of neurocognitive impairment, as survivors of critical illness are already predisposed to developing cerebrovascular disease and cognitive dysfunction long-term relative to healthy controls. Regional cerebral oxygen saturation may provide a critical early marker of long-term neurocognitive impairment in this population. This study aims to understand cerebral oxygenation in patients undergoing KRT (continuous or intermittent) in the ICU. These findings will be correlated with long-term cognitive and functional outcomes, and structural brain pathology. METHODS AND ANALYSIS 108 patients scheduled to undergo treatment for acute kidney injury with KRT in the Kingston Health Sciences Centre ICU will be recruited into this prospective observational study. Enrolled patients will be assessed with intradialytic cerebral oximetry using near infrared spectroscopy. Delirium will be assessed daily with the Confusion Assessment Method-ICU (CAM-ICU) and severity quantified as cumulative CAM-ICU-7 scores. Neurocognitive impairment will be assessed at 3 and 12 months after hospital discharge using the Kinarm and Repeatable Battery for the Assessment of Neuropsychological Status. Structural brain pathology on MRI will also be measured at the same timepoints. Driving safety, adverse events and medication adherence will be assessed at 12 months to evaluate the impact of neurocognitive impairment on functional outcomes. ETHICS AND DISSEMINATION This study is approved by the Queen's University Health Sciences/Affiliated Teaching Hospitals Research Ethics Board (DMED-2424-20). Results will be presented at critical care conferences, and a lay summary will be provided to patients in their preferred format. TRIAL REGISTRATION NUMBER NCT04722939.
Collapse
Affiliation(s)
| | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Samuel A Silver
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
- Kingston General Health Research Institute, Kingston, Ontario, Canada
| | - Patrick A Norman
- Kingston General Health Research Institute, Kingston, Ontario, Canada
| | - Benjamin Y M Kwan
- Department of Diagnostic Radiology, Queen's University, Kingston, Ontario, Canada
| | - David M Maslove
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - John Muscedere
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| | - John Gordon Boyd
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
| |
Collapse
|
6
|
Carmona LEO, Nielfa MDCC, Alvarado ALD. The Covid-19 pandemic seen from the frontline. Int Braz J Urol 2020; 46:181-194. [PMID: 32618463 PMCID: PMC7719980 DOI: 10.1590/s1677-5538.ibju.2020.s123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 disease caused by infection with the SARS-CoV-2 virus produces respiratory symptoms, predominantly of the upper airways, which can progress to pneumonia after 7 days with persistent fever, cough and dyspnea, and even develop a syndrome of acute respiratory distress (ARDS), multi-organ failure and death. Since COVID-19 disease was declared by the WHO there has been a redistribution of the healthcare system for these types of patients, especially in the front line, which is, in primary care, emergencies and in intensive care units (ICU). In primary care, the fundamental role is the diagnosis of the suspected patients, follow-up mainly by telemedicine (specially telephone calls) to detect warning signs in case of worsening and subsequent referral to the emergency department; as well as explaining home isolation measures. In the emergency department, it is included the management of suspicious cases and, if it any risk factor is found, complementary tests are carried out for precise diagnosis and admission assessment; In case of oxygen saturation <95% and poor general condition, valuation is requested for admission to the ICU. Depending on the severity of the patient, he/she would be or not a candidate for invasive mechanical ventilation, which must be performed by trained personnel to prevent the spread of the infection minimizing the risk of contagion. ARDS's treatment strategies include pulmonary protection ventilation, prone position, recruitment maneuvers and, less frequently, oxygenation by extracorporeal membrane. Among the specific treatments for COVID-19 stand out mainly drugs to reduce viral load, although sometimes specific drugs will be needed to treat hyperinflammation, hypercoagulability and concomitant infections. One of the goals to be achieved is for patients to recover and be able to successfully return to work; for this purpose, an adequate physical and psychological rehabilitation program is essential, as about 50% have symptoms of anxiety and depression.
Collapse
|
7
|
Kamdar BB, Suri R, Suchyta MR, Digrande KF, Sherwood KD, Colantuoni E, Dinglas VD, Needham DM, Hopkins RO. Return to work after critical illness: a systematic review and meta-analysis. Thorax 2020; 75:17-27. [PMID: 31704795 PMCID: PMC7418481 DOI: 10.1136/thoraxjnl-2019-213803] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/11/2019] [Accepted: 09/01/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Survivors of critical illness often experience poor outcomes after hospitalisation, including delayed return to work, which carries substantial economic consequences. OBJECTIVE To conduct a systematic review and meta-analysis of return to work after critical illness. METHODS We searched PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from 1970 to February 2018. Data were extracted, in duplicate, and random-effects meta-regression used to obtain pooled estimates. RESULTS Fifty-two studies evaluated return to work in 10 015 previously employed survivors of critical illness, over a median (IQR) follow-up of 12 (6.25-38.5) months. By 1-3, 12 and 42-60 months' follow-up, pooled return to work prevalence (95% CI) was 36% (23% to 49%), 60% (50% to 69%) and 68% (51% to 85%), respectively (τ2=0.55, I2=87%, p=0.03). No significant difference was observed based on diagnosis (acute respiratory distress syndrome (ARDS) vs non-ARDS) or region (Europe vs North America vs Australia/New Zealand), but was observed when comparing mode of employment evaluation (in-person vs telephone vs mail). Following return to work, 20%-36% of survivors experienced job loss, 17%-66% occupation change and 5%-84% worsening employment status (eg, fewer work hours). Potential risk factors for delayed return to work include pre-existing comorbidities and post-hospital impairments (eg, mental health). CONCLUSION Approximately two-thirds, two-fifths and one-third of previously employed intensive care unit survivors are jobless up to 3, 12 and 60 months following hospital discharge. Survivors returning to work often experience job loss, occupation change or worse employment status. Interventions should be designed and evaluated to reduce the burden of this common and important problem for survivors of critical illness. TRIAL REGISTRATION NUMBER PROSPERO CRD42018093135.
Collapse
Affiliation(s)
- Biren B Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, California, USA
| | - Rajat Suri
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mary R Suchyta
- InstaCare, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Kyle F Digrande
- Department of Medicine, University of California Irvine, Irvine, California, USA
| | - Kyla D Sherwood
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Colantuoni
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Victor D Dinglas
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, 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
| | - Ramona O Hopkins
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, USA
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| |
Collapse
|
8
|
Return to Employment after Critical Illness and Its Association with Psychosocial Outcomes. A Systematic Review and Meta-Analysis. Ann Am Thorac Soc 2019; 16:1304-1311. [DOI: 10.1513/annalsats.201903-248oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
9
|
MacTavish P, Quasim T, Shaw M, Devine H, Daniel M, Kinsella J, Fenelon C, Kishore R, Iwashyna TJ, McPeake J. Impact of a pharmacist intervention at an intensive care rehabilitation clinic. BMJ Open Qual 2019; 8:e000580. [PMID: 31637320 PMCID: PMC6768365 DOI: 10.1136/bmjoq-2018-000580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/20/2022] Open
Abstract
Objective While disruptions in medications are common among patients who survive critical illness, there is limited information about specific medication-related problems among survivors of critical care. This study sought to determine the prevalence of specific medication-related problems detected in patients, seen after critical care discharge. Design Consecutive patients attending an intensive care unit (ICU) follow-up programme were included in this single-centre service evaluation. Setting Tertiary care regional centre in Scotland (UK). Participants 47 patients reviewed after critical care discharge at an ICU follow-up programme. Interventions Pharmacists conducted a full medication review, including: medicines reconciliation, assessing the appropriateness of each prescribed medication, identification of any medication-related problems and checking adherence. Measurements Medication-related problems in patients following critical care discharge. Interventions and medication-related problems were systematically graded and risk factors were identified using an adapted version of the National Patient Safety Agency Risk Matrix. Main results 69 medication-related problems were identified in 38 (81%) of the 47 patients. The most common documented problem was drug omission (29%). 64% of the medication-related problems identified were classified as either moderate or major. The number of pain medications prescribed at discharge from intensive care was predictive of medication-related problems (OR 2.02, 95% CI 1.14 to 4.26, p=0.03). Conclusions Medication problems are common following critical care. Better communication of medication changes both to patients and their ongoing care providers may be beneficial following a critical care admission. In the absence of highly effective communication, a pharmacy intervention may contribute substantially to an intensive care rehabilitation or recovery programme.
Collapse
Affiliation(s)
| | - Tara Quasim
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Martin Shaw
- Clinical Physics, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Helen Devine
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Malcolm Daniel
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - John Kinsella
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Carl Fenelon
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rakesh Kishore
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Joanne McPeake
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Niittyvuopio M, Liisanantti JH, Pikkupeura J, Spalding MB, Sälkiö S, Ala-Kokko TI. Factors associated with impaired physical functioning and mental health in working-age patients attending a post-intensive care follow-up clinic three months after hospital discharge. Anaesth Intensive Care 2019; 47:160-168. [PMID: 31106561 DOI: 10.1177/0310057x19838910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients recovering from critical illness are often suffering from remarkable limitations in their everyday life. The purpose of this study was to find factors associated with poor physical functioning and mental health after critical illness. The study was conducted among patients who met the inclusion criteria of our post-intensive care unit follow-up clinic. The patients were invited to the follow-up clinic three months after hospital discharge. The participants filled out a RAND-36 questionnaire, underwent a clinical examination and were stratified to those with good or poor recovery according to physical functioning and emotional wellbeing. Altogether 332 out of 351 follow-up clinic attendees had data available for analysis. In physical functioning 40% of patients achieved a poor outcome. In mental health the percentage was 8%. The patients with poor physical functioning had a longer hospital stay and were more likely to have received vasopressors. Eleven out of 16 (69%) multitrauma patients had poor physical functioning. Patients with poor physical functioning had more memories of pain, achieved worse results in a six-minute walk test and were less likely to be able to move independently. The patients with poor mental health had higher delirium incidence and fewer memories of relatives' visits and of nurses. The conclusions of this study were that the memories of pain, multitrauma and longer hospital stay were associated with a poor physical functioning outcome. Delirium and a lack of memories of relatives and nurses were associated with a poor mental health outcome.
Collapse
Affiliation(s)
- Miikka Niittyvuopio
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Finland
| | - Janne H Liisanantti
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Finland
| | - Jaana Pikkupeura
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Finland
| | - Michael B Spalding
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Finland
| | - Sinikka Sälkiö
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Finland
| | - Tero I Ala-Kokko
- Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Finland
| |
Collapse
|
11
|
|
12
|
McPeake J, Shaw M, Iwashyna TJ, Daniel M, Devine H, Jarvie L, Kinsella J, MacTavish P, Quasim T. Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention. PLoS One 2017; 12:e0188028. [PMID: 29186177 PMCID: PMC5706708 DOI: 10.1371/journal.pone.0188028] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/29/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors. METHODS Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008-2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID. RESULTS 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07-0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15). CONCLUSIONS AND RELEVANCE This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.
Collapse
Affiliation(s)
- Joanne McPeake
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, Scotland, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom
- * E-mail:
| | - Martin Shaw
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, Scotland, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Clinical Physics Department, Glasgow, Scotland, United Kingdom
| | - Theodore J. Iwashyna
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan, United States of America
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Malcolm Daniel
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom
| | - Helen Devine
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom
| | - Lyndsey Jarvie
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom
| | - John Kinsella
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, Scotland, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom
| | - Pamela MacTavish
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, Scotland, United Kingdom
| | - Tara Quasim
- University of Glasgow, School of Medicine, Dentistry and Nursing, Glasgow, Scotland, United Kingdom
- NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Intensive Care Unit, Glasgow, United Kingdom
| |
Collapse
|
13
|
McPeake J, Quasim T. The role of peer support in ICU rehabilitation. Intensive Crit Care Nurs 2016; 37:1-3. [PMID: 27554607 DOI: 10.1016/j.iccn.2016.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 01/13/2023]
Affiliation(s)
- Joanne McPeake
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Building, 10-16 Alexandra Parade, Glasgow, Scotland G31 2ER, United Kingdom.
| | - Tara Quasim
- Glasgow Royal Infirmary, 84 Castle Street, Glasgow, Scotland G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Building, 10-16 Alexandra Parade, Glasgow, Scotland G31 2ER, United Kingdom.
| |
Collapse
|
14
|
McPeake J, Devine H, MacTavish P, Fleming L, Crawford R, Struthers R, Kinsella J, Daniel M, Shaw M, Quasim T. Caregiver strain following critical care discharge: An exploratory evaluation. J Crit Care 2016; 35:180-4. [PMID: 27481756 DOI: 10.1016/j.jcrc.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of this exploratory evaluation was to understand the impact of critical care survivorship on caregivers. DESIGN Family members who attended a quality improvement initiative within our critical care unit were asked to complete 4 questionnaires. SETTING The setting for this study was a 20-bedded mixed critical care unit in a large teaching hospital in Scotland. Data were collected as a part of an evaluation of a quality improvement initiative. PARTICIPANTS Thirty-six carers completed the questionnaire set. MEASUREMENTS AND MAIN RESULTS A total of 53% of caregivers suffered significant strain. Poor quality of life in the patient was significantly associated with higher caregiver strain (P= .006). Anxiety was present in 69% of caregivers. Depression was present in 56% of caregivers, with a significant association between carer strain and depression (P< .001). Those caregivers who were defined as being strained also had significantly higher Insomnia Severity Index scores than those without carers strain (P= .007). CONCLUSION This evaluation has demonstrated that there is a significant burden for caregivers of critical care survivors. Furthermore, they reported high levels of posttraumatic stress disorder, anxiety, depression, and insomnia. Future work on rehabilitation from critical care should focus on the inclusion of caregivers.
Collapse
Affiliation(s)
- Joanne McPeake
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Bldg, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
| | - Helen Devine
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Pamela MacTavish
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Leanne Fleming
- University of the West of Scotland, Department of Psychology, Paisley Campus, Paisley, Scotland, PA1-2BE, United Kingdom
| | - Rebecca Crawford
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Ruth Struthers
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - John Kinsella
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Bldg, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
| | - Malcolm Daniel
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Martin Shaw
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom
| | - Tara Quasim
- Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, United Kingdom; University of Glasgow, School of Medicine, Glasgow Royal Infirmary, New Lister Bldg, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom
| |
Collapse
|
15
|
McPeake J, Forrest E, Quasim T, Kinsella J, O'Neill A. Health and social consequences of an alcohol-related admission to critical care: a qualitative study. BMJ Open 2016; 6:e009944. [PMID: 27048633 PMCID: PMC4823434 DOI: 10.1136/bmjopen-2015-009944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. DESIGN In-depth, semistructured interviews with participants (patients) 3-7 months post intensive care discharge. SETTING The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. PARTICIPANTS 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. CONCLUSIONS There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated.
Collapse
Affiliation(s)
- Joanne McPeake
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Tara Quasim
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - John Kinsella
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| | - Anna O'Neill
- University of Glasgow, School of Medicine, Glasgow Royal Infirmary, Glasgow, UK
| |
Collapse
|
16
|
Affiliation(s)
- Joanne McPeake
- Clinical Research Fellow, NHS Greater Glasgow and Clyde/University of Glasgow
| | - Tara Quasim
- Senior Lecturer in Anaesthesia, Critical Care & Pain Medicine, University of Glasgow
| |
Collapse
|