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Ageel M, Shbeer A, Tawhari M, Darraj H, Baiti M, Mobaraki R, Hakami A, Bakri N, Almahdi RH, Ageeli R, Mustafa M. Prevalence of Depression, Anxiety, and Post-traumatic Stress Syndrome Among Intensive Care Unit Survivors in Jazan, Saudi Arabia. Cureus 2024; 16:e60523. [PMID: 38883092 PMCID: PMC11180542 DOI: 10.7759/cureus.60523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/18/2024] Open
Abstract
Objective To quantify the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) among ICU survivors in the Jazan region, Saudi Arabia, and explore the correlational relationships among these conditions to inform targeted mental health interventions in this unique regional context. Methods The study employed a cross-sectional observational design to assess ICU survivors from two major hospitals in the Jazan Region: Prince Mohammed Bin Nasser Hospital and King Fahad Central Hospital. One hundred participants were interviewed face-to-face to gather detailed insights into their post-ICU experiences. We employed the hospital anxiety and depression scale (HADS) and the post-trauma symptom scale (PTSS-10) to systematically assess the psychological impacts of anxiety, depression, and PTSD among participants. Results The demographic breakdown of participants showed a youthful skew, with 37% under 35 years, 49% aged between 36-60 years, and only 14% over 60 years, contrasting with typical ICU demographics, which generally skew older. This younger distribution may influence the psychological outcomes observed. The sample was fairly gender-balanced, with 53% male and 47% female, closely reflecting the regional gender ratio of ICU admissions. Among the participants, 24% were classified as 'abnormal' and 20% as 'borderline abnormal' for anxiety, while 25% were 'borderline abnormal' and 21% 'abnormal' for depression. About 8% of participants were diagnosed with severe PTSD. Anxiety was more strongly correlated with PTSD than depression. The analysis demonstrated significant associations between demographic factors and psychological distress among ICU survivors. Females reported higher anxiety, while lower education and unemployment were associated with increased depression. Additionally, lower household income was associated with higher PTSS scores, and marital status was linked to depression, suggesting that socioeconomic factors play a critical role in post-ICU psychological recovery. Conclusion The findings emphasize the imperative need for comprehensive mental health evaluations and tailored interventions for ICU survivors in the Jazan region.
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Affiliation(s)
- Mohammed Ageel
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Abdullah Shbeer
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Mariam Tawhari
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Hussam Darraj
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Maisa Baiti
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Raghad Mobaraki
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Areej Hakami
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Nawaf Bakri
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Rahf H Almahdi
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Raghd Ageeli
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Mawada Mustafa
- Department of Surgery, College of Medicine, Jazan University, Jazan, SAU
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Weiss-Dagan S, Taubman-Ben-Ari O. Perceived stress and personal growth following the transition to military service: The role of sense of coherence and perceived social support. Stress Health 2024:e3406. [PMID: 38646939 DOI: 10.1002/smi.3406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/04/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
Relying on personal growth and structuration theories, we aimed to examine the internal (sense of coherence/SOC and help-seeking/HS) and external (perceived social support) resources that contribute to soldiers' personal growth following the transition to military service. We also investigated the role that perceived social support plays in moderating the relationship between SOC and personal growth, and between HS and personal growth. Two-hundred-and-seventy-one compulsory service soldiers (of whom 135 were men and 136 were women) completed self-report questionnaires between 6 and 12 months post-recruitment. The results showed both linear and curvilinear associations between soldiers' perceived stress and personal growth; SOC, HS, and perceived social support were positively correlated with personal growth; and perceived social support moderated both SOC and HS correlations with personal growth. Empirical evidence of personal growth in the transition to military service has been scant. Transitioning from civilian life to military service can be stressful and even traumatic but it can also provide opportunities for personal development. Our findings shed light on contributors to personal growth in the transition to military service, with both internal and external resources found to help one gain personal growth. It is evident that in order for soldiers to thrive, both perceived social support and active help-seeking are key factors.
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Affiliation(s)
- Shlomit Weiss-Dagan
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Orit Taubman-Ben-Ari
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
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Kalfon P, El-Hage W, Geantot MA, Favier C, Bodet-Contentin L, Kuteifan K, Olivier PY, Thévenin D, Pottecher J, Crozon-Clauzel J, Mauchien B, Galbois A, de Varax R, Valera S, Estagnasie P, Berric A, Nyunga M, Revel N, Simon G, Kowalski B, Sossou A, Signouret T, Leone M, Delalé C, Seemann A, Lasocki S, Quenot JP, Monsel A, Michel O, Page M, Patrigeon RG, Nicola W, Thille AW, Hekimian G, Auquier P, Baumstarck K. Impact of COVID-19 on posttraumatic stress disorder in ICU survivors: a prospective observational comparative cohort study. Crit Care 2024; 28:77. [PMID: 38486304 PMCID: PMC10938700 DOI: 10.1186/s13054-024-04826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/01/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) after a stay in the intensive care unit (ICU) can affect one in five ICU survivors. At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, admission to the ICU for COVID-19 was stressful due to the severity of this disease. This study assessed whether admission to the ICU for COVID-19 was associated with a higher prevalence of PTSD compared with other causes of ICU admission after adjustment for pre-ICU psychological factors. METHODS This prospective observational comparative cohort study included 31 ICUs. Eligible patients were adult ICU survivors hospitalized during the first wave of COVID-19 pandemic in France, regardless of the reason for admission. The prevalence of presumptive diagnosis of PTSD at 6 months was assessed using the PTSD Checklist for DSM-5 (PCL-5). Sociodemographics, clinical data, history of childhood trauma (Childhood Trauma Questionnaire [CTQ]), and exposure to potentially traumatic events (Life Events Checklist for DSM-5 [LEC-5]) were assessed. RESULTS Of the 778 ICU survivors included during the first wave of COVID-19 pandemic in France, 417 and 361 were assigned to the COVID-19 and non-COVID-19 cohorts, respectively. Fourteen (4.9%) and 11 (4.9%), respectively, presented with presumptive diagnosis of PTSD at 6 months (p = 0.976). After adjusting for age, sex, severity score at admission, use of invasive mechanical ventilation, ICU duration, CTQ and LEC-5, COVID-19 status was not associated with presumptive diagnosis of PTSD using the PCL-5. Only female sex was associated with presumptive diagnosis of PTSD. However, COVID-19 patients reported significantly more intrusion and avoidance symptoms than non-COVID patients (39% vs. 29%, p = 0.015 and 27% vs. 19%, p = 0.030), respectively. The median PCL-5 score was higher in the COVID-19 than non-COVID-19 cohort (9 [3, 20] vs. 4 [2, 16], p = 0.034). CONCLUSION Admission to the ICU for COVID-19 was not associated with a higher prevalence of PTSD compared with admission for another cause during the first wave of the COVID-19 pandemic in France. However, intrusion and avoidance symptoms were more frequent in COVID-19 patients than in non-COVID-19 patients. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03991611, registered on June 19, 2019.
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Affiliation(s)
- Pierre Kalfon
- Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray, France.
- Unité de Recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France.
- Réanimation Polyvalente, Hôpital Privé la Casamance, 33 Boulevard Des Farigoules, 13400, Aubagne, France.
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, INSERM, Tours, France
- Centre Régional de Psychotraumatologie, CHRU de Tours, Tours, France
| | | | - Constance Favier
- Unité de Recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
| | - Laetitia Bodet-Contentin
- Médecine Intensive Réanimation, INSERM CIC1415, CRICS-TriGGERSep Network, CHRU de Tours, Tours, France
- et INSERM UMR1246 SPHERE, Universités de Nantes et Tours, Tours, France
| | - Khaldoun Kuteifan
- Service de Réanimation Médicale, Groupe Hospitalier de la Région de Mulhouse Sud Alsace, Mulhouse, France
| | | | | | - Julien Pottecher
- Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Hautepierre, CHU de Strasbourg, Strasbourg, France
| | - Jullien Crozon-Clauzel
- Département d'Anesthésie Réanimation, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte Mauchien
- Réanimation Polyvalente, Hôpital Louis Pasteur, CH de Chartres, Le Coudray, France
| | - Arnaud Galbois
- Service de Réanimation Polyvalente, Hôpital Privé Claude Galien, Quincy-Sous-Sénart, France
| | | | - Sabine Valera
- Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Audrey Berric
- Réanimation Polyvalente, Hôpital Sainte-Musse, Toulon, France
| | - Martine Nyunga
- Réanimation Polyvalente, Hôpital Victor Provo, Roubaix, France
| | - Nathalie Revel
- Réanimation Médico-Chirurgicale, Hôpital Pasteur, CHU de Nice, Nice, France
| | | | | | - Achille Sossou
- Département d'Anesthésie-Réanimation, Hôpital Émile Roux, Le Puy-en-Velay, France
| | | | - Marc Leone
- Réanimation, Département d'Anesthésie-Réanimation, Hôpital Nord, AP-HM, Marseille, France
| | - Charles Delalé
- Réanimation, Hôpital Simone Veil, CH de Blois, Blois, France
| | | | | | - Jean-Pierre Quenot
- Service de Médecine Intensive Réanimation, CHU Dijon Bourgogne, Dijon, France
| | - Antoine Monsel
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, GRC 29, DMU DREAM, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Olivier Michel
- Service de Réanimation Polyvalente, CH de Bourges, Bourges, France
| | | | | | | | - Arnaud W Thille
- Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Guillaume Hekimian
- Service de Médecine Intensive Réanimation, Hôpital Pitié-Salpêtrière, Sorbonne Université AP-HP, Paris, France
| | - Pascal Auquier
- Unité de Recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
| | - Karine Baumstarck
- Unité de Recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
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Rai S, Neeman T, Brown R, Sundararajan K, Rajamani A, Miu M, Panwar R, Nourse M, van Haren FM, Mitchell I, Needham DM. Psychological symptoms and health-related quality of life in intubated and non-intubated intensive care survivors: A multicentre, prospective observational cohort study. CRIT CARE RESUSC 2024; 26:8-15. [PMID: 38690186 PMCID: PMC11056421 DOI: 10.1016/j.ccrj.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 05/02/2024]
Abstract
Objective To compare long-term psychological symptoms and health-related quality of life (HRQOL) in intubated versus non-intubated ICU survivors. Design Prospective, multicentre observational cohort study. Setting Four tertiary medical-surgical ICUs in Australia. Participants Intubated and non-intubated adult ICU survivors. Main outcome measures Primary outcomes: clinically significant psychological symptoms at 3- and 12-month follow-up using Post-Traumatic Stress Syndrome-14 for post-traumatic stress disorder; Depression, Anxiety Stress Scales-21 for depression, anxiety, and stress. Secondary outcomes: HRQOL, using EuroQol-5D-5L questionnaire. Results Of the 133 ICU survivors, 54/116 (47 %) had at least one clinically significant psychological symptom (i.e., post-traumatic stress disorder, anxiety, depression, stress) at follow-up. Clinically significant scores for psychological symptoms were observed in 26 (39 %) versus 16 (32 %) at 3-months [odds ratio 1.4, 95 % confidence interval (0.66-3.13), p = 0.38]; 23 (37 %) versus 10 (31 %) at 12-months [odds ratio 1.3, 95 % confidence interval (0.53-3.31), p = 0.57] of intubated versus non-intubated survivors, respectively. Usual activities and mobility were the most commonly affected HRQOL dimension, with >30 % at 3 versus months and >20 % at 12-months of overall survivors reporting ≥ moderate problems. There was no difference between the groups in any of the EQ5D dimensions. Conclusions Nearly one-in-two (47 %) of the intubated and non-intubated ICU survivors reported clinically significant psychological symptoms at 3 and 12-month follow-ups. Overall, more than 30 % at 3-months and over 20 % at 12-months of the survivors in both groups had moderate or worse problems with their usual activities and mobility. The presence of psychological symptoms and HRQOL impairments was similar between the groups.
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Affiliation(s)
- Sumeet Rai
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Teresa Neeman
- Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Krishnaswamy Sundararajan
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Arvind Rajamani
- Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia
| | | | - Rakshit Panwar
- Intensive Care Unit, John Hunter Hospital, New Lambton, Australia
| | - Mary Nourse
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Frank M.P. van Haren
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia
| | - Imogen Mitchell
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
| | - Dale M. Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA
- John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | - for the PRICE study investigators
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Intensive Care Unit, Canberra Hospital, Canberra, Australia
- Biological Data Science Institute, College of Science, Australian National University, Canberra, Australia
- Research School of Psychology, Australian National University, Canberra, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- Nepean Clinical School, University of Sydney, Kingswood, Sydney, Australia
- Intensive Care Unit, Nepean Hospital, Kingswood, Sydney, Australia
- Nepean Hospital, Kingswood, Sydney, Australia
- Intensive Care Unit, John Hunter Hospital, New Lambton, Australia
- Intensive Care Unit, St. George Hospital, Kogarah, Sydney, Australia
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA
- John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
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Frankort J, Krabbe J, Otte N, Doukas P, Krabbe H, Jacobs MJ, Gombert A. Posttraumatic stress disorder and quality of life in patients after open thoracoabdominal aortic repair. VASA 2024; 53:45-52. [PMID: 38047758 DOI: 10.1024/0301-1526/a001103] [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: 12/05/2023]
Abstract
Background: Open thoracoabdominal aortic aneurysm (TAAA) repair is often related to significant morbidity and complications like paraplegia or acute kidney injury. Subsequently, prolonged intensive care stay is common. However, there is a lack of research on post-traumatic stress disorder (PTSD) and the perceived quality of life (QOL) in patients undergoing complex aortic procedures, such as open TAAA repair. Therefore, our study aims to determine the prevalence of PTSD and the current QOLin these patients and whether it is associated with demographic factors or complications following open thoracoabdominal aortic repair. Patients and methods: In this retrospective study, a total of 213 adult surviving patients after open thoracoabdominal aortic repair were contacted with two questionnaires one to assess PTSD and another to evaluate current QOL after open thoracoabdominal aortic repair. 61 patients returned one or both the questionnaires, and 59 patients (97%) answered all questions of the 4-item primary care PTSD section of the survey. In addition to the PTSD screening, patients were sent an SF-36 questionnaire to assess their current quality of life. 60 patients answered the SF-36 questionnaire partially or completely (98%). Results: 27% of patients (16/59) screened positive for PTSD. Electronic medical records were matched to all responding patients. Patients who were screened positive for PTSD spent more days in intensive care (OR, 1.073; 95% CI 1.02-1.13; p=0.005), had a higher frequency of tracheotomy (OR, 6.43; 95% CI 1.87-22.06; p=0.004), sepsis (OR, 5.63; 95% CI 1.56-20.33; p=0.014), as well as postoperative paraparesis (OR, 13.23; 95% CI 1.36-129.02; p=0.019). In patients with postoperative complications, a statistically significant decrease in the overall score was observed for certain categories of the SF-36. Conclusions: The prevalence of PTSD is higher, in comparison to the general population's prevalence, and the quality of life is affected following open thoracoabdominal aortic aneurysm repair, with a significant relation to postoperative complications as well as the length of ICU stay. Further research and screening for PTSD in relation to open TAAA repair is needed to assess its role in patient QOL during follow up.
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Affiliation(s)
- Jelle Frankort
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany
- European Vascular Centre Maastricht-Aachen, Department of Vascular Surgery, MUMC Maastricht, The Netherlands
| | - Julia Krabbe
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Germany
| | - Nelly Otte
- Institute of Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Germany
| | - Panagiotis Doukas
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany
| | - Hanif Krabbe
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany
| | - Michael J Jacobs
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany
- European Vascular Centre Maastricht-Aachen, Department of Vascular Surgery, MUMC Maastricht, The Netherlands
| | - Alexander Gombert
- European Vascular Centre Aachen-Maastricht, Department of Vascular Surgery, RWTH Aachen, Germany
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Kim T, Kim H. Pathophysiology and Therapeutic Management of Bone Loss in Patients with Critical Illness. Pharmaceuticals (Basel) 2023; 16:1718. [PMID: 38139844 PMCID: PMC10747168 DOI: 10.3390/ph16121718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Patients with critical illnesses are at higher risk of comorbidities, which can include bone mineral density loss, bone turnover marker increase, and fragility fractures. Patients admitted to intensive care units (ICUs) have a higher risk of bone fractures. Since hypermetabolism is a characteristic of ICU patients, such patients are often rapidly affected by systemic deterioration, which often results in systemic wasting disease. Major risk factors for ICU-related bone loss include physical restraint, inflammation, neuroendocrine stress, malnutrition, and medications. A medical history of critical illness should be acknowledged as a risk factor for impaired bone metabolism. Bone loss associated with ICU admission should be recognized as a key component of post-intensive care syndrome, and further research that focuses on treatment protocols and prevention strategies is required. Studies aimed at maintaining gut integrity have emphasized protein administration and nutrition, while research is ongoing to evaluate the therapeutic benefits of anti-resorptive agents and physical therapy. This review examines both current and innovative clinical strategies that are used for identifying risk factors of bone loss. It provides an overview of perioperative outcomes and discusses the emerging novel treatment modalities. Furthermore, the review presents future directions in the treatment of ICU-related bone loss.
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Affiliation(s)
- Taejin Kim
- Department of Urology, CHA University Ilsan Medical Center, CHA University School of Medicine, Goyang-si 10414, Republic of Korea;
| | - Hyojin Kim
- Division of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si 14353, Republic of Korea
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Fuller BM, Driver BE, Roberts MB, Schorr CA, Thompson K, Faine B, Yeary J, Mohr NM, Pappal RD, Stephens RJ, Yan Y, Johnson NJ, Roberts BW. Awareness with paralysis and symptoms of post-traumatic stress disorder among mechanically ventilated emergency department survivors (ED-AWARENESS-2 Trial): study protocol for a pragmatic, multicenter, stepped wedge cluster randomized trial. Trials 2023; 24:753. [PMID: 38001507 PMCID: PMC10675941 DOI: 10.1186/s13063-023-07764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Awareness with paralysis (AWP) is memory recall during neuromuscular blockade (NMB) and can cause significant psychological harm. Decades of effort and rigorous trials have been conducted to prevent AWP in the operating room, where prevalence is 0.1-0.2%. By contrast, AWP in mechanically ventilated emergency department (ED) patients is common, with estimated prevalence of 3.3-7.4% among survivors given NMB. Longer-acting NMB use is a critical risk for AWP, and we have shown an association between ED rocuronium use and increased AWP prevalence. As NMB are given to more than 90% of ED patients during tracheal intubation, this trial provides a platform to test an intervention aimed at reducing AWP. The overall objective is to test the hypothesis that limiting ED rocuronium exposure will significantly reduce the proportion of patients experiencing AWP. METHODS This is a pragmatic, stepped wedge cluster randomized trial conducted in five academic EDs, and will enroll 3090 patients. Per the design, all sites begin in a control phase, under observational conditions. At 6-month intervals, sites sequentially enter a 2-month transition phase, during which we will implement the multifaceted intervention, which will rely on use of nudges and defaults to change clinician decisions regarding ED NMB use. During the intervention phase, succinylcholine will be the default NMB over rocuronium. The primary outcome is AWP, assessed with the modified Brice questionnaire, adjudicated by three independent, blinded experts. The secondary outcome is the proportion of patients developing clinically significant symptoms of post-traumatic stress disorder at 30 and 180 days after hospital discharge. We will also assess for symptoms of depression and anxiety, and health-related quality of life. A generalized linear model, adjusted for time and cluster interactions, will be used to compare AWP in control versus intervention phases, analyzed by intention-to-treat. DISCUSSION The ED-AWARENESS-2 Trial will be the first ED-based trial aimed at preventing AWP, a critical threat to patient safety. Results could shape clinical use of NMB in the ED and prevent more than 10,000 annual cases of AWP related to ED care. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT05534243 . Registered 06, September 2022.
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Affiliation(s)
- Brian M Fuller
- Department of Anesthesiology, Division of Critical Care, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA
| | - Michael B Roberts
- Department of Institutional Research, Department of Psychology, Philadelphia College of Osteopathic Medicine, Rowland Hall, 514B, 4190 City Avenue, Philadelphia, PA, 19131, USA
| | - Christa A Schorr
- Cooper Research Institute, Cooper University Health Care, One Cooper Plaza, Dorrance, Camden, NJ, 08103, USA
| | - Kathryn Thompson
- Department of Emergency Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brett Faine
- Departments of Emergency Medicine and Pharmacy, Roy J. and Lucille A. Carver College of Medicine, University of Iowa College of Pharmacy, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Julianne Yeary
- Emergency Department, Charles F. Knight Emergency and Trauma Center, Barnes-Jewish Hospital, 1 Barnes Jewish Hospital Plaza, St. Louis, MO, 63110, USA
| | - Nicholas M Mohr
- Departments of Emergency Medicine and Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, 200 Hawkins Drive, 1008 RCP, Iowa City, IA, 52242, USA
| | - Ryan D Pappal
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Robert J Stephens
- Department of Medicine, Division of Critical Care Medicine, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Division of Biostatistics, Washington University School of Medicine, 418E, 2Nd Floor, 600 South Taylor Ave., St. Louis, MO, 63110, USA
| | - Nicholas J Johnson
- Departments of Emergency Medicine and Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington/Harborview Medical Center, 325 9th Avenue, Seattle, WA, 98104, USA
| | - Brian W Roberts
- Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza, K152, Camden, NJ, 08103, USA
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Springer F, Kuba K, Ernst J, Friedrich M, Glaesmer H, Platzbecker U, Vucinic V, Heyne S, Mehnert-Theuerkauf A, Esser P. Symptoms of posttraumatic stress disorder and adjustment disorder in hematological cancer patients with different treatment regimes. Acta Oncol 2023; 62:1110-1117. [PMID: 37517064 DOI: 10.1080/0284186x.2023.2239477] [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: 05/12/2023] [Accepted: 07/14/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Symptoms of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) are common in hematological cancer patients as they face severe stressors during their serious disease and often intensive treatment, such as stem cell transplantation (SCT). Aims of the present study were to provide frequency and risk factors for PTSD and AjD based on updated diagnostic criteria that are lacking to date. MATERIAL AND METHODS In a cross-sectional study, hematological cancer patients were assessed for stressor-related symptoms via validated self-report questionnaires based on updated criteria for PTSD (PCL-5) and AjD (ADMN-20). Frequency and symptom severity were estimated among the total sample and SCT subgroups (allogeneic, autologous, no SCT). SCT subgroups were compared using Chi-squared-tests and ANOVAs. Linear regression models investigated sociodemographic and medical factors associated with symptomatology. RESULTS In total, 291 patients were included (response rate: 58%). 26 (9.3%), 66 (23.7%) and 40 (14.2%) patients met criteria for cancer-related PTSD, subthreshold PTSD and AjD, respectively. Symptom severity and frequency of criteria-based PTSD and AjD did not differ between SCT subgroups (all p > 0.05). Factors associated with elevated symptomatology were younger age (PTSD: p < 0.001; AjD: p = 0.02), physical comorbidity (PTSD: p < 0.001; AjD: p < 0.001) and active disease (PTSD: p = 0.12; AjD: p = 0.03). CONCLUSION Based on new criteria, a considerable part of hematological cancer patients reports PTSD and AjD symptoms. Younger patients and patients with physical symptom burden might be particularly at risk and need to be monitored closely to enable effective treatment at an early stage.
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Affiliation(s)
- Franziska Springer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Katharina Kuba
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Vladan Vucinic
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany
| | - Svenja Heyne
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Zhang Q, Chen S, Zhang Y, Ni J, Huang J, Wu Y, Li M. Interventions targeting psychosocial adaptation in people with stroke: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 113:107751. [PMID: 37116222 DOI: 10.1016/j.pec.2023.107751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This scoping review aimed to describe and map interventions targeting psychosocial adaptation in people with stroke. METHODS A scoping review was conducted using the Joanna Briggs Institute methodology and reported according to Systematic Review and Meta-Analyses Extension for Scoping Reviews guidelines. We included original studies with interventions targeting psychosocial adaptation (concept) on people with stroke (population) in any setting (context). We searched five online electronic databases (PubMed, Embase, CINAHL, PsycINFO, and Cochrane Central Registry of Controlled Trials). We described interventions in terms of design characteristics, theoretical basis, details of interventions, and quantitative outcomes indicated in psychosocial adaptation. RESULTS Forty-three studies were identified. Five intervention categories were identified to describe the interventions targeting psychosocial adaptation. Quantitative outcomes indicated psychosocial adaptation in our review were grouped into four domains: global adaptation, psychological adaptation, social adaptation, and others. CONCLUSIONS The mapping and description brought to light the large heterogeneity of interventions targeting psychosocial adaptation in people with stroke. PRACTICE IMPLICATIONS Deepening understanding of psychosocial adaptation can help health professionals further develop effective interventions aiming at promoting psychosocial adaptation and reducing negative health sequelae, such as risk of reduced psychosomatic recovery post stroke.
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Shanshan Chen
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Jieqing Ni
- School of Social Sciences in Applied Psychology, Lingnan University, Hong Kong, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
| | - Yi Wu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China.
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10
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Taft TH, Carlson DA, Marchese SH, Pandolfino JE. Initial assessment of medical post-traumatic stress among patients with chronic esophageal diseases. Neurogastroenterol Motil 2023; 35:e14540. [PMID: 36703507 PMCID: PMC10133015 DOI: 10.1111/nmo.14540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/20/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Diagnosis and management of chronic esophageal disease requires the use of potentially traumatic medical procedures, performed with or without sedation. Medical trauma and post-traumatic stress (PTS) are emerging as important considerations in patients with digestive illness. To date, no study assesses medical PTS from procedures in patients with esophageal disease. METHODS Adult patients with achalasia, eosinophilic esophagitis, gastroesophageal reflux disease, or functional esophageal disease at a university-based gastroenterology clinic completed: Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5), Gastroesophageal Disease Questionnaire, Brief Esophageal Dysphagia Questionnaire, Northwestern Esophageal Quality of Life scale (HRQoL), NIH-PROMIS Depression scale, and a study-specific questionnaire about esophageal procedures (endoscopy with sedation; functional lumen imaging probe (FLIP) with sedation; high-resolution manometry (HRM); wireless pH testing; or 24-h pH-impedance testing). KEY RESULTS Half of 149 participants reported at least one traumatic procedure, with HRM most often cited. Only 2.7% met the cutoff for PTS on PCL-5. This increased to 7.1% for patients with a traumatic procedure combined with experiencing intense fear. Rates of moderate-severe PTS ranged from 7.4%-12% for all patients and 14%-29% for those with a traumatic procedure with fear. Medical PTS was associated with poorer HRQoL, and increased esophageal symptoms, depression, and hypervigilance and symptom anxiety. CONCLUSIONS & INFERENCES Preliminary evidence suggests medical PTS affects few patients with esophageal disease. However traumatic procedures, most often associated with HRM, significantly increase PTS symptoms. The potential impacts of medical PTS on esophageal patient assessment and outcomes are considerable and warrants further study.
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Affiliation(s)
- Tiffany H Taft
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dustin A Carlson
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sara H Marchese
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - John E Pandolfino
- Division of Gastroenterology & Hepatology Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Olszewski AE, Dervan LA, Smith MB, Asaro LA, Wypij D, Curley MAQ, Watson RS. Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial. Pediatr Crit Care Med 2023; 24:222-232. [PMID: 36728954 PMCID: PMC9992163 DOI: 10.1097/pcc.0000000000003150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation. DESIGN Nonprespecified secondary analysis of a randomized clinical trial. SETTING Thirty-one U.S. PICUs. PATIENTS Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov ) over 8 years old who completed PTSD screening 6 months after discharge. INTERVENTIONS RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care. MEASUREMENTS AND MAIN RESULTS PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork ( n = 18, 58%) and happiness ( n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3-458.1 and $40,000-$79,999 OR, 15.6; 95% CI, 1.3-182.8), renal dysfunction (OR 5.3, 95% CI 1.7-16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9-35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen. CONCLUSIONS Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.
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Affiliation(s)
- Aleksandra E Olszewski
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
| | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Mallory B Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - David Wypij
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA
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12
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Carola V, Vincenzo C, Morale C, Pelli M, Rocco M, Nicolais G. Psychological health in COVID-19 patients after discharge from an intensive care unit. Front Public Health 2022; 10:951136. [PMID: 36033791 PMCID: PMC9411785 DOI: 10.3389/fpubh.2022.951136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 01/24/2023] Open
Abstract
Along with physical changes, psychological changes are detectable in patients with COVID-19. In these patients, the stressful experience of intensive care unit (ICU) hospitalization may aggravate psychological conditions. Our study examines the short- and long-term psychological consequences of COVID-19 in ICU patients. COVID-19 patients completed the self-rating questionnaires Kessler 10 Psychological Distress Scale (K10), Perceived Stress Scale-10 (PSS), Impact of Event Scale Revised (IES-R), and Post-traumatic Growth Inventory (PTGI) and were clinically interviewed 1 and 6 months after discharge. Altered behavioral-psychological symptoms and patients' strategies (adaptive vs. maladaptive) for coping with stress during and after hospitalization were coded during clinical interviews. Between 20 and 30% of patients showed moderate symptoms of depression or anxiety and perceived stress 1 and 6 months after discharge. Sleep problems, difficulty concentrating, confusion in placing events, and fear of reinfection were observed in many (6-17%) patients. At 6 months, only 7% of patients showed PTSD symptoms, and 50% showed post-traumatic growth in the "appreciation of life" sub-scale. Finally, 32% of subjects were classified as "maladaptive coping patients," and 68% as "adaptive coping patients." Patients who adopted "adaptive" coping strategies showed significantly lower levels of anxious-depressive symptoms and perceived stress when compared to subjects with "maladaptive" strategies at both time points. Coping strategy had no effect on PTSD symptoms or post-traumatic growth at 6 months. These findings clarify the short- and long-term psychological effects of intensive care due to COVID-19 infection and demonstrate that patient characteristics, particularly strategies for coping with stress, seem to play a critical role in psychological outcomes.
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Affiliation(s)
- Valeria Carola
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Cristina Vincenzo
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Chiara Morale
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Pelli
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Monica Rocco
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Giampaolo Nicolais
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Pant U, Frishkopf M, Park T, Norris CM, Papathanassoglou E. A Neurobiological Framework for the Therapeutic Potential of Music and Sound Interventions for Post-Traumatic Stress Symptoms in Critical Illness Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053113. [PMID: 35270804 PMCID: PMC8910287 DOI: 10.3390/ijerph19053113] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022]
Abstract
Overview: Post traumatic stress disorder (PTSD) has emerged as a severely debilitating psychiatric disorder associated with critical illness. Little progress has been made in the treatment of post-intensive care unit (ICU) PTSD. Aim: To synthesize neurobiological evidence on the pathophysiology of PTSD and the brain areas involved, and to highlight the potential of music to treat post-ICU PTSD. Methods: Critical narrative review to elucidate an evidence-based neurobiological framework to inform the study of music interventions for PTSD post-ICU. Literature searches were performed in PubMed and CINAHL. The Scale for the Assessment of Narrative Review Articles (SANRA) guided reporting. Results: A dysfunctional HPA axis feedback loop, an increased amygdalic response, hippocampal atrophy, and a hypoactive prefrontal cortex contribute to PTSD symptoms. Playing or listening to music can stimulate neurogenesis and neuroplasticity, enhance brain recovery, and normalize stress response. Additionally, evidence supports effectiveness of music to improve coping and emotional regulation, decrease dissociation symptoms, reduce depression and anxiety levels, and overall reduce severity of PTSD symptoms. Conclusions: Despite the lack of music interventions for ICU survivors, music has the potential to help people suffering from PTSD by decreasing amygdala activity, improving hippocampal and prefrontal brain function, and balancing the HPA-axis.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405-87th Ave, Edmonton, AB T6G 1C9, Canada; (U.P.); (T.P.); (C.M.N.)
| | - Michael Frishkopf
- Department of Music, Faculty of Arts, University of Alberta, 3-98 Fine Arts Building, Edmonton, AB T6G 2C9, Canada;
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada
- Canadian Centre for Ethnomusicology (CCE), University of Alberta, 11204-89 Ave NW, Edmonton, AB T6G 2J4, Canada
| | - Tanya Park
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405-87th Ave, Edmonton, AB T6G 1C9, Canada; (U.P.); (T.P.); (C.M.N.)
| | - Colleen M. Norris
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405-87th Ave, Edmonton, AB T6G 1C9, Canada; (U.P.); (T.P.); (C.M.N.)
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, AB T6G 2R7, Canada
- School of Public Health, University of Alberta, ECHA 4-081, 11405-87 Ave NW, Edmonton, AB T6G 1C9, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services Corporate Office Seventh Street Plaza 14th Floor, North Tower 10030-107 Street NW, Edmonton, AB T5J 3E4, Canada
| | - Elizabeth Papathanassoglou
- Faculty of Nursing, Edmonton Clinic Health Academy (ECHA), University of Alberta, 11405-87th Ave, Edmonton, AB T6G 1C9, Canada; (U.P.); (T.P.); (C.M.N.)
- Neurosciences Rehabilitation & Vision Strategic Clinical Network, Alberta Health Services Corporate Office Seventh Street Plaza 14th Floor, North Tower 10030-107 Street NW, Edmonton, AB T5J 3E4, Canada
- Correspondence:
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Casarin J, Ielmini M, Cromi A, Laganà AS, Poloni N, Callegari C, Ghezzi F. Post-traumatic stress following total hysterectomy for benign disease: an observational prospective study. J Psychosom Obstet Gynaecol 2022; 43:11-17. [PMID: 32319346 DOI: 10.1080/0167482x.2020.1752174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Over the last decade, there has been growing interest in the psychophysical integrity of surgical patients in the context of healthcare events. In the present study, we aimed to evaluate the incidence rate of postoperative distress symptoms, namely post-traumatic stress disorder (PTSD), following total hysterectomy for benign disease. We also investigated possible associations between sociodemographic characteristics, clinical outcomes, anxiety, depression, and PTSD. METHODS We prospectively enrolled 100 consecutive patients who underwent total hysterectomy for benign disease between 01/01/2019 and 15/04/2019. Demographic and surgical-related characteristics have been registered. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered preoperatively (Time1), postoperatively (Time2), and at follow-up clinical evaluation, between two and three months after surgery (Time3). PTSD was defined based on the results of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at Time3. RESULTS At Time3, the median PCL-5 score was 12,8 (0-70), and 16.4% of patients had PTSD symptoms (PCL-5 > 33). No correlation between sociodemographic or gynecologic characteristics and PTSD was detected. A significant association between depression (HADS > 8) at Time2 (p = 0.002) and Time3 (p < 0.001) and PTSD symptoms was shown. CONCLUSION Hysterectomy for benign disease is associated with a non-negligible risk of PTDS; the use of the HADS questionnaires might be useful to select patients who might benefit from dedicated psychological support.
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Affiliation(s)
- Jvan Casarin
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Marta Ielmini
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | | | - Nicola Poloni
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
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15
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Marwale AV, Phadke SS, Kocher AS. Psychiatric management of Patients in intensive care units. Indian J Psychiatry 2022; 64:S292-S307. [PMID: 35602362 PMCID: PMC9122158 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_28_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Arun V Marwale
- Department of Psychiatry, M.G.M. Medical College, Aurangabad, India
- Department of Psychiatry, Shraddha Nursing Home, Aurangabad, India
| | - Sanjay S Phadke
- Department of Neuropsychiatry, Jehangir Hospital, Maharashtra, India
- Deenanath Mangeshkar Hospital and Research Center, Maharashtra, India
- Center for Behavioural Medicine, Pune, Maharashtra, India
| | - Angad S Kocher
- Department of Psychiatry, Kocher Clinic, New Delhi, India
- Department of Psychiatry, Sabharwal Hospital, New Delhi, India
- Vedant Medical Centre, New Delhi, India E-mail:
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16
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Ke S, Sun L, Zhou J, Wang Y, Bu T, Chu H, Yang J, Wang W, Wang W, Li J, Zhao L, Qiao Z, Qiu X, Yang X, Cao D, Yang Y. Factors Influencing Post-traumatic Stress Symptoms in Chinese Adolescents During the COVID-19 Pandemic. Front Psychiatry 2022; 13:892014. [PMID: 35711600 PMCID: PMC9192973 DOI: 10.3389/fpsyt.2022.892014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/07/2022] [Indexed: 11/20/2022] Open
Abstract
To investigate the prevalence of post-traumatic stress symptoms (PTSSs) and analyze the influencing factors of PTSS among adolescents in a large sample study during the COVID-19 pandemic, we did a cross-sectional study by collecting demographic data and mental health measurements from a large group of 175,318 adolescents in 32 Chinese provinces and autonomous regions, using the Impact of Event Scale-Revised (IES-R) that was used to measure the PTSS of the participants. The results showed that the prevalence of PTSS was 35.7% in Chinese adolescents during the COVID-19 pandemic. Binary logistic regression analysis showed that, for the personal risk factors, the older age, female gender, the personality domains of extroversion, the irregular sleep schedule, the lack of aerobic exercise, and the lack of peer support were associated with the higher levels of PTSS. The family subjective and objective factors were associated with higher levels of PTSS. Our findings suggested that family factors are the most important factors that affect Chinese adolescents' PTSS due to the longtime home quarantine.
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Affiliation(s)
- Siyuan Ke
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Li Sun
- Department of Medical Education Management, School of Health Management of Harbin Medical University, Harbin, China
| | - Jiawei Zhou
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Medical Psychology, Harbin Medical University, Harbin, China.,The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianyi Bu
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Haiyun Chu
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Jiarun Yang
- Department of Medical Education Management, School of Health Management of Harbin Medical University, Harbin, China
| | - Wenbo Wang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Wantong Wang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Jiarui Li
- Department of Medical Education Management, School of Health Management of Harbin Medical University, Harbin, China
| | - Lu Zhao
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Zhengxue Qiao
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Xiaohui Qiu
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Xiuxian Yang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
| | - Depin Cao
- Department of Medical Education Management, School of Health Management of Harbin Medical University, Harbin, China
| | - Yanjie Yang
- Department of Medical Psychology, Harbin Medical University, Harbin, China
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. SPLIT ENZ: Survivorship of Patients post Long Intensive care stay, Exploration/Experience in a New Zealand cohort (A mixed methods study protocol) (Preprint). JMIR Res Protoc 2021; 11:e35936. [PMID: 35297773 PMCID: PMC8972103 DOI: 10.2196/35936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Post Intensive Care Syndrome (PICS) was defined by the Society of Critical Care Medicine in 2012 with subsequent international research highlighting poor long-term outcomes; reduced quality of life; and impairments, for survivors of critical illness. To date, there has been no published research on the long-term outcomes of survivors of critical illness in New Zealand. Objective The aim of this study is to explore long-term outcomes after critical illness in New Zealand. The primary objectives are to describe and quantify symptoms and disability, explore possible risk factors, and to identify unmet needs in survivors of critical illness. Methods This will be a mixed methods study with 2 components. First, a prospective cohort study of approximately 100 participants with critical illness will be followed up at 1, 6, and 12 months after hospital discharge. The primary outcome will be disability assessed using the World Health Organization Disability Assessment Scale 2.0. Secondary outcomes will focus on mental health using the Hospital Anxiety and Depression Scale and the Impact of Events Scale-revised, cognitive function using the Montreal Cognitive Assessment (Montreal Cognitive Assessment–BLIND), and health-related quality of life using the European Quality of Life-Five Dimension-Five Level. The second element of the study will use qualitative grounded theory methods to explore participants experiences of recovery and highlight unmet needs. Results This study was approved by the New Zealand Northern A Health and Disability Ethics Committee on August 16, 2021 (21/NTA/107), and has been registered with the Australian New Zealand Clinical Trials Registry on October 5, 2021. SPLIT ENZ is due to start recruitment in early 2022, aiming to enroll 125 patients over 2 years. Data collection is estimated to be completed by 2024-2025 and will be published once all data are available for reporting. Conclusions Although international research has identified the prevalence of PICS and the extent of disability in survivors of critical illness, there is no published research in New Zealand. Research in this field is particularly pressing in the context of COVID-19, an illness that may include PICS in its sequelae. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN1262100133588; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382566&showOriginal=true&isReview=true International Registered Report Identifier (IRRID) PRR1-10.2196/35936
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Affiliation(s)
- Lynsey Sutton
- Intensive Care Unit, Level 3, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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18
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Elumn JE, Keating L, Smoyer AB, Wang EA. Healthcare-induced trauma in correctional facilities: a qualitative exploration. HEALTH & JUSTICE 2021; 9:14. [PMID: 34152487 PMCID: PMC8215321 DOI: 10.1186/s40352-021-00139-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND While incarcerated people are known to experience trauma at higher rates than the general population, little is known about how the correctional health system contributes to trauma rates. METHODS We conducted 20 semi-structured qualitative interviews with men who were recently released from a correctional system to understand their experiences with healthcare systems and medical staff during incarceration. Using reflexive thematic analysis within a critical realist framework, we coded and analyzed the data iteratively to refine and unify emerging themes. RESULTS The unanticipated concept of healthcare-induced trauma emerged and was revealed in three overall themes: (1) healthcare leading to fear of serious illness or death, (2) healthcare leading to fear of people, including healthcare providers, correctional staff, and other incarcerated people, and (3) the correctional institutional, social, and physical environment leads to fear of place. CONCLUSIONS Healthcare in correctional settings has the potential to induce trauma, even when the medical conditions addressed are not life-threatening. Future research should examine the factors contributing to the development of healthcare-induced trauma in correctional settings and develop interventions to prevent and address this phenomenon.
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Affiliation(s)
- Johanna E. Elumn
- SEICHE Center for Health and Justice, General Internal Medicine, Yale School of Medicine, New Haven, USA
| | - Layne Keating
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, USA
| | - Amy B. Smoyer
- Department of Social Work, Southern Connecticut State University, New Haven, USA
| | - Emily A. Wang
- SEICHE Center for Health and Justice, General Internal Medicine, Yale School of Medicine, New Haven, USA
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19
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Nordness MF, Hayhurst CJ, Pandharipande P. Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. J Pain Res 2021; 14:1733-1744. [PMID: 34163231 PMCID: PMC8214553 DOI: 10.2147/jpr.s256406] [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: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Critical illness is often painful, both from the underlying source of illness, as well as necessary procedures performed for the monitoring and care of these patients. Pain is often under-recognized in the critically ill, especially among those who cannot self-report, so accurate assessment and management continue to be major consideration in their care. Pain management in the intensive care unit (ICU) is an evolving practice, with a focus on accurate and frequent pain assessment, and targeted pharmacologic and non-pharmacologic treatment methods to maximize analgesia and minimize sedation. In this review, we will evaluate several validated methods of pain assessment in the ICU and present management options. We will review the evidence-based recommendations put forth by the largest critical care societies and several high-quality studies related to both the in-hospital approach to pain, as well as the short- and long-term consequences of untreated pain in ICU patients. We conclude with future directions.
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Affiliation(s)
- Mina F Nordness
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christina J Hayhurst
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pratik Pandharipande
- Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Apitzsch S, Larsson L, Larsson AK, Linder A. The physical and mental impact of surviving sepsis - a qualitative study of experiences and perceptions among a Swedish sample. Arch Public Health 2021; 79:66. [PMID: 33933171 PMCID: PMC8088073 DOI: 10.1186/s13690-021-00585-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/18/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sepsis is a critical illness with high morbidity and mortality rates. Each year, sepsis affects about 48.9 million people all over the world. This study aims to illuminate how sepsis survivors experience sepsis and the impact of sepsis, as well as the health-related quality of life thereafter. METHODS An interview study with eight sepsis survivors was carried out in Sweden with an inductive qualitative method. The data were analyzed with content analysis. RESULTS Four themes were identified during the analysis; The experience of health care and being a sepsis patient, New circumstances´ impact on life, Family and social interactions, and The psychological impact on life. The lack of information about how sepsis can impact the survivors' lives and what to expect can lead to prolonged agony. The long recovery time comes as an unexpected and unpleasant surprise to those affected. Initially, the sepsis survivors are almost euphoric that they have survived, which can later lead to chock and trauma when they realize that they could have died. This insight needs to be processed in order to reach reconciliation with life after sepsis. CONCLUSION Sepsis has a huge impact on both physical and mental aspects of life. Many survivors suffer from persistent residual symptoms of varying degrees, to which they have to adapt. The sepsis survivors need individually adjusted information about the sepsis recovery trajectory, and what to expect during and after the hospital stay.
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Affiliation(s)
- Sabine Apitzsch
- The Emergency Department, Skåne University Hospital, Lund, Sweden
| | - Lotta Larsson
- Faculties of humanities and theology, Centre for Languages and Literature, Lund University, Lund, Sweden
| | - Anna-Karin Larsson
- Region Skåne, Department of Quality Management and Production, Lund/Malmö, Sweden
| | - Adam Linder
- Faculty of Medicine, Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, Lund, Sweden.
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21
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Luo ZR, Liao DS, Chen LW. Comparative analysis of postoperative sexual dysfunction and quality of life in type a aortic dissection patients of different ages. J Cardiothorac Surg 2021; 16:117. [PMID: 33933114 PMCID: PMC8088030 DOI: 10.1186/s13019-021-01468-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background To compare postoperative sexual dysfunction (SD) and quality of life (QOL) in Type A Aortic Dissection (AAD) Patients of Different Ages. Methods From January 2018 to December 2019, 204 AAD postoperative survivors in Union Hospital of Fujian Medical University were selected and were divided into young group (less than 50 years old) and elderly group (more than 50 years old). We evaluated SD according to the male International Erectile Dysfunction Index (IIEF-5) and female sexual function index (FSFI). The Short Form 12 Health Survey Questionnaire (SF-12) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to investigate the QOL, Quick Inventory Depressive Symptomatology-Self Report (QIDS-SR) and the Beck Depression Inventory-II (BDI-II) to investigate depressive symptoms. Results One hundred seventy-five patients completed all the questionnaire (85.8%). The total SD prevalence rate was 38.9% (68 cases), with 27.4% of the young (20 cases) and 47.1% of the elderly (48 cases). The age of non-SD and SD patients was 49.0 ± 11.5 and 56.9 ± 10.8 years, respectively (P = 0.03). Compared with non-SD patients, the total physical health of SD patients was significantly worse (P = 0.04), however, the mental health was not significantly worse (P = 0.77); the depressive symptoms did not expressed a significant difference between the SD and non-SD groups (QIDS-SR P = 0.15, BDI-II P = 0.06). Total physical health scores in the young SD group did not show significant better than elderly SD group (P = 0.24), however, total mental health scores showed significantly worse (P = 0.04), depressive symptoms scores were significantly higher (QIDS-SR P = 0.03, BDI-II P = 0.04). Conclusion The postoperative AAD SD prevalence of elderly is higher than that of young, and the total physical health of SD patients is poorer than those without SD patients. The young SD patients did not show a significant higher physical health scores than the elderly SD patients, instead, the young SD patients were more psychologically affected than the elderly SD patients, whose mental health was worse, and depression symptoms were more obvious, suggesting that the factors affecting the QOL of postoperative SD patients are related to physical factors, but the young postoperative SD patients mainly affected by psychological factors. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01468-0.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, P. R. China
| | - Dong-Shan Liao
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, P. R. China.
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, P. R. China
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22
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Rousseau AF, Prescott HC, Brett SJ, Weiss B, Azoulay E, Creteur J, Latronico N, Hough CL, Weber-Carstens S, Vincent JL, Preiser JC. Long-term outcomes after critical illness: recent insights. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:108. [PMID: 33731201 PMCID: PMC7968190 DOI: 10.1186/s13054-021-03535-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 02/08/2023]
Abstract
Intensive care survivors often experience post-intensive care sequelae, which are frequently gathered together under the term “post-intensive care syndrome” (PICS). The consequences of PICS on quality of life, health-related costs and hospital readmissions are real public health problems. In the present Viewpoint, we summarize current knowledge and gaps in our understanding of PICS and approaches to management.
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Affiliation(s)
- Anne-Françoise Rousseau
- Department of Intensive Care and Burn Center, University Hospital, University of Liège, Liège, Belgium
| | - Hallie C Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephen J Brett
- Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Elie Azoulay
- Réanimation Médicale, Hôpital St Louis, Paris, France
| | - Jacques Creteur
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicola Latronico
- Department of Anesthesiology, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.,Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium. .,Erasme University Hospital, Route de Lennik 808, Brussels, Belgium.
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23
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Reducing Severity of Posttraumatic Stress Disorder in Intensive Care Unit Survivors. Dimens Crit Care Nurs 2021; 39:298-304. [PMID: 33009267 DOI: 10.1097/dcc.0000000000000439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
When patients are in the intensive care unit (ICU), they are in their most vulnerable and fragile state. These critically ill patients are often unable to make their needs known, which can produce an overwhelming feeling of helplessness and fear. The environment can seem threatening and foreign, and patients are often subjected to a multitude of disturbances that can be detrimental to their physical and psychological recovery. Loud noises, diagnostic tests performed at all hours, and poor natural lighting contribute to debilitating delirium and disturbed diurnal rhythms. Loss of privacy and basic human dignity, as well as painful procedures, has been associated with traumatic memories and distress in the post-ICU survivor population. All of these factors have contributed to patients developing ICU-related posttraumatic stress disorder after they leave the hospital. Recently, there has been an increase in awareness regarding this phenomenon within the medical community, which has generated more literature on the topic. Evidence suggests that ICU-related posttraumatic stress disorder can be mitigated. This article proposes the implementation of interventions by critical care health care providers that focus on reducing sleep disturbances, delirium, and benzodiazepine use in ICU patients, thereby improving patient comfort and reducing the severity of posttraumatic stress disorder in ICU survivors.
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24
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Abstract
Sleep is fundamental for everyday functioning, yet it is often negatively impacted in critically ill patients by the intensive care setting. With a focus on the neurological intensive care unit (NeuroICU), this narrative review summarizes methods of measuring sleep and addresses common causes of sleep disturbance in the hospital including environmental, pharmacological, and patient-related factors. The effects of sleep deprivation on the cardiovascular, pulmonary, immune, endocrine, and neuropsychological systems are discussed, with a focus on short-term deprivation in critically ill populations. Where evidence is lacking in the literature, long-term sleep deprivation studies and the effects of sleep deprivation in healthy individuals are also referenced. Lastly, strategies for the promotion of sleep in the NeuroICU are presented.
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25
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Ullmann U. [Posttraumatic stress disorder : Risk factors, phenomenology, early recognition and management]. Unfallchirurg 2020; 124:15-20. [PMID: 33300092 DOI: 10.1007/s00113-020-00930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder is characterized by the symptom levels intrusion, avoidance and hyperarousal as a reaction to an exceptionally threatening event. It is a well-investigated and well-treatable mental condition; however, the frequently accompanying disturbances in sleep, cognition, affect and especially avoidance behavior represent substantial hurdles in the trauma surgery treatment as well in occupational reintegration. Basic knowledge about risk factors and the clinical phenomenology also enable early identification by the primary trauma surgeon or the accident insurance consultant (D-physician) and if necessary to initiate a qualified psychotraumatologically founded treatment.
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Affiliation(s)
- U Ullmann
- Abteilung Medizinische Psychologie, BG Klinikum Bergmannstrost, Merseburger Str. 165, 06112, Halle/Saale, Deutschland.
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26
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ICU Recovery Clinic Attendance, Attrition, and Patient Outcomes: The Impact of Severity of Illness, Gender, and Rurality. Crit Care Explor 2020; 2:e0206. [PMID: 33063022 PMCID: PMC7523871 DOI: 10.1097/cce.0000000000000206] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: The primary purpose is to characterize patients attending ICU recovery clinic and then describe their trajectory of cognitive and emotional health in 1 year. Design: Retrospective observational study to assess attendance, attrition, and patient outcomes. Setting: ICU Recovery Clinic. Patients: Adult patients recently admitted to ICU for sepsis or acute respiratory failure and who were referred to clinic. Interventions: None. Measurements and Main Results: Thirty-eight patients (63%) attended ICU recovery clinic with a mean age of 53.2 ± 16 years (range, 20–82 yr), 42% female and mean Sequential Organ Failure Assessment scores at an ICU admission of 9.4 ± 2.9 participated in outcomes. Twelve patients (32%) were lost to follow up and 12 patients (32%) were transferred to different providers before the end of 1 year. Sequential Organ Failure Assessment scores were negatively associated with health-related quality of life at baseline (r = –0.41; p = 0.033; n = 28) and short term (r = –0.40; p = 0.037; n = 27). Male patients had higher Sequential Organ Failure Assessment scores (mean difference = 2.4; t = 2.779; p = 0.008) and longer hospital length of stay (mean difference = 9.3; t = 2.27; p = 0.029). Female patients had higher scores on Hospital Anxiety and Depression Scale (mean difference = 7.2; t = 2.74; p = 0.01) and Impact of Events Scale-Revised (mean difference = 18.9; t = 2.74; p = 0.011) at the initial follow-up visit. Patients never attending clinic were more likely to live further away, have a tracheotomy, and spent longer time in the ICU. Conclusions: Attendance and attrition in ICU recovery clinic are related to patient factors (living in rural area) and ICU factors. Data suggest different recovery trajectories exist based on gender, severity of illness, and self-reported outcomes.
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27
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Nedergaard HK, Jensen HI, Stylsvig M, Olsen HT, Strøm T, Toft P. Effect of non-sedation on post-traumatic stress and psychological health in survivors of critical illness-A substudy of the NONSEDA randomized trial. Acta Anaesthesiol Scand 2020; 64:1136-1143. [PMID: 32470147 DOI: 10.1111/aas.13648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/23/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Critical illness can cause post-traumatic stress and impaired mental health. The NONSEDA trial was a Scandinavian multicenter RCT, assessing non-sedation versus sedation with a daily wake-up call during mechanical ventilation in critically ill adults. The aim of this substudy was to assess the effect of non-sedation on post-traumatic stress and mental health. METHODS This substudy is based on all participating patients from a single NONSEDA trial site (Kolding, Denmark). Patients were randomized to sedation or non-sedation within the first 24 hours of mechanical ventilation. Three months after ICU discharge survivors were examined by a neuropsychologist for post-traumatic stress, anxiety and depression, and filled out the SF-36 questionnaire regarding quality of life. RESULTS The two groups of survivors were similar with regard to baseline characteristics, length of admission and mechanical ventilation. Sedated patients received more propofol and midazolam. Doses of morphine and haloperidole were equal. PRIMARY OUTCOME the number of patients with post-traumatic stress disorder did not differ between groups (non-sedated: 2 patients vs sedated: 0, P = .23). SECONDARY OUTCOMES there were no differences between groups in Beck Anxiety Index (median, non-sedated: 0 vs sedated: 0, P = .62), Beck Depression Index (median, non-sedated: 7 vs sedated: 4, P = .24), SF-36 mental component score (mean, non-sedated: 46.7 vs sedated: 47.5, P = .73) or number of patients with symptoms of post-traumatic stress (8 in both groups, P = .89). CONCLUSION Levels of PTSD, anxiety and depression and quality of life regarding mental health were similar between the non-sedated and sedated group.
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Affiliation(s)
- Helene K. Nedergaard
- Department of Anesthesiology and Intensive Care Lillebaelt Hospital KoldingUniversity Hospital of Southern Denmark Kolding Denmark
- Department of Clinical Research University of Southern Denmark Odense Denmark
| | - Hanne I. Jensen
- Department of Anesthesiology and Intensive Care Lillebaelt Hospital KoldingUniversity Hospital of Southern Denmark Kolding Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | | | - Hanne T. Olsen
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Anesthesiology and Intensive Care Odense University Hospital Svendborg Denmark
| | - Thomas Strøm
- Department of Anesthesiology and Intensive Care Odense University Hospital Odense Denmark
| | - Palle Toft
- Department of Anesthesiology and Intensive Care Odense University Hospital Odense Denmark
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28
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Bulic D, Bennett M, Georgousopoulou EN, Shehabi Y, Pham T, Looi JCL, van Haren FMP. Cognitive and psychosocial outcomes of mechanically ventilated intensive care patients with and without delirium. Ann Intensive Care 2020; 10:104. [PMID: 32748298 PMCID: PMC7399009 DOI: 10.1186/s13613-020-00723-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 01/02/2023] Open
Abstract
Objective Delirium is common in intensive care patients and is associated with short- and long-term adverse outcomes. We investigated the long-term risk of cognitive impairment and post-traumatic stress disorder (PTSD) in intensive care patients with and without delirium. Methods This is a prospective cohort study in ICUs in two Australian university-affiliated hospitals. Patients were eligible if they were older than 18 years, mechanically ventilated for more than 24 h and did not meet exclusion criteria. Delirium was assessed using the Confusion Assessment Method for Intensive Care Unit. Variables assessing cognitive function and PTSD symptoms were collected at ICU discharge, after 6 and 12 months: Mini-Mental State Examination, Telephone Interview for Cognitive Status, Impact of Events Scale-Revised and Informant Questionnaire for Cognitive Decline (caregiver). Results 103 participants were included of which 36% developed delirium in ICU. Patients with delirium were sicker and had longer duration of mechanical ventilation and ICU length of stay. After 12 months, 41/60 (68.3%) evaluable patients were cognitively impaired, with 11.6% representing the presence of symptoms consistent with dementia. When evaluated by the patient’s caregiver, the patient’s cognitive function was found to be severely impaired in a larger proportion of patients (14/60, 23.3%). Delirium was associated with worse cognitive function at ICU discharge, but not with long-term cognitive function. IES-R scores, measuring PTSD symptoms, were significantly higher in patients who had delirium compared to patients without delirium. In regression analysis, delirium was independently associated with cognitive function at ICU discharge and PTSD symptoms at 12 months. Conclusions Intensive care survivors have significant rates of long-term cognitive decline and PTSD symptoms. Delirium in ICU was independently associated with short-term but not long-term cognitive function, and with long-term PTSD symptoms. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001116415, 15/8/2016 retrospectively registered, https://www.anzctr.org.au
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Affiliation(s)
- Daniella Bulic
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael Bennett
- Prince of Wales Clinical School of Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ekavi N Georgousopoulou
- Australian National University Medical School, Canberra, Australia.,Centre for Health and Medical Research, ACT Health Directorate, Canberra, Australia
| | - Yahya Shehabi
- Prince of Wales Clinical School of Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Monash Health and Monash University, Melbourne, Australia
| | - Tai Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Service de Médecine Intensive-Réanimation, APHP, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, Australia
| | - Frank M P van Haren
- Australian National University Medical School, Canberra, Australia. .,ICU, Canberra Hospital, Canberra, Australia.
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29
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A Comparison between the Effectiveness of the Combined Couple Therapy and Emotionally Focused Therapy for couples on the improvement of intimacy and PTSD. LEARNING AND MOTIVATION 2020. [DOI: 10.1016/j.lmot.2020.101637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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30
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Impact of Critical Illness on Resource Utilization: A Comparison of Use in the Year Before and After ICU Admission. Crit Care Med 2020; 47:1497-1504. [PMID: 31517693 PMCID: PMC6798747 DOI: 10.1097/ccm.0000000000003970] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Supplemental Digital Content is available in the text. Increasingly, patients admitted to an ICU survive to hospital discharge; many with ongoing medical needs. The full impact of an ICU admission on an individual’s resource utilization and survivorship trajectory in the United States is not clear. We sought to compare healthcare utilization among ICU survivors in each year surrounding an ICU admission.
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31
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Noguchi A, Hosokawa K, Amaya F, Yokota I. Factors related to memory absence and delusional memories in patients in intensive care units managed with light sedation. Intensive Crit Care Nurs 2020; 59:102830. [PMID: 32217019 DOI: 10.1016/j.iccn.2020.102830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Currently, light sedation is typically given to patients in intensive care units and studies have not extensively examined the factors related to absences or abnormalities of their memories. We, therefore, analysed the factors related to the absence/abnormalities of patients' memories in intensive care units. RESEARCH METHODOLOGY A secondary analysis of previously collected survey data examining patients' experiences in an intensive care unit was undertaken (n = 405; women = 38%; median age = 70 years). To observe absent or distorted memories, patients were interviewed after leaving the intensive care unit. We analysed key factors through content analysis of the interviews and field notes. SETTING The intensive care unit of a university hospital. MAIN OUTCOME MEASURE Patients' absent or distorted memories after leaving the intensive care unit. RESULTS Half the patients reported an absence of memories. This was associated with old age and with longer duration of mechanical ventilation. Absent or fragmentary memories were not distressing. Fragmentary and fearful intensive care unit memories were associated with being older. Delusional memories, some of which reflected actual events, were present in 3% of patients. CONCLUSION Absence of memories were not distressing, delusional memories occurred less and these memories could comprise of an event in ICU that is difficult for patients to understand.
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Affiliation(s)
- Ayako Noguchi
- Department of Nursing, University Hospital, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokouji-agaru Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Koji Hosokawa
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi Hirokouji-agaru Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
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32
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Meyers EE, McCurley J, Lester E, Jacobo M, Rosand J, Vranceanu AM. Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:321-335. [PMID: 32863700 DOI: 10.1016/j.cbpra.2020.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss "Recovering Together," a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad's experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.
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Affiliation(s)
- Emma E Meyers
- Massachusetts General Hospital and Harvard Medical School
| | | | - Ethan Lester
- Massachusetts General Hospital and Harvard Medical School
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Burns KEA, Misak C, Herridge M, Meade MO, Oczkowski S. Patient and Family Engagement in the ICU. Untapped Opportunities and Underrecognized Challenges. Am J Respir Crit Care Med 2019; 198:310-319. [PMID: 29624408 DOI: 10.1164/rccm.201710-2032ci] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The call for meaningful patient and family engagement in health care and research is gaining impetus. Healthcare institutions and research funding agencies increasingly encourage clinicians and researchers to work actively with patients and their families to advance clinical care and research. Engagement is increasingly mandated by healthcare organizations and is becoming a prerequisite for research funding. In this article, we review the rationale and the current state of patient and family engagement in patient care and research in the ICU. We identify opportunities to strengthen engagement in patient care by promoting greater patient and family involvement in care delivery and supporting their participation in shared decision-making. We also identify challenges related to patient willingness to engage, barriers to participation, participant risks, and participant expectations. To advance engagement, clinicians and researchers can develop the science behind engagement in the ICU context and demonstrate its impact on patient- and process-related outcomes. In addition, we provide practical guidance on how to engage, highlight features of successful engagement strategies, and identify areas for future research. At present, enormous opportunities remain to enhance engagement across the continuum of ICU care and research.
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Affiliation(s)
- Karen E A Burns
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and.,3 Department of Clinical Epidemiology and Biostatistics and
| | - Cheryl Misak
- 4 Department of Philosophy, University of Toronto, Toronto, Ontario, Canada; and
| | - Margaret Herridge
- 1 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,2 Interdepartmental Division of Critical Care and
| | - Maureen O Meade
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simon Oczkowski
- 3 Department of Clinical Epidemiology and Biostatistics and.,5 Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Bakhru RN, Davidson JF, Bookstaver RE, Kenes MT, Peters SP, Welborn KG, Creech OR, Morris PE, Files DC. Implementation of an ICU Recovery Clinic at a Tertiary Care Academic Center. Crit Care Explor 2019; 1:e0034. [PMID: 32166275 PMCID: PMC7063951 DOI: 10.1097/cce.0000000000000034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Post-ICU clinics may facilitate the care of survivors of critical illness, but there is a paucity of data describing post-ICU clinic implementation. We sought to describe implementation of our ICU recovery clinic, including an assessment of barriers and facilitators to clinic attendance. DESIGN Adults admitted to the medical ICU of a large tertiary care academic hospital with shock and/or respiratory failure requiring mechanical ventilation were screened for participation in a newly formed ICU recovery clinic. Participant selection and attendance rates were tracked. Reasons for nonattendance were assessed by phone call in a subset of patients. SETTING A newly formed ICU recovery clinic of a large tertiary care academic hospital. PATIENTS All patients admitted to the medical ICU were screened. INTERVENTIONS ICU recovery clinic appointments were scheduled for all eligible patients. A subset of nonattenders were called to assess reasons for nonattendance. MEASUREMENTS AND MAIN RESULTS Over 2 years, we admitted 5,510 patients to our medical ICU. Three hundred sixty-two were screened into the recovery clinic. One-hundred sixty-six were not scheduled for clinic; major reasons included discharge to hospice/death in the hospital (n = 55) and discharge to a facility (n = 50). One-hundred ninety-six patients were scheduled for a visit and of those, 101 (52%) arrived to clinic. Reasons for nonattendance in a surveyed subset of nonattenders included patient's lack of awareness of the appointment (50%, n = 9/18), financial concerns (17%, n = 3/18), and transportation difficulty (17%, n = 3/18). CONCLUSIONS ICU recovery clinics may address the needs of survivors of critical illness. Barriers to clinic attendance include high mortality rates, high rates of clinic appointment cancelations and nonattendance, and discharge to locations such as skilled nursing facilities or long-term acute care hospitals. Improved communication to patients about the role of the clinic may facilitate attendance and minimize canceled appointments.
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Affiliation(s)
- Rita N Bakhru
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, NC
- Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston-Salem, NC
| | - James F Davidson
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Rebeca E Bookstaver
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Stephen P Peters
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kristin G Welborn
- Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Oksana R Creech
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Peter E Morris
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, NC
- Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston-Salem, NC
| | - D Clark Files
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, NC
- Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston-Salem, NC
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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de Haro C, Ochagavia A, López-Aguilar J, Fernandez-Gonzalo S, Navarra-Ventura G, Magrans R, Montanyà J, Blanch L. Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities. Intensive Care Med Exp 2019; 7:43. [PMID: 31346799 PMCID: PMC6658621 DOI: 10.1186/s40635-019-0234-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mechanical ventilation is common in critically ill patients. This life-saving treatment can cause complications and is also associated with long-term sequelae. Patient-ventilator asynchronies are frequent but underdiagnosed, and they have been associated with worse outcomes. MAIN BODY Asynchronies occur when ventilator assistance does not match the patient's demand. Ventilatory overassistance or underassistance translates to different types of asynchronies with different effects on patients. Underassistance can result in an excessive load on respiratory muscles, air hunger, or lung injury due to excessive tidal volumes. Overassistance can result in lower patient inspiratory drive and can lead to reverse triggering, which can also worsen lung injury. Identifying the type of asynchrony and its causes is crucial for effective treatment. Mechanical ventilation and asynchronies can affect hemodynamics. An increase in intrathoracic pressure during ventilation modifies ventricular preload and afterload of ventricles, thereby affecting cardiac output and hemodynamic status. Ineffective efforts can decrease intrathoracic pressure, but double cycling can increase it. Thus, asynchronies can lower the predictive accuracy of some hemodynamic parameters of fluid responsiveness. New research is also exploring the psychological effects of asynchronies. Anxiety and depression are common in survivors of critical illness long after discharge. Patients on mechanical ventilation feel anxiety, fear, agony, and insecurity, which can worsen in the presence of asynchronies. Asynchronies have been associated with worse overall prognosis, but the direct causal relation between poor patient-ventilator interaction and worse outcomes has yet to be clearly demonstrated. Critical care patients generate huge volumes of data that are vastly underexploited. New monitoring systems can analyze waveforms together with other inputs, helping us to detect, analyze, and even predict asynchronies. Big data approaches promise to help us understand asynchronies better and improve their diagnosis and management. CONCLUSIONS Although our understanding of asynchronies has increased in recent years, many questions remain to be answered. Evolving concepts in asynchronies, lung crosstalk with other organs, and the difficulties of data management make more efforts necessary in this field.
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Affiliation(s)
- Candelaria de Haro
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain. .,CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
| | - Ana Ochagavia
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Josefina López-Aguilar
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | - Sol Fernandez-Gonzalo
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain.,CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillem Navarra-Ventura
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain
| | - Rudys Magrans
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lluís Blanch
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208, Sabadell, Spain.,CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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Rose L, Muttalib F, Adhikari NKJ. Psychological Consequences of Admission to the ICU: Helping Patients and Families. JAMA 2019; 322:213-215. [PMID: 31310279 DOI: 10.1001/jama.2019.9059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Louise Rose
- Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Muttalib
- Center for Global Child Health, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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McCurley JL, Funes CJ, Zale EL, Lin A, Jacobo M, Jacobs JM, Salgueiro D, Tehan T, Rosand J, Vranceanu AM. Preventing Chronic Emotional Distress in Stroke Survivors and Their Informal Caregivers. Neurocrit Care 2019; 30:581-589. [PMID: 30421266 PMCID: PMC6958510 DOI: 10.1007/s12028-018-0641-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Chronic emotional distress (e.g., depression, anxiety, post-traumatic stress) is common after stroke and interdependent between patients and their informal caregivers. We measured stroke survivors', caregivers', and neurocritical care nurses' views of primary drivers of distress during the stroke experience, and needs and preferences for the structure, topics, mode of delivery, and timing of an intervention to promote emotional recovery. METHODS We conducted semi-structured interviews with 24 patient-caregiver dyads within the Neuroscience Intensive Care Unit (Neuro-ICU). Additionally, we conducted two focus groups with 15 nurses. Interviews and focus groups were audio-recorded, transcribed, and coded using NVivo 11 (QSR International) software. RESULTS AND CONCLUSIONS The challenges and impacts of stroke most commonly reported by dyads were: uncertainty about future health, fear of recurrent strokes, negative emotions, and role changes post-stroke. Dyads and nurses agreed that resiliency skills such as mindfulness/focusing on the present, problem solving, gratitude/optimism, self-care, interpersonal communication and developing a supportive team of family, friends, and medical staff are beneficial to optimize recovery. The potential barrier to intervention delivery was accessibility, due to challenges of time and travel to appointments. Participants agreed that starting the intervention at hospitalization and continuing via live video after discharge is an ideal delivery modality. Stroke survivors, caregivers, and Neuro-ICU nurses believe that a resiliency skills-based intervention to prevent chronic emotional distress is necessary and urgent. This qualitative study provides valuable information on the challenges faced by dyads, intervention topics to prioritize, and strategies to maximize feasibility, acceptability, and effect.
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Affiliation(s)
- Jessica L McCurley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Christopher J Funes
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - Emily L Zale
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ann Lin
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
| | - Michelle Jacobo
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Jamie M Jacobs
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Danielle Salgueiro
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, One Bowdoin Square, 1st Floor, Boston, MA, 02114, USA.
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA.
- Neuroscience Intensive Care Unit, Massachusetts General Hospital/Harvard Medical School, Boston, USA.
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The Relationships Among Symptom Distress, Posttraumatic Stress Symptoms, and Depression in Patients With Female-specific Cancers. Cancer Nurs 2019; 41:181-188. [PMID: 28151832 DOI: 10.1097/ncc.0000000000000479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Previous studies have demonstrated that posttraumatic stress symptoms (PTSS) affect women with breast cancer. However, few studies have explored the relationships among PTSS, symptom distress, and depression in association with cancers specific to women in Taiwan. OBJECTIVE The aim of this study was to explore the relationships among symptom distress, PTSS, and depression in women given a diagnosis of female-specific cancers. METHODS A cross-sectional design was used, and 220 women given a diagnosis of female-specific cancer were recruited from a general hospital in southern Taiwan. The outcome measures included the subjects' scores on a symptom distress scale, the Chinese Davidson Trauma Scale, and the Center for Epidemiologic Studies-Depressive Scale; their personal characteristics; and disease-related variables. RESULTS There were significant positive relationships among the frequency of PTSS, the severity of PTSS, symptom distress, and depressive symptoms. Logistic regression analysis demonstrated that educational level, symptom distress, and the frequency of PTSS were significant predictors of depression. CONCLUSIONS The study demonstrated a high prevalence of depression in women with female-specific cancer, and the results confirm the relationship between PTSS and depression. In addition, educational level and physical distress were also found to be predictors of depression. IMPLICATIONS FOR PRACTICE Screening for depressive symptoms should be a component of routine screening in women with female-specific cancer. Oncology nurses should be aware of the distress symptoms experienced by these women and recognize PTSS in patients who are given a diagnosis of female-specific cancer. Awareness will reduce the multiple risks of posttraumatic stress disorder and depression and decrease the depressive symptoms of women after surviving cancer.
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Kalfon P, Alessandrini M, Boucekine M, Renoult S, Geantot MA, Deparis-Dusautois S, Berric A, Collange O, Floccard B, Mimoz O, Julien A, Robert R, Audibert J, Renault A, Follin A, Thevenin D, Revel N, Venot M, Patrigeon RG, Signouret T, Fromentin M, Sharshar T, Vigne C, Pottecher J, Levrat Q, Sossou A, Garrouste-Orgeas M, Quenot JP, Boulle C, Azoulay E, Baumstarck K, Auquier P. Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year. Intensive Care Med 2019; 45:223-235. [PMID: 30701294 DOI: 10.1007/s00134-018-05511-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors. METHODS This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1 year was assessed based on the Impact of Event Scale-Revised (IES-R). RESULTS Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1 year (p = 0.015). CONCLUSIONS Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1 year. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02762409.
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Affiliation(s)
- Pierre Kalfon
- Réanimation Polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, 28018, Le Coudray, France. .,Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France.
| | - Marine Alessandrini
- Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
| | - Mohamed Boucekine
- Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
| | | | | | | | - Audrey Berric
- Réanimation polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne sur mer, Toulon, France
| | - Olivier Collange
- Réanimation chirurgicale polyvalente, Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Bernard Floccard
- Réanimation polyvalente, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Olivier Mimoz
- Réanimation chirurgicale, CHU La Milétrie, Poitiers, France
| | - Amour Julien
- Réanimation de chirurgie cardiaque, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - René Robert
- Réanimation médicale, CHU La Milétrie, Poitiers, France
| | - Juliette Audibert
- Réanimation Polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, 28018, Le Coudray, France
| | | | - Arnaud Follin
- Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | | | - Nathalie Revel
- Réanimation Médico-Chirurgicale, Hôpital Pasteur, CHU Nice, Nice, France
| | - Marion Venot
- Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Tarek Sharshar
- Réanimation médicale adulte, CHU Raymond Poincaré, AP-HP, Paris, France
| | - Coralie Vigne
- Réanimation chirurgicale, CHU Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Julien Pottecher
- Réanimation chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France
| | - Quentin Levrat
- Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France
| | | | | | | | | | - Elie Azoulay
- Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France
| | - Karine Baumstarck
- Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
| | - Pascal Auquier
- Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France
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Azimian J, Assar O, Javadi A, Froughi Z. Effect of Using Eye Masks and Earplugs on the Risk of Post-traumatic Stress Disorder Development in Patients Admitted to Cardiac Surgery Intensive Care Units. Indian J Crit Care Med 2019; 23:31-34. [PMID: 31065206 PMCID: PMC6481258 DOI: 10.5005/jp-journals-10071-23109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Context Critically ill patients are at risk of post-traumatic stress disorder development. Aim The purpose of this study was to investigate the effect of using eye masks and earplugs on the risk of post-traumatic stress disorder development in patients admitted to cardiac surgery intensive care units. Settings and design This is a clinical trial that conducted in intensive care units in Iran. Materials and methods Sample of the present clinical trial consisted of 68 patients undergoing open-heart cardiac surgery that were randomly assigned to two groups. Patients in the control group received the usual care, and patients in the intervention group used eye masks and earplugs during sleep. The risk of post-traumatic stress disorder development before surgery and 2 months after discharge from the intensive care unit was assessed using the impact of event scale-revised. Statistical analysis Statistical analysis: Data were analyzed using paired t-test and independent t-test in Statistical Package for Social Sciences (SPSS) version 24 software. Results Patients in the two groups were similar in terms of demographic characteristics. The mean of the total scores of patients in the control and intervention group before surgery was 10.41 ± 5.25 and 10.71 ± 5.10, respectively (p = 0.82). The mean of the total scores of patients in the control and intervention group 2 months after discharge was 29.50 ± 5.90 and 11.72 ± 6.48, respectively (p <0.001). Conclusion The use of eye masks and earplugs significantly reduces the risk of post-traumatic stress disorder (PTSD) development in patients undergoing open-heart cardiac surgery. How to cite this article Azimian J, Assar O, Javadi A, Froughi Z. Effect of Using Eye Masks and Earplugs on the Risk of Posttraumatic Stress Disorder Development in Patients Admitted to Cardiac Surgery Intensive Care Units. Indian Journal of Critical Care Medicine, January 2019;23(1):31-34.
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Affiliation(s)
- Jalil Azimian
- Department of Critical Care Nursing, School of Nursing and Midwifery, Qazvin University of Medical Science, Qazvin, Iran
| | - Omid Assar
- Open-heart cardiac surgery intensive care unit, Shahid Rajaee Hospital, Alborz University of Medical Science, Karaj, Iran
| | - Amir Javadi
- Social Medicine Department, Medicine Faculty, Qazvin University of Medical Science, Qazvin, Iran
| | - Zohreh Froughi
- Student Research Committee, Qazvin University of Medical Science, Qazvin, Iran
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Wintermann GB, Rosendahl J, Weidner K, Strauß B, Petrowski K. Predictors of Major Depressive Disorder following Intensive Care of Chronically Critically Ill Patients. Crit Care Res Pract 2018; 2018:1586736. [PMID: 30155292 PMCID: PMC6093074 DOI: 10.1155/2018/1586736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 06/05/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) is a common condition following treatment in the Intensive Care Unit (ICU). Long-term data on MDD in chronically critically ill (CCI) patients are scarce. Hence, the primary aim of the present study was to investigate the frequency and predictors of MDD after intensive care of CCI patients. MATERIALS AND METHODS In a prospective cohort study, patients with long-term mechanical ventilation requirements (n=131) were assessed with respect to a diagnosis of MDD, using the Structured Clinical Interview for DSM-IV, three and six months after the transfer from acute ICU to post-acute ICU. Sociodemographic, psychological, and clinical risk factors with p values ≤ 0.1 were identified in a univariate logistic regression analysis and entered in a multivariable logistic regression model. A mediator analysis was run using the bootstrapping method, testing the mediating effect of perceived helplessness during the ICU stay, between the recalled traumatic experience from the ICU and a post-ICU MDD. RESULTS 17.6% (n=23) of the patients showed a full- or subsyndromal MDD. Perceived helplessness, recalled experiences of a traumatic event from the ICU, symptoms of acute stress disorder, and the diagnosis of posttraumatic stress disorder (PTSD) after ICU could be identified as significant predictors of MDD. In a mediator analysis, perceived helplessness could be proved as a mediator. CONCLUSIONS Every fifth CCI patient suffers from MDD up to six months after being discharged from ICU. Particularly, perceived helplessness during the ICU stay seems to mainly affect the long-term evolvement of MDD. CCI patients with symptoms of acute stress disorder/PTSD should also be screened for MDD.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jenny Rosendahl
- Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Katja Petrowski
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Institute of Medical Psychology and Medical Sociology, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Nydahl P, Fischill M, Deffner T, Neudeck V, Heindl P. [Diaries for intensive care unit patients reduce the risk for psychological sequelae : Systematic literature review and meta-analysis]. Med Klin Intensivmed Notfmed 2018; 114:68-76. [PMID: 29995235 DOI: 10.1007/s00063-018-0456-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications. METHODS The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment. RESULTS The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24-1.42, p = 0.23), and (b) for relatives' PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08-0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07-0.77, p = 0.02; OR 0.27, 95%CI: 0.09-0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%. CONCLUSION ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.
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Affiliation(s)
- P Nydahl
- Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland. .,Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland.
| | | | - T Deffner
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | | | - P Heindl
- Internistischer Intensivbehandlungsbereich, Notfallmedizin und Intensivbehandlung für Brandverletzte, Allgemeines Krankenhaus der Stadt Wien, Medizinischer Universitätscampus, Wien, Österreich
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Sommer JL, Mota N, Edmondson D, El-Gabalawy R. Comorbidity in illness-induced posttraumatic stress disorder versus posttraumatic stress disorder due to external events in a nationally representative study. Gen Hosp Psychiatry 2018; 53:88-94. [PMID: 29776731 DOI: 10.1016/j.genhosppsych.2018.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/03/2018] [Accepted: 02/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The current study compared physical and mental health characteristics and quality of life of illness-induced posttraumatic stress disorder (PTSD) versus those with PTSD due to external traumatic events in a population-based sample. METHOD PTSD was assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5) using DSM-5 criteria in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Participants with past-year PTSD (n = 1779) were categorized into two groups: illness-induced (6.5%) and other trauma-induced PTSD (92.9%) based on index trauma. Group differences in physical health, mental health, and quality of life were estimated using multiple logistic and linear regressions with adjustment for demographics and medical morbidity. RESULTS Compared to PTSD due to external events, illness-induced PTSD had higher rates of life-threatening illness in the past year. Illness-induced PTSD compared to PTSD due to external events was associated with reduced odds of depressive/bipolar disorders and antisocial personality disorder, but increased odds of cannabis use disorder. The groups did not differ on quality of life after accounting for medical morbidity. CONCLUSION Illness-induced PTSD is common among American adults and has a similar impact on quality of life as PTSD due to external events, but may have distinct mental health correlates.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, United States; Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, United States
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, United States; Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
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Abstract
RATIONALE Poor functional status is common after critical illness, and can adversely impact the abilities of intensive care unit (ICU) survivors to live independently. Instrumental activities of daily living (IADL), which encompass complex tasks necessary for independent living, are a particularly important component of post-ICU functional outcome. OBJECTIVES To conduct a systematic review of studies evaluating IADLs in survivors of critical illness. METHODS We searched PubMed, CINAHL, Cochrane Library, SCOPUS, and Web of Science for all relevant English-language studies published through December 31, 2016. Additional articles were identified from personal files and reference lists of eligible studies. Two trained researchers independently reviewed titles and abstracts, and potentially eligible full text studies. Eligible studies included those enrolling adult ICU survivors with IADL assessments, using a validated instrument. We excluded studies involving specific ICU patient populations, specialty ICUs, those enrolling fewer than 10 patients, and those that were not peer-reviewed. Variables related to IADLs were reported using the Patient Reported Outcomes Measurement Information System (PROMIS). RESULTS Thirty of 991 articles from our literature search met inclusion criteria, and 23 additional articles were identified from review of reference lists and personal files. Sixteen studies (30%) published between 1999 and 2016 met eligibility criteria and were included in the review. Study definitions of impairment in IADLs were highly variable, as were reported rates of pre-ICU IADL dependencies (7-85% of patients). Eleven studies (69%) found that survivors of critical illness had new or worsening IADL dependencies. In three of four longitudinal studies, survivors with IADL dependencies decreased over the follow-up period. Across multiple studies, no risk factors were consistently associated with IADL dependency. CONCLUSIONS Survivors of critical illness commonly experience new or worsening IADL dependency that may improve over time. As part of ongoing efforts to understand and improve functional status in ICU survivors, future research must focus on risk factors for IADL dependencies and interventions to improve these cognitive and physical dependencies after critical illness.
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Oliveira HSBD, Fumis RRL. Sex and spouse conditions influence symptoms of anxiety, depression, and posttraumatic stress disorder in both patients admitted to intensive care units and their spouses. Rev Bras Ter Intensiva 2018; 30:35-41. [PMID: 29742213 PMCID: PMC5885229 DOI: 10.5935/0103-507x.20180004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/24/2017] [Indexed: 11/28/2022] Open
Abstract
Objectives To assess the effect of sex and spouse condition on symptoms of anxiety,
depression and posttraumatic stress symptoms in patients and their
spouses. Methods A prospective study conducted in a 22-bed adult mixed intensive care unit in
a tertiary hospital in São Paulo, Brazil. Patients and their spouses
were enrolled 2 days after intensive care unit admission. They were
interviewed while in the intensive care unit using the Hospital Anxiety and
Depression Scale. At 30 and 90 days after intensive care unit discharge,
they completed the Impact of Event Scale and Hospital Anxiety and Depression
Scale by phone. Results From March 2011 to March 2013, we analyzed 118 patients and their spouses. We
observed that female sex was associated with higher scores than male sex was
in terms of the anxiety Hospital Anxiety and Depression Scale - subscale (p
= 0.032) and depression (p = 0.034). There was no association between sex
and posttraumatic stress disorder symptoms. However, spouses had higher
Impact of Event Scale points compared with patients (p = 0.001). Conclusions Female sex was associated with anxiety and depression, and spouses were more
vulnerable to post-traumatic stress symptoms than the patients were.
Increasing age and a later time of assessment were also associated with
lower scores on the Impact of Event Scale.
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Adam U, Habazettl H, Graefe K, Kuppe H, Wundram M, Kurz SD. Health-related quality of life of patients after surgery for acute Type A aortic dissection. Interact Cardiovasc Thorac Surg 2018; 27:48-53. [DOI: 10.1093/icvts/ivy036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/21/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Uyanga Adam
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Helmut Habazettl
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katharina Graefe
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Hermann Kuppe
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Maximilian Wundram
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stephan Dominik Kurz
- Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Institute of Physiology, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Song JY, Jeong KS, Choi KS, Kim MG, Ahn YS. Psychological Risk Factors for Posttraumatic Stress Disorder in Workers After Toxic Chemical Spill in Gumi, South Korea. Workplace Health Saf 2018; 66:393-402. [PMID: 29436290 DOI: 10.1177/2165079917750168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The extent and severity of the psychological effects following chemical release disasters have not been widely reported. The aim of this study was to examine the prevalence of hydrogen fluoride (HF)-related posttraumatic stress disorder (PTSD) and to identify associated psychological risk factors. On September 2012, an estimated 8 to 12 tons of HF gas, which dissolves in air moisture to form droplets of corrosive hydrofluoric acid, escaped from an industrial complex in Gumi, South Korea. Ten months later, structured questionnaires that included items from the Impacts of Event Scale (revised Korean version) as well as questions about demographic and psychological risk factors related to PTSD were distributed to workers in the affected area. The prevalence rate of PTSD was 5.7%. The odds of PTSD in non-alcohol-dependent workers (odds ratio [OR] = 3.10, 95% confidence interval [CI] = [1.27, 7.60]) was significantly higher than in alcohol-independent workers. The OR for PTSD in workers with anxiety (OR = 7.63, 95% CI = [2.10, 27.71) was significantly higher than the OR workers without anxiety. The odds of PTSD in workers with high perceived stress scale (PSS) scores (OR = 8.72, 95 % CI = [2.29, 33.16]) was significantly higher than for workers with low PSS. Alcohol dependence, psychiatric symptoms at the time of the event, anxiety, and high PSS were associated with HF-related PTSD. Long-term employee assistance programs are needed to assist occupational health nurses and clinicians to reduce PTSD after industrial disasters.
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Bakhru RN, Davidson JF, Bookstaver RE, Kenes MT, Welborn KG, Morris PE, Clark Files D. Physical function impairment in survivors of critical illness in an ICU Recovery Clinic. J Crit Care 2018; 45:163-169. [PMID: 29494941 DOI: 10.1016/j.jcrc.2018.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The aims were to 1) determine feasibility of measuring physical function in our ICU Recovery Clinic (RC), 2) determine if physical function was associated with 6-month re-hospitalization and 1-year mortality and 3) compare ICU survivors' physical function to other comorbid populations. MATERIALS AND METHODS We established the Wake Forest ICU RC. Patients were seen in clinic 1month following hospital discharge. Testing included the Short Form-36 questionnaire and Short Physical Performance Battery (SPPB). We related these measures to 6month re-hospitalizations and 1year mortality, and compared patients' functional performance with other comorbid populations. RESULTS Thirty-six patients were seen in clinic from July 2014 to June 2015; the median SPPB score was 5 (IQR 5). The median SF-36 physical component summary score was 21.8 (IQR 28.8). Mortality was 14% at 1year. Of those who did not die by 1year, 35% were readmitted to our hospital within 6months of hospital discharge. SPPB scores demonstrated a non-significant trend with both mortality (p=0.06) and readmissions (p=0.09). ICU survivors' SPPB scores were significantly lower than those of other chronically ill populations (p<0.001). CONCLUSIONS Physical function measurement in a recovery clinic is feasible and may inform subsequent morbidity and mortality.
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Affiliation(s)
- Rita N Bakhru
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA; Critical Illness Injury and Recovery Research Center, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - James F Davidson
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Rebecca E Bookstaver
- Department of Pharmacy, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Michael T Kenes
- Department of Pharmacy, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Kristin G Welborn
- Department of Pharmacy, Wake Forest Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Peter E Morris
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, 740 S. Limestone, Lexington, KY 40536, USA.
| | - D Clark Files
- Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy, and Immunology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA; Critical Illness Injury and Recovery Research Center, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA; Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Shiban E, Lehmberg J, Hoffmann U, Thiel J, Probst T, Friedl M, Mühlberger A, Meyer B, Shiban Y. Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery. Eur J Psychotraumatol 2018; 9:1423824. [PMID: 29410774 PMCID: PMC5795762 DOI: 10.1080/20008198.2018.1423824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/17/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Growing evidence shows the significance of illness and surgical procedures as traumatizing stressors. Risk factors are widely investigated in various settings and samples, using numerous measures of posttraumatic stress and posttraumatic stress disorder (PTSD). While pretrauma psychological distress is acknowledged as an influential factor, peritraumatic experiences are controversially still being discussed as relevant to the development of PTSD. Objective: In a group of patients consecutively undergoing elective spine surgery (N = 89) in a German hospital, this longitudinal study addressed the question of how pretrauma PTSD symptoms and peritrauma distress interact with one another in regard to the amount of posttrauma symptoms of PTSD. Methods: Pre- and posttrauma symptoms of PTSD as well as peritrauma distress were assessed through questionnaires one week before, one week after or three months after surgery. Results: Even though all three variables showed significant correlations with one another, mediation analysis revealed that peritrauma distress fully mediated the relationship between pre- and posttrauma PTSD symptoms. Conclusions: These results add new insights to the controversial discussion on the role peritraumatic experiences play in the development of PTSD, especially in medical settings.
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Affiliation(s)
- Ehab Shiban
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Ute Hoffmann
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Jeff Thiel
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Margret Friedl
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
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Abstract
The main aim of this study was to investigate factors associated with a delayed-onset posttraumatic stress disorder (PTSD) after the intensive care unit (ICU) treatment of patients with a chronic critical illness (CCI). Patients (n = 97) with critical illness polyneuropathy or critical illness myopathy were interviewed via the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. The diagnosis of the acute stress disorder was assessed within 1 month (t1), the diagnosis of PTSD at 3 (t2) and 6 (t3) months after transfer from the acute care ICU to the post-acute ICU. Patients showing a delayed-onset or persistent course of PTSD were subsumed in one group; 24.7% (n = 24) showed a delayed-onset PTSD. Significant risk factors were as follows: the severity of the medical illness, the perceived fear of dying at the ICU, the number of traumatic memories from the ICU, and the presence of a coronary heart disease. Every fourth patient with CCI showed a delayed-onset PTSD up to 6 months after the ICU treatment. Markers for a delayed-onset PTSD should already be assessed at the time of discharge from the ICU.
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