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Rossi AA, Panzeri A, Fernandez I, Invernizzi R, Taccini F, Mannarini S. The impact of trauma core dimensions on anxiety and depression: a latent regression model through the Post-Traumatic Symptom Questionnaire (PTSQ). Sci Rep 2024; 14:23036. [PMID: 39362897 PMCID: PMC11449904 DOI: 10.1038/s41598-024-72274-6] [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: 05/05/2024] [Accepted: 09/05/2024] [Indexed: 10/05/2024] Open
Abstract
Adverse life events (e.g., severe accidents, violence/abuse, organic disorders) can elicit traumatic responses characterized by intrusive thoughts, hyperarousal, and avoidance-highlighting the need for sound assessment tools. Also, these traumatic components could heighten anxiety and depression symptoms. This study aims included to: (1) assessing the psychometric properties of the Post-Traumatic Symptom Questionnaire (PTSQ) and delineating clinical cut-offs; (2) investigating how distinct trauma components contribute to anxiety and depression symptoms. Involving 761 participants who experienced a traumatic event, Part I tested the PTSQ psychometric properties, defining clinical cut-offs. Part II tested the impact of traumatic components on anxiety and depression symptoms, using a multiple multivariate latent regression model. PTSQ exhibited exemplary fit indices and robust psychometric properties. Clinically relevant cut-offs were identified. The differential contributions of intrusion, avoidance, and hyperarousal to anxiety and depression symptoms were evaluated, elucidating the strength and nature of these relationships. This study reaffirms the PTSQ as a psychometrically sound and reliable instrument. It underscores the effects of intrusion, avoidance, and hyperarousal on anxiety and depression symptoms in individuals with traumatic experiences. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with trauma components, fostering adaptation and supporting psychological health.
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Affiliation(s)
- Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy.
- Center for Intervention and Research on Family studies - CIRF, Department FISPPA, University of Padova, Padua, Italy.
| | - Anna Panzeri
- Department of General Psychology, University of Padova, Padua, Italy
| | | | - Roberta Invernizzi
- Child Neurology and Psychiatry Unit, ASST Lecco, Lecco, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Federica Taccini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
- Center for Intervention and Research on Family studies - CIRF, Department FISPPA, University of Padova, Padua, Italy
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padua, Italy
- Center for Intervention and Research on Family studies - CIRF, Department FISPPA, University of Padova, Padua, Italy
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Ibounig T, Sanders S, Haas R, Jones M, Järvinen TL, Taimela S, Docking S, Rämö L, Buchbinder R. Systematic Review of Shoulder Imaging Abnormalities in Asymptomatic Adult Shoulders (SCRUTINY): Abnormalities of the glenohumeral joint. Osteoarthritis Cartilage 2024; 32:1184-1196. [PMID: 38876437 DOI: 10.1016/j.joca.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE The primary objective was to determine the population prevalence of glenohumeral joint imaging abnormalities in asymptomatic adults. METHOD We systematically reviewed studies reporting the prevalence of X-ray, ultrasound (US), computed tomography, and magnetic resonance imaging (MRI) abnormalities in adults without shoulder symptoms (PROSPERO registration number CRD42018090041). This report presents the glenohumeral joint imaging findings. We searched Ovid MEDLINE, Embase, CINAHL and Web of Science from inception to June 2023 and assessed risk of bias using a tool designed for prevalence studies. The primary analysis was planned for the general population. The certainty of evidence was assessed using a modified Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) for prognostic studies. RESULTS Thirty-five studies (4 X-ray, 10 US, 20 MRI, 1 X-ray and MRI) reported useable prevalence data. Two studies were population-based (846 shoulders), 15 studies included miscellaneous study populations (1715 shoulders) and 18 included athletes (727 shoulders). All were judged to be at high risk of bias. Clinical diversity precluded pooling. Population prevalence of glenohumeral osteoarthritis ranged from 15% to 75% (2 studies, 846 shoulders, 1 X-ray, 1 X-ray and MRI; low certainty evidence). Prevalence of labral abnormalities, humeral head cysts and long head of biceps tendon abnormalities were 20%, 5%, 30% respectively (1 study, 20 shoulders, X-ray and MRI; very low certainty evidence). CONCLUSION The population-based prevalence of glenohumeral joint imaging abnormalities in asymptomatic individuals remains uncertain, but may range between 30% and 75%. Better estimates are needed to inform best evidence-based management of people with shoulder pain.
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Affiliation(s)
- Thomas Ibounig
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland.
| | - Sharon Sanders
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Romi Haas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Teppo Ln Järvinen
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Simo Taimela
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Sean Docking
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lasse Rämö
- Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland; Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Rhodes A, Wilson C, Zelenkov D, Adams K, Poyant JO, Han X, Faugno A, Montalvo C. "The Psychiatric Domain of Post-Intensive Care Syndrome: A Review for the Intensivist". J Intensive Care Med 2024:8850666241275582. [PMID: 39169853 DOI: 10.1177/08850666241275582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Post-intensive care syndrome (PICS) is a clinical syndrome characterized by new or worsening changes in mental health, cognition, or physical function that persist following critical illness. The psychiatric domain of PICS encompasses new or worsened psychiatric burdens following critical illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Many of the established predisposing and precipitating factors for the psychiatric domain of PICS are commonly found in the setting of critical illness, including mechanical ventilation (MV), exposure to sedating medications, and physical restraint. Importantly, previous psychiatric history is a strong risk factor for the development of the psychiatric domain of PICS and should be considered when screening patients to diagnose psychiatric impairment and interventions. Delirium has been associated with psychiatric symptoms following ICU admission, therefore prevention warrants careful consideration. Dexmedetomidine has been shown to have the lowest risk for development of delirium when compared to other sedatives and has been the only sedative studied in relation to the psychiatric domain of PICS. Nocturnal dexmedetomidine and intensive care unit (ICU) diaries have been associated with decreased psychiatric burden after ICU discharge. Studies evaluating the impact of other intra-ICU practices on the development of the psychiatric domain of PICS, including the ABCDEF bundle, depth of sedation, and daily spontaneous awakening trials, have been limited and inconclusive. The psychiatric domain of PICS is difficult to treat and may be less responsive to multidisciplinary post-discharge programs and targeted interventions than the cognitive and physical domains of PICS. Given the high morbidity associated with the psychiatric domain of PICS, intensivists should familiarize themselves with the risk factors and intra-ICU interventions that can mitigate this important and under-recognized condition.
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Affiliation(s)
- Allison Rhodes
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | | | | | - Kathryne Adams
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | | | - Xuan Han
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | - Anthony Faugno
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
| | - Cristina Montalvo
- Tufts Medical Center, Boston, MA, USA
- Tufts University School of Medicine, Boston, MA
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Phillips K, Callaghan BL, Webb A, Kan J, Ooi CY, Kasparian NA. MEDIC: Development and validation of a new instrument to assess emotional reactivity to medical stimuli in a representative community sample of adults. J Psychiatr Res 2024; 176:265-275. [PMID: 38901391 DOI: 10.1016/j.jpsychires.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
To support investigation of the etiology and psychophysiology of medical traumatic stress, we developed a standardized set of emotionally-salient medical images, called the 'MEDical Image Collection' (MEDIC), for use in neuroimaging or psychological research. This study aimed to establish internal consistency, test re-test reliability, and congruent validity of the image set. A representative sample of 300 adults in the United States were recruited via research recruitment platform, Prolific. Participants rated 124 images depicting medical stimuli on one of two dimensions: emotional arousal (i.e., how strongly an evoked emotion is felt) or affective valence (i.e., how positive or negative the evoked emotion is). Sociodemographic and health-related characteristics, including experiences during the COVID-19 pandemic, were also assessed. To assess test re-test reliability, a subset (n = 200) rated the images on the same dimension a second time, 3 months later. The MEDIC image set was found to: (a) elicit a range of emotional arousal and valence ratings, (b) have excellent inter-rater reliability, (c) moderate test-retest reliability, and (d) good face validity. Results indicate the new MEDIC 124-image set is a reliable and valid instrument, enabling researchers to provide context-specific and emotionally-salient stimuli to individuals when studying affective responses in relation to health and medicine.
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Affiliation(s)
- Katelyn Phillips
- School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, University of New South Wales (UNSW Sydney). UNSW Sydney, High St, Kensington, NSW, 2052, Australia
| | - Bridget L Callaghan
- Department of Psychology, University of California Los Angeles, 1285 Psychology Building Box, Los Angeles, CA, 951563, USA
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Health and Medicine, The University of Sydney, Sydney, 88 Mallett St, Camperdown, NSW, 2050, Australia
| | - Janice Kan
- School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Private Bag 30, Hobart, TAS, 7001, Australia
| | - Chee Y Ooi
- School of Clinical Medicine, Discipline of Paediatrics & Child Health, UNSW Medicine and Health, University of New South Wales (UNSW Sydney). UNSW Sydney, High St, Kensington, NSW, 2052, Australia; Department of Gastroenterology, Sydney Children's Hospital, Randwick, Australia; Sydney Children's Hospital, High St, Randwick, NSW, 2031, Australia
| | - Nadine A Kasparian
- Heart and Mind Wellbeing Center, Heart Institute and the Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Clarke R, Weare V, Chow H, Bowering-Sheehan L, Hitchcock C. "It saved me": A thematic analysis of experiences of psychological therapy following critical illness and intensive care. J Intensive Care Soc 2024; 25:288-295. [PMID: 39224428 PMCID: PMC11366185 DOI: 10.1177/17511437241241243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Background ICU-survivors are likely to struggle with psychological wellbeing. Providing post-ICU therapeutic interventions is a relatively novel field and little is known about patients' experiences. Methods Thematic analysis was used to analyze semi-structured interviews with 20 ICU-survivors who had accessed psychological therapy following discharge from an ICU in the Southwest of Britain. Descriptive statistics were used to summarize data to provide service related contextual information. Results Five themes emerged from the data: the impact of critical illness, value of therapy, accessing therapy, process of therapy and role of psychologist. Psychological therapy is viewed as an important part of recovery. Critical illness is a complex experience. Therapy supported sense-making, acceptance and moving forwards. Although therapy could be initially difficult, there were lasting positive effects. There were different challenges to and facilitators of accessing therapy and offering ongoing support provided reassurance. A safe therapeutic relationship and an ICU-specific service was important. Conclusion Psychological therapy, alongside other rehabilitation interventions, can facilitate recovery. Considerations for local and wider service development are discussed.
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Affiliation(s)
- Rachel Clarke
- Critical Care, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Victoria Weare
- Critical Care, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Homen Chow
- Critical Care, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Lydia Bowering-Sheehan
- Critical Care, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Clark Hitchcock
- Critical Care, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK
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Bates A, Baldwin DS, Pattison N, Moyses H, Huneke NT, Cortese S, Grocott MP, Cusack R. Eye movement desensitisation and reprocessing for survivors of life-threatening medical events. Cochrane Database Syst Rev 2024; 7:CD015640. [PMID: 39041417 PMCID: PMC11264321 DOI: 10.1002/14651858.cd015640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of eye movement desensitisation and reprocessing (EMDR), a psychological intervention programme, on symptoms related to traumatic stress in survivors of life-threatening medical events. SECONDARY OBJECTIVES to evaluate whether the effects of EMDR differ according to the nature of the medical event (associated diagnosis or setting), measured outcome (post-traumatic stress disorder (PTSD), anxiety, depression, or quality of life), or intervention (online, face-to-face, group or individual sessions).
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Affiliation(s)
- Andrew Bates
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
- East and North Herts NHS Trust, Stevenage, UK
| | - Helen Moyses
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Nathan Tm Huneke
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
- Dorset Healthcare University NHS Foundation Trust, Bournemouth, UK
| | - Samuele Cortese
- School of Psychology, Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Michael Pw Grocott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative and Critical Care Research Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Rebecca Cusack
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Perioperative Medicine and Critical Care Research Theme, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Haug V, Tapking C, Panayi AC, Veeramani A, Knoedler S, Tchiloemba B, Abdulrazzak O, Kadakia N, Bonaventura B, Culnan D, Kneser U, Hundeshagen G. Outcome comparison of the most commonly employed wound coverage techniques in patients with massive burns ≥50% TBSA - A systematic review and meta-analysis. Burns 2024:S0305-4179(24)00210-9. [PMID: 39322501 DOI: 10.1016/j.burns.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 09/27/2024]
Abstract
INTRODUCTION Early wound coverage is one of the most essential factors influencing the survival of extensively burned patients, especially those with a total body surface area (TBSA) burned greater than 50 %. In patients with limited donor sites available for autografting, techniques such as the Meek micrograft procedure or cultured epidermal allografts (CEA) have proven to be viable alternatives. In this systematic review and meta-analysis, we analyzed the outcomes of different wound coverage techniques in patients with massive burn injuries ≥ 50 % TBSA in the past 17 years. METHODS The EMBASE, PUBMED, Google Scholar and MEDLINE databases were searched from inception to December 2022 for studies investigating major burn reconstruction (>50 % TBSA) with the use of one of: a) autografts, b) allografts, c) cell-based therapies, and d) Meek micrografting. The review was conducted in accordance with the PRISMA guidelines. The outcomes evaluated were mortality, length of hospital stay, graft take and number of operations performed. RESULTS Following a two-stage review process, 30 studies with 1369 patients were identified for analysis. Methods of coverage comprised the original autografting, and the newer Meek micrografting, CEA autografting, and allografting. Pooled mean age of the entire cohort was 32.5 years ( ± SE 3.6) with mean burn size of 66.1 % ( ± 2.5). After pooling the data, advantages in terms of mortality rate, length of stay, graft take and number of required surgeries were seen for the Meek and CEA groups. Mortality was highest in patients treated with autografts (50 %) and lowest with cell-based therapy (11 %). Length of stay was longest with cell-based therapy (91 ± 16 days) and shortest with Meek micrografting (50 ± 24 days). Graft take was highest with autografts (96 ± 2 %) and lowest with cell-based therapy (72 ± 9 %). Average number of operations was highest with cell-based therapy (9 ± 4) and lowest with Meek micrografting (4 ± 2). CONCLUSIONS Comparison of the four techniques highlighted differences in terms of all outcomes assessed, and each technique was associated with different advantages. Interestingly autografting, the option with the highest graft take rate, was also associated with the highest mortality. This study not only serves to provide the first comparison of the most commonly used techniques in major burn reconstruction, but also highlights the need for prospective studies that directly compare the efficacy of the different techniques to ultimately establish whether a true superior option exists.
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Affiliation(s)
- Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Adriana C Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anamika Veeramani
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Samuel Knoedler
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bianief Tchiloemba
- Division of Plastic Surgery, Department of Surgery, University of Calgary, AB T2N 4N1, Canada
| | - Obada Abdulrazzak
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nikita Kadakia
- Department of Plastic Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Bastian Bonaventura
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Derek Culnan
- JMS Burn and Reconstructive Center at Merit Health Central, Jackson, MS, USA
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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Richardson BR, Decavèle M, Demoule A, Murtagh FEM, Johnson MJ. Breathlessness assessment, management and impact in the intensive care unit: a rapid review and narrative synthesis. Ann Intensive Care 2024; 14:107. [PMID: 38967813 PMCID: PMC11229436 DOI: 10.1186/s13613-024-01338-7] [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: 03/07/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Adults in the intensive care unit (ICU) commonly experience distressing symptoms and other concerns such as pain, delirium, and breathlessness. Breathlessness management is not supported by any ICU guidelines, unlike other symptoms. AIM To review the literature relating to (i) prevalence, intensity, assessment, and management of breathlessness in critically ill adults in the ICU receiving invasive and non-invasive mechanical ventilation (NIV) and high-flow oxygen therapy, (HFOT), (ii) the impact of breathlessness on ICU patients with regard to engagement with rehabilitation. METHODS A rapid review and narrative synthesis using the Cochrane Methods Group Recommendations was conducted and reported in accordance with PRISMA. All study designs investigating breathlessness in adult ICU patients receiving either invasive mechanical ventilation (IMV), NIV or HFOT were eligible. PubMed, MEDLINE, The Cochrane Library and CINAHL databased were searched from June 2013 to June 2023. Studies were quality appraised. RESULTS 19 studies representing 2822 ICU patients were included (participants mean age 48 years to 71 years; proportion of males 43-100%). The weighted mean prevalence of breathlessness in ICU patients receiving IMV was 49% (range 34-66%). The proportion of patients receiving NIV self-reporting moderate to severe dyspnoea was 55% prior to initiation. Breathlessness assessment tools included visual analogue scale, (VAS), numerical rating scale, (NRS) and modified BORG scale, (mBORG). In patients receiving NIV the highest reported median (interquartile range [IQR]) VAS, NRS and mBORG scores were 6.2cm (0-10 cm), 5 (2-7) and 6 (2.3-7) respectively (moderate to severe breathlessness). In patients receiving either NIV or HFOT the highest reported median (IQR) VAS, NRS and mBORG scores were 3 cm (0-6 cm), 8 (5-10) and 4 (3-5) respectively. CONCLUSION Breathlessness in adults receiving IMV, NIV or HFOT in the ICU is prevalent and clinically important with median intensity ratings indicating the presence of moderate to severe symptoms.
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Affiliation(s)
- Ben R Richardson
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough, TS1 3BX, UK
| | - Maxens Decavèle
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
- Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), 75013, Paris, France
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
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Pasaribu J, Keliat BA, Daulima NHC, Lisum K, Widodo GG. Nurse Strategies to Improve the Quality of Psychosocial Care During the COVID-19 Pandemic. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2024; 29:491-492. [PMID: 39205843 PMCID: PMC11349160 DOI: 10.4103/ijnmr.ijnmr_369_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 09/04/2024]
Abstract
Background Nurses play a critical role in combating the COVID-19 pandemic, facing numerous challenges in providing care to COVID-19 patients, particularly addressing their psychological issues. This study aims to explore nurses' experiences in overcoming care challenges and enhancing nursing strategies. The study was held in Indonesia. Materials and Methods Primary nurses and nurse managers responsible for COVID-19 patient care were interviewed extensively for data collection. The Collaizi method was used for data processing. Results The study identified three key themes: psychosocial nursing interventions, addressing obstacles in psychosocial care, and enhancing the quality of psychosocial nursing care. Conclusions Comprehensive nursing care proves effective in addressing the psychosocial challenges faced by COVID-19 patients.
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Affiliation(s)
- Jesika Pasaribu
- Psychiatric Nursing Deparment, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
- Psychiatric Nursing Deparment, Sint Carolus School of Health Sciences, Jakarta, Indonesia
| | - Budi A. Keliat
- Psychiatric Nursing Deparment, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Novy H. C. Daulima
- Psychiatric Nursing Deparment, Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Kristina Lisum
- Psychiatric Nursing Deparment, Sint Carolus School of Health Sciences, Jakarta, Indonesia
| | - Gipta G. Widodo
- Medical Nursing Department, Faculty of Nursing, Ngudi Waluyo University, West Java, Indonesia
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Yoshino Y, Unoki T, Hata K, Ito K. Association of social support before ICU admission with postdischarge mental health symptoms in ICU patients: a single-centre prospective cohort study in Japan. BMJ Open 2024; 14:e082810. [PMID: 38904131 PMCID: PMC11191801 DOI: 10.1136/bmjopen-2023-082810] [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: 12/21/2023] [Accepted: 05/31/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES Mental health problems after discharge from the intensive care unit (ICU) interfere with physical recovery and seriously affect daily life. Social support has been suggested to be associated with mental health but has not been sufficiently characterised. This study aimed to evaluate the association of social support before ICU admission with mental health after ICU discharge. DESIGN Prospective cohort study. SETTING Medical-surgical ICU of a hospital in Japan. PARTICIPANTS Patients admitted to the ICU for more than 48 hours were surveyed on social support prior to ICU admission, and 3 months after discharge from the ICU, mental health questionnaires were mailed to the patient. PRIMARY OUTCOME MEASURES Post-traumatic stress disorder (PTSD)-related symptoms were measured using the Impact of Event Scale-Revised, and anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. RESULTS A total of 153 patients were enrolled; the prevalence of PTSD-related symptoms, anxiety and depressive symptoms 3 months after discharge from the ICU was 11.3%, 14.0% and 24.6%, respectively. Multivariate analysis using linear regression models adjusted for age, sex and years of education for PTSD-related symptoms, anxiety and depressive symptoms revealed that social support (β=-0.018, 95% CI: -0.029 to 0.006, p=0.002) and female sex (β=0.268, 95% CI: 0.005 to 0.531, p=0.046) were independent factors associated with the severity of depressive symptoms. In addition, sex differences were observed in the association between depressive symptoms and social support (p for interaction=0.056). CONCLUSIONS Higher social support before ICU admission was not associated with PTSD symptoms after ICU discharge, although it may be associated with a lower prevalence depressive symptoms after ICU discharge. Therefore, it is important to provide necessary social support when needed.
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Affiliation(s)
- Yasuyo Yoshino
- Department of Nursing, Komazawa Women's University, Inagi, Tokyo, Japan
- Doctoral Program, Graduate School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Takeshi Unoki
- Department of Adult Health Nursing, School of Nursing, Sapporo City University, Sapporo, Hokkaido, Japan
| | - Kimiko Hata
- Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan
| | - Kiyoe Ito
- Yokosuka General Hospital Uwamachi, Yokosuka, Kanagawa, Japan
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Teixeira C, Rosa RG. Unmasking the hidden aftermath: postintensive care unit sequelae, discharge preparedness, and long-term follow-up. CRITICAL CARE SCIENCE 2024; 36:e20240265en. [PMID: 38896724 PMCID: PMC11152445 DOI: 10.62675/2965-2774.20240265-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/03/2024] [Indexed: 06/21/2024]
Abstract
A significant portion of individuals who have experienced critical illness encounter new or exacerbated impairments in their physical, cognitive, or mental health, commonly referred to as postintensive care syndrome. Moreover, those who survive critical illness often face an increased risk of adverse consequences, including infections, major cardiovascular events, readmissions, and elevated mortality rates, during the months following hospitalization. These findings emphasize the critical necessity for effective prevention and management of long-term health deterioration in the critical care environment. Although conclusive evidence from well-designed randomized clinical trials is somewhat limited, potential interventions include strategies such as limiting sedation, early mobilization, maintaining family presence during the intensive care unit stay, implementing multicomponent transition programs (from intensive care unit to ward and from hospital to home), and offering specialized posthospital discharge follow-up. This review seeks to provide a concise summary of recent medical literature concerning long-term outcomes following critical illness and highlight potential approaches for preventing and addressing health decline in critical care survivors.
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Affiliation(s)
- Cassiano Teixeira
- Department of Internal MedicineUniversidade Federal de Ciências da Saúde de Porto AlegrePorto AlegreRSBrazilDepartment of Internal Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS), Brazil.
| | - Regis Goulart Rosa
- Department of Internal MedicineHospital Moinhos de VentoPorto AlegreRSBrazilDepartment of Internal Medicine, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
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12
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Kilian K, Panayi A, Matar D, Hamwi C, Bigdeli A, Kneser U, Vollbach F. Similarity of Seroma Rate at the Medial Thigh following Free Flap Harvesting or Medial Thigh Lift: A Systematic Review and Meta-analysis. JPRAS Open 2024; 40:360-374. [PMID: 38770115 PMCID: PMC11103577 DOI: 10.1016/j.jpra.2024.03.013] [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] [Received: 02/26/2024] [Accepted: 03/30/2024] [Indexed: 05/22/2024] Open
Abstract
Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
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Affiliation(s)
- K.K. Kilian
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - A.C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - D.Y. Matar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C. Hamwi
- Department of Data Science, Saint Louis University, St. Louis, MO, USA
| | - A.K. Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - U. Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - F.H. Vollbach
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany
- Department of Hand and Plastic Surgery, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Munich, Germany
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13
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Nelson-Piercy C, Luyckx VA, Krawczyk P. Maternal critical care. Intensive Care Med 2024; 50:928-930. [PMID: 38844641 DOI: 10.1007/s00134-024-07443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 06/11/2024]
Affiliation(s)
| | - Valerie A Luyckx
- University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Paweł Krawczyk
- Department of Anesthesiology and Intensive Care, Jagiellonian University Medical College, Cracow, Poland
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Wang X, Wen X, Yuan S, Zhang J. Gut-brain axis in the pathogenesis of sepsis-associated encephalopathy. Neurobiol Dis 2024; 195:106499. [PMID: 38588753 DOI: 10.1016/j.nbd.2024.106499] [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: 03/04/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024] Open
Abstract
The gut-brain axis is a bidirectional communication network linking the gut and the brain, overseeing digestive functions, emotional responses, body immunity, brain development, and overall health. Substantial research highlights a connection between disruptions of the gut-brain axis and various psychiatric and neurological conditions, including depression and Alzheimer's disease. Given the impact of the gut-brain axis on behavior, cognition, and brain diseases, some studies have started to pay attention to the role of the axis in sepsis-associated encephalopathy (SAE), where cognitive impairment is the primary manifestation. SAE emerges as the primary and earliest form of organ dysfunction following sepsis, potentially leading to acute cognitive impairment and long-term cognitive decline in patients. Notably, the neuronal damage in SAE does not stem directly from the central nervous system (CNS) infection but rather from an infection occurring outside the brain. The gut-brain axis is posited as a pivotal factor in this process. This review will delve into the gut-brain axis, exploring four crucial pathways through which inflammatory signals are transmitted and elevate the incidence of SAE. These pathways encompass the vagus nerve pathway, the neuroendocrine pathway involving the hypothalamic-pituitary-adrenal (HPA) axis and serotonin (5-HT) regulation, the neuroimmune pathway, and the microbial regulation. These pathways can operate independently or collaboratively on the CNS to modulate brain activity. Understanding how the gut affects and regulates the CNS could offer the potential to identify novel targets for preventing and treating this condition, ultimately enhancing the prognosis for individuals with SAE.
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Affiliation(s)
- Xin Wang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Xiaoyue Wen
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China
| | - Shiying Yuan
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China.
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China; Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, PR China.
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15
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Friberg K, Hofsø K, Rustøen T, Ræder J, Hagen M, Puntillo K, Olsen BF. Patient characteristics associated with posttraumatic stress symptoms in intensive care unit survivors during a one-year follow-up: A multicenter study. Heart Lung 2024; 66:1-8. [PMID: 38492243 DOI: 10.1016/j.hrtlng.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival. OBJECTIVES To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission. METHODS Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures. RESULTS High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times. CONCLUSIONS The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health professionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these.
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Affiliation(s)
- Klara Friberg
- Østfold Hospital Trust, Intensive and post operative unit, Postbox 300, 1714 Grålum, Norway; University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316 Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University Collage, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway; Oslo University Hospital, Department of Postoperative and Critical Care Nursing, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Tone Rustøen
- University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316 Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway
| | - Johan Ræder
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Postbox 0316 Oslo, Norway
| | - Milada Hagen
- Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950 Nydalen, 0424 Oslo, Norway; Oslo Metropolitan University, Department of Public Health, Faculty of Health Sciences, Postbox 4, St Olavs plass, 0130 Oslo, Norway
| | - Kathleen Puntillo
- University of California, Department of Physiological Nursing, School of Nursing, 2 Koret Way, San Francisco, 94143 California, USA
| | - Brita Fosser Olsen
- Østfold Hospital Trust, Intensive and post operative unit, Postbox 300, 1714 Grålum, Norway; Østfold University College, Faculty of Health and Welfare, Postbox 700, 1757 Halden, Norway
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Sharshar T, Grimaldi-Bensouda L, Siami S, Cariou A, Salah AB, Kalfon P, Sonneville R, Meunier-Beillard N, Quenot JP, Megarbane B, Gaudry S, Oueslati H, Robin-Lagandre S, Schwebel C, Mazeraud A, Annane D, Nkam L, Friedman D. A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year. Intensive Care Med 2024; 50:665-677. [PMID: 38587553 DOI: 10.1007/s00134-024-07359-x] [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: 10/10/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Critical illness is associated with long-term increased mortality and impaired quality of life (QoL). We assessed whether multidisciplinary consultations would improve outcome at 12 months (M12) after intensive care unit (ICU) discharge. METHODS We performed an open, multicenter, parallel-group, randomized clinical trial. Eligible are patients discharged alive from ICU in 11 French hospitals between 2012 and 2018. The intervention group had a multidisciplinary face-to-face consultation involving an intensivist, a psychologist, and a social worker at ICU discharge and then at M3 and M6 (optional). The control group had standard post-ICU follow-up. A consultation was scheduled at M12 for all patients. The QoL was assessed using the EuroQol-5 Dimensions-5 Level (Euro-QoL-5D-5L) which includes five dimensions (mobility, self-care, usual activities, pain, and anxiety/depression), each ranging from 1 to 5 (1: no, 2: slight, 3: moderate, 4: severe, and 5: extreme problems). The primary endpoint was poor clinical outcome defined as death or severe-to-extreme impairment of at least one EuroQoL-5D-5L dimension at M12. The information was collected by a blinded investigator by phone. Secondary outcomes were functional, psychological, and cognitive status at M12 consultation. RESULTS 540 patients were included (standard, n = 272; multidisciplinary, n = 268). The risk for a poor outcome was significantly greater in the multidisciplinary group than in the standard group [adjusted odds ratio 1.49 (95% confidence interval, (1.04-2.13)]. Seventy-two (13.3%) patients died at M12 (standard, n = 32; multidisciplinary, n = 40). The functional, psychological, and cognitive scores at M12 did not statistically differ between groups. CONCLUSIONS A hospital-based, face-to-face, intensivist-led multidisciplinary consultation at ICU discharge then at 3 and 6 months was associated with poor outcome 1 year after ICU.
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Affiliation(s)
- Tarek Sharshar
- Anesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Paris, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France.
| | - Lamiae Grimaldi-Bensouda
- Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, UMR1018 Anti-Infective Evasion and Pharmacoepidemiology Team, University of Versailles Saint-Quentin en Yvelines, INSERM, Versailles, France
| | - Shidasp Siami
- General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique-Hôpitaux de Paris-Centre (APHP-CUP), Université de Paris Paris-Cardiovascular-Research-Center, INSERM U970, 75014, Paris, France
| | - Abdel Ben Salah
- Réanimation Polyvalente, Hôpital Louis Pasteur Hospital, Centre Hospitalier de Chartres, 28018, Chartres Cedex, France
| | - Pierre Kalfon
- Réanimation Polyvalente, Hôpital Louis Pasteur Hospital, Centre Hospitalier de Chartres, 28018, Chartres Cedex, France
| | - Romain Sonneville
- France Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Université de Paris, INSERM UMR1148, Team 6, 7501875018, Paris, France
| | - Nicolas Meunier-Beillard
- INSERM CIC 1432, Clinical Epidemiology, DRCI, USMR, Francois Mitterrand University Hospital, University of Burgundy, Dijon, France
| | - Jean-Pierre Quenot
- INSERM CIC 1432, Clinical Epidemiology, DRCI, USMR, Francois Mitterrand University Hospital, University of Burgundy, Dijon, France
- Department of Intensive Care, François Mitterrand University Hospital: INSERM LNC-UMR1231, INSERM CIC 1432, Clinical Epidemiology University of Burgundy, Dijon, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Université de Paris, Paris, France
| | - Stephane Gaudry
- Réanimation Médico-Chirurgicale, Louis Mourier Hospital, Assistance-Publique-Hôpitaux de Paris, 92700, Colombes, France
- Université de Paris. Epidémiologie Clinique-Évaluation Économique Appliqué Aux Populations Vulnérables (ECEVE, INSERM et, Centre d'investigation Clinique-Epidémiologie Clinique (CIC-EC) 1425, Paris, France
| | - Haikel Oueslati
- Department of Anesthesiology, Burn and Critical Care Medicine, AP-HP, Saint Louis and Lariboisiere University Hospitals, 75010, Paris, France
| | - Segolene Robin-Lagandre
- Anesthesiology and Intensive Care Department, European Hospital Georges-Pompidou, Université de Paris, 75015, Paris, France
| | - Carole Schwebel
- UJF-Grenoble I, Medical Intensive Care Unit, University Hospital Albert Michallon, 38041, Grenoble, France
| | - Aurelien Mazeraud
- Anesthesia and Intensive Care Department, Département Neurosciences, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte-Anne Hospital, Institut Pasteur, Unité Perception et Mémoire, Université de Paris, Paris, France
| | - Djillali Annane
- General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, 92380, Garches, France
| | - Lionelle Nkam
- Clinical Research Unit APHP. Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Diane Friedman
- General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, 92380, Garches, France
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Gupta L, Subair MN, Munjal J, Singh B, Bansal V, Gupta V, Jain R. Beyond survival: understanding post-intensive care syndrome. Acute Crit Care 2024; 39:226-233. [PMID: 38863353 PMCID: PMC11167423 DOI: 10.4266/acc.2023.01158] [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: 09/11/2023] [Revised: 11/03/2023] [Accepted: 11/08/2023] [Indexed: 06/13/2024] Open
Abstract
Post-intensive care syndrome (PICS) refers to persistent or new onset physical, mental, and neurocognitive complications that can occur following a stay in the intensive care unit. PICS encompasses muscle weakness; neuropathy; cognitive deficits including memory, executive, and attention impairments; post-traumatic stress disorder; and other mood disorders. PICS can last long after hospital admission and can cause significant physical, emotional, and financial stress for patients and their families. Several modifiable risk factors, such as duration of sepsis, delirium, and mechanical ventilation, are associated with PICS. However, due to limited awareness about PICS, these factors are often overlooked. The objective of this paper is to highlight the pathophysiology, clinical features, diagnostic methods, and available preventive and treatment options for PICS.
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Affiliation(s)
| | | | - Jaskaran Munjal
- Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India
| | - Bhupinder Singh
- Howard County Center for Lung and Sleep Medicine, Columbia, MD, USA
| | - Vasu Bansal
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, India
| | - Vasu Gupta
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Rohit Jain
- Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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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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Rosa RG, Teixeira C, Piva S, Morandi A. Anticipating ICU discharge and long-term follow-up. Curr Opin Crit Care 2024; 30:157-164. [PMID: 38441134 DOI: 10.1097/mcc.0000000000001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW This review aims to summarize recent literature findings on long-term outcomes following critical illness and to highlight potential strategies for preventing and managing health deterioration in survivors of critical care. RECENT FINDINGS A substantial number of critical care survivors experience new or exacerbated impairments in their physical, cognitive or mental health, commonly named as postintensive care syndrome (PICS). Furthermore, those who survive critical illness often face an elevated risk of adverse outcomes in the months following their hospital stay, including infections, cardiovascular events, rehospitalizations and increased mortality. These findings underscore the need for effective prevention and management of long-term health deterioration in the critical care setting. While robust evidence from well designed randomized clinical trials is limited, potential interventions encompass sedation limitation, early mobilization, delirium prevention and family presence during intensive care unit (ICU) stay, as well as multicomponent transition programs (from ICU to ward, and from hospital to home) and specialized posthospital discharge follow-up. SUMMARY In this review, we offer a concise overview of recent insights into the long-term outcomes of critical care survivors and advancements in the prevention and management of health deterioration after critical illness.
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Affiliation(s)
| | - Cassiano Teixeira
- Internal Medicine Department, Hospital Moinhos de Vento
- Critical Care Department, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brazil
| | - Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Alessandro Morandi
- Rehabilitation and Intermediate Care, Azienda Speciale Cremona Solidale, Cremona, Italy
- REFiT Bcn Research Group, Parc Sanitari Pere Virgili and Vall d'Hebrón Institut de Recerca (VHIR), Barcelona, Spain
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20
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Salve G, Mongodi S, Mangiagalli M, Tintim Lobato C, Mojoli F. Memories of ICU stay in patients admitted for severe COVID-19. Intensive Care Med 2024; 50:602-604. [PMID: 38436721 DOI: 10.1007/s00134-024-07365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Giulia Salve
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Rianimazione I, Viale Golgi 19, Pavia, Italy
| | - Silvia Mongodi
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Rianimazione I, Viale Golgi 19, Pavia, Italy.
| | - Matteo Mangiagalli
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
- Psychology department, Fondazione Soleterre, Milan, Italy
| | - Carolina Tintim Lobato
- Department of Emergency Medicine and Intensive Care, Hospital Pedro Hispano, Local Health Unit of Matosinhos, Matosinhos, Portugal
| | - Francesco Mojoli
- Anesthesia and Intensive Care 1St, Fondazione IRCCS Policlinico San Matteo, Rianimazione I, Viale Golgi 19, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
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21
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Chrisman M, Chesnut SR, Thompson M, Hopper A, Lasiter S. Physical activity and sedentary behavior in middle-aged intensive care unit survivors discharged home: A systematic review. Intensive Crit Care Nurs 2024; 81:103608. [PMID: 38155051 DOI: 10.1016/j.iccn.2023.103608] [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: 05/27/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES The purpose of this study was to review literature on physical activity and sedentary behavior of middle-aged adults post-discharge from the intensive care unit, with a particular focus on studies using wearable activity trackers. METHODOLOGY Systematic review conducted using correlational, cohort, and intervention studies of physical activity and sedentary behavior of intensive care unit survivors' post-discharge. Literature in PubMed, Embase, and CINAHL was searched using keywords derived from patient status, activity, and activity monitoring. Two independent reviewers used the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess quality of articles and potential biases in study design. MAIN OUTCOME MEASURES Physical activity and sedentary behavior assessed via wearable activity trackers. RESULTS Two hundred and fifty-six studies met inclusion criteria; six studies comprising 265 participants were retained. Outcomes varied widely and were not synthesized, but instead discussed individually. Average steps/day ranged from 1278 to 4958 and average minutes of activity ranged from 26 to 45 min/day. One study reported 12 hours and 17 min/day spent in sedentary activity and another reported 90 % of hospitalization was in sedentary behavior compared to 58 % post-discharge. CONCLUSION Few studies have examined physical activity and sedentary levels of middle-aged intensive care unit survivors wearing activity trackers. Findings are limited in generalizability, and no randomized controlled trials were included here. Eliciting support from clinical and post-discharge care teams to encourage activity and/or attend prescribed therapy or rehabilitation sessions is important. IMPLICATIONS FOR CLINICAL PRACTICE Clinicians should emphasize the importance of physical activity throughout the day to decrease sedentary time during a hospital stay and to continue being active after discharge to home. Physical activity is valuable, even in short spurts, from hospital stay through discharge. Interventions to increase physical activity and decrease sedentary time are needed to improve intensive care unit survivor recovery and quality of life post-discharge.
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Affiliation(s)
- Matthew Chrisman
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States.
| | - Steven R Chesnut
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States
| | - Marie Thompson
- University of Missouri-Kansas City, Health Sciences Library, 2411 Holmes, Kansas City, MO 64108, United States
| | - Amelia Hopper
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States
| | - Sue Lasiter
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States
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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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Abdelbaky AM, Eldelpshany MS. Intensive Care Unit (ICU)-Related Post-traumatic Stress Disorder: A Literature Review. Cureus 2024; 16:e57049. [PMID: 38681363 PMCID: PMC11046361 DOI: 10.7759/cureus.57049] [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: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
An intensive care unit (ICU) is a challenging environment characterized by frequent incidences of stressors and traumatic situations. Therefore, both patients and caregivers are at high risk of developing psychological disorders such as post-traumatic stress disorder (PTSD), anxiety, and depression. ICU-related PTSD is a significant concern that remains under-recognized. This literature review examines the current state of knowledge regarding ICU-related PTSD, including its prevalence, risk factors, clinical manifestations, and potential interventions. Key findings suggest that a considerable proportion of ICU survivors develop PTSD symptoms, which can significantly impact their quality of life and recovery. The most common predictors investigated for PTSD in ICU survivors are age, gender, pre-illness psychopathy, length of stay in the ICU, delirium, and sedative agents. The treatment and prevention strategies of ICU-related PTSD include psychological therapies and pharmacological and non-pharmacological treatments. Psychological interventions, including cognitive-behavioral therapy and pharmacotherapy, have shown promise in mitigating PTSD symptoms in ICU survivors. However, further research is needed to better understand the mechanisms underlying ICU-related PTSD and to develop targeted interventions to prevent and manage this debilitating condition.
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de Souza Cantão ABC, da Silva Lima TC, Fernandes MIAP, Nagendrababu V, Bastos JV, Levin L. Prevalence of dental, oral, and maxillofacial traumatic injuries among domestic violence victims: A systematic review and meta-analysis. Dent Traumatol 2024; 40 Suppl 2:33-42. [PMID: 38214027 DOI: 10.1111/edt.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND/AIMS Domestic violence (DV) encompasses a series of abusive behaviors, perpetrated in a family environment, against individuals of all ages and genders. Injuries to the head, neck, and face are frequent findings among victims of abuse, negatively impacting their quality of life. Although oral and maxillofacial injuries (OMFI) and traumatic dental injuries (TDI) are commonly diagnosed among DV victims, their prevalence is still unknown. This systematic review was aimed to assess the prevalence of OMFI and TDI among victims of DV. METHODS The protocol of the review was registered in PROSPERO (CRD42023424235). Literature searches were performed in eight electronic databases, up to August 7th, 2023. Observational studies published in the Latin-roman alphabet and reporting the prevalence of OMFI and/or TDI were included. The Joanna Briggs Institute's critical appraisal tool, checklist for prevalence studies, was used for quality assessment. Results were presented as qualitative and quantitative syntheses. RESULTS Seventeen studies, totaling 12,375 victims of domestic violence, were included. Meta-analyses showed an overall prevalence of 29% (95% CI: 15%-48%, I2 = 99%) and 4% (95% CI: 1%-10%, I2 = 98%) for OMFI and TDI, respectively. Higher pooled prevalence for OMFI (41%, 95% CI: 13%-46%, I2 = 99%) was demonstrated in samples with only women. OMFI was less prevalent (20%) among DV victims under 18, while TDI was lower among adults (1%). Hospital samples presented higher pooled prevalence of OMFI (32%), and forensic data from fatal victims presented higher prevalence of TDI (8%). CONCLUSION The overall prevalence of OMFI and TDI in DV victims was 29% and 4%, respectively. Women victims of DV presented higher rates of OFMI (41%) and TDI (6%).
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Affiliation(s)
| | | | | | | | | | - Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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26
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Friberg K, Hofsø K, Ræder J, Rustøen T, Småstuen MC, Olsen BF. Prevalence of and predictive factors associated with high levels of post-traumatic stress symptoms 3 months after intensive care unit admission: A prospective study. Aust Crit Care 2024; 37:222-229. [PMID: 37455211 DOI: 10.1016/j.aucc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms (PTSS) following intensive care unit (ICU) treatment may increase morbidity and mortality. Therefore, it is important to identify patients at risk of suffering from such symptoms. OBJECTIVES The objective of this study was to describe the prevalence and identify possible predictive factors associated with high levels of PTSS 3 months after ICU admission. METHODS A multicentre, observational study was carried out in six ICUs in Norway. Patients aged ≥18 years were included. The Impact of Event Scale-Revised measured PTSS 3 months after ICU admission. The impacts of pre-ICU measures; demographic and clinical measures; and daily measures of pain, agitation, and delirium were analysed using univariate and multivariate logistic regression models. RESULTS In total, of the 273 patients included, the prevalence rate of high levels of PTSS was 19.8% (n = 54) 3 months after ICU admission (95% confidence interval [CI]: [15.2, 25.0]). Female gender, age, pre-ICU unemployment, a minimum of one episode of agitation or delirium, and pre-ICU level of functioning in daily living were all significantly associated with high levels of PTSS in univariate logistic analyses. In the multivariate logistic regression, two models were analysed. In model 1, episodes of agitation during ICU stay (odds ratio [OR] = 4.73; 95% CI: [1.17, 19.0]), pre-ICU unemployment (OR = 3.33; 95% CI: [1.26, 8.81]), and pre-ICU level of functioning in daily living (OR = 0.78; 95% CI: [0.63, 0.96]) (implying lower level) increased the odds of reporting high levels of PTSS. In model 2, pre-ICU unemployment (OR = 2.70; 95% CI: [1.05, 6.93]) and pre-ICU level of functioning in daily living (OR = 0.77; 95% CI: [0.62, 0.95]) (implying lower level) increased the odds of reporting high levels of PTSS. CONCLUSIONS Healthcare personnel are suggested to be aware of ICU patients' pre-ICU employment status, pre-ICU functioning in daily living, and agitation during ICU stay to identify those at risk of PTSS after discharge.
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Affiliation(s)
- Klara Friberg
- Østfold Hospital Trust, Intensive and Post Operative Unit, Postbox 300, 1714 Grålum, Norway; University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316, Oslo, Norway.
| | - Kristin Hofsø
- Lovisenberg Diaconal University Collage, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway; Oslo University Hospital, Department of Postoperative and Critical Care Nursing, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway
| | - Johan Ræder
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Postbox 0316, Oslo, Norway
| | - Tone Rustøen
- University of Oslo, Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, Postbox 0316, Oslo, Norway; Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway
| | - Milada Cvancarova Småstuen
- Oslo University Hospital, Department of Research and Development, Division of Emergencies and Critical Care, Postbox 4950, Nydalen, 0424 Oslo, Norway; Oslo Metropolitan University, Department of Public Health, Faculty of Health Sciences, Postbox 4, St Olavs Plass, 0130 Oslo, Norway
| | - Brita Fosser Olsen
- Østfold Hospital Trust, Intensive and Post Operative Unit, Postbox 300, 1714 Grålum, Norway; Østfold University Collage, Faculty of Health and Welfare, Postbox 700, 1757 Halden, Norway
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27
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Mossberg R, Ahlström B, Lipcsey M. A nationwide cohort study on the association between intensive care treatments and mental distress linked psychiatric disorders. Sci Rep 2024; 14:4519. [PMID: 38402361 PMCID: PMC10894289 DOI: 10.1038/s41598-024-55102-9] [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: 04/18/2023] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
Given the psychic strain patients experience in the intensive care unit (ICU), a potential risk of mental disorders has been suggested. However, the effects of intensive care treatment per se are unknown. We investigated whether the level of intensive care treatments is an independent risk factor for developing long-term mental disorders after intensive care. In a national cohort of adult ICU patients we combined data on diagnoses, treatment, and causes of death. We defined extensive ICU treatment as being treated with invasive ventilation for > 24 h, continuous renal replacement therapy, or both. The primary outcome was incident mental disorder 1 year after ICU admission. Extensive ICU treatment was found to be associated with a decreased risk of developing a mental disorder ≥ 1 year after ICU admission (HR 0.90, 95% CI 0.82-0.99, p = 0.04), and increasing severity of acute illness (HR 1.18, 95% CI 1.06-1.32, p < 0.001) were associated with an increased risk of mental disorders. Because death acted as a competing risk for mental illness, mortality might help explain the apparent protective effect of extensive ICU care.Trial registration Clinical Trials Registry (Identification number NCT05137977). Registered 16 November 2021. As a registry trial the patients were already included at the trial registration i.e. it was retrospectively registered.
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Affiliation(s)
- Rasmus Mossberg
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Region Värmland, Center for Clinical Research Värmland, Centralsjukhuset Karlstad, Rosenborgsgatan 9, 65230, Karlstad, Sweden.
| | - Björn Ahlström
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Healthcare Region Dalarna, Center for Clinical Research Dalarna, Falu Lasarett, Nissers väg 3, 79182, Falun, Sweden
| | - Miklos Lipcsey
- Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden
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Demoule A, Decavele M, Antonelli M, Camporota L, Abroug F, Adler D, Azoulay E, Basoglu M, Campbell M, Grasselli G, Herridge M, Johnson MJ, Naccache L, Navalesi P, Pelosi P, Schwartzstein R, Williams C, Windisch W, Heunks L, Similowski T. Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement. Eur Respir J 2024; 63:2300347. [PMID: 38387998 DOI: 10.1183/13993003.00347-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/16/2023] [Indexed: 02/24/2024]
Abstract
This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society and the European Society of Intensive Care Medicine. Dyspnoea ranks among the most distressing experiences that human beings can endure. Approximately 40% of patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) report dyspnoea, with an average intensity of 45 mm on a visual analogue scale from 0 to 100 mm. Although it shares many similarities with pain, dyspnoea can be far worse than pain in that it summons a primal fear response. As such, it merits universal and specific consideration. Dyspnoea must be identified, prevented and relieved in every patient. In the ICU, mechanically ventilated patients are at high risk of experiencing breathing difficulties because of their physiological status and, in some instances, because of mechanical ventilation itself. At the same time, mechanically ventilated patients have barriers to signalling their distress. Addressing this major clinical challenge mandates teaching and training, and involves ICU caregivers and patients. This is even more important because, as opposed to pain which has become a universal healthcare concern, very little attention has been paid to the identification and management of respiratory suffering in mechanically ventilated ICU patients.
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Affiliation(s)
- Alexandre Demoule
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation, Département R3S, F-75013 Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Maxens Decavele
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation, Département R3S, F-75013 Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Camporota
- Department of Adult Critical Care, Health Centre for Human and Applied Physiological Sciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fekri Abroug
- ICU and Research Lab (LR12SP15), Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Dan Adler
- Division of Pulmonary Diseases, Hôpital de la Tour, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP Hôpital Saint-Louis, Paris, France
| | - Metin Basoglu
- Istanbul Center for Behaviorial Sciences (DABATEM), Istanbul, Turkey
| | | | - Giacomo Grasselli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Anesthesia, Critical Care and Emergency, Milan, Italy
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Margaret Herridge
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lionel Naccache
- Département de Neurophysiologie, Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
| | - Paolo Navalesi
- Department of Medicine, University of Padua, Padua, Italy
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Richard Schwartzstein
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln, Witten/Herdecke University, Cologne, Germany
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
- L. Heunks and T. Similowski contributed equally to the manuscript
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, F-75013 Paris, France
- L. Heunks and T. Similowski contributed equally to the manuscript
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Demoule A, Decavele M, Antonelli M, Camporota L, Abroug F, Adler D, Azoulay E, Basoglu M, Campbell M, Grasselli G, Herridge M, Johnson MJ, Naccache L, Navalesi P, Pelosi P, Schwartzstein R, Williams C, Windisch W, Heunks L, Similowski T. Dyspnoea in acutely ill mechanically ventilated adult patients: an ERS/ESICM statement. Intensive Care Med 2024; 50:159-180. [PMID: 38388984 DOI: 10.1007/s00134-023-07246-x] [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: 04/14/2023] [Accepted: 09/16/2023] [Indexed: 02/24/2024]
Abstract
This statement outlines a review of the literature and current practice concerning the prevalence, clinical significance, diagnosis and management of dyspnoea in critically ill, mechanically ventilated adult patients. It covers the definition, pathophysiology, epidemiology, short- and middle-term impact, detection and quantification, and prevention and treatment of dyspnoea. It represents a collaboration of the European Respiratory Society (ERS) and the European Society of Intensive Care Medicine (ESICM). Dyspnoea ranks among the most distressing experiences that human beings can endure. Approximately 40% of patients undergoing invasive mechanical ventilation in the intensive care unit (ICU) report dyspnoea, with an average intensity of 45 mm on a visual analogue scale from 0 to 100 mm. Although it shares many similarities with pain, dyspnoea can be far worse than pain in that it summons a primal fear response. As such, it merits universal and specific consideration. Dyspnoea must be identified, prevented and relieved in every patient. In the ICU, mechanically ventilated patients are at high risk of experiencing breathing difficulties because of their physiological status and, in some instances, because of mechanical ventilation itself. At the same time, mechanically ventilated patients have barriers to signalling their distress. Addressing this major clinical challenge mandates teaching and training, and involves ICU caregivers and patients. This is even more important because, as opposed to pain which has become a universal healthcare concern, very little attention has been paid to the identification and management of respiratory suffering in mechanically ventilated ICU patients.
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Affiliation(s)
- Alexandre Demoule
- Service de Médecine Intensive-Réanimation, Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France.
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France.
| | - Maxens Decavele
- Service de Médecine Intensive-Réanimation, Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
| | - Massimo Antonelli
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Camporota
- Department of Adult Critical Care, Health Centre for Human and Applied Physiological Sciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fekri Abroug
- ICU and Research Lab (LR12SP15), Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Dan Adler
- Division of Pulmonary Diseases, Hôpital de la Tour, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Elie Azoulay
- Medical Intensive Care Unit, APHP Hôpital Saint-Louis, Paris, France
| | - Metin Basoglu
- Istanbul Center for Behavioral Sciences (DABATEM), Istanbul, Turkey
| | | | - Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Margaret Herridge
- Toronto General Research Institute, University Health Network, Toronto, ON, Canada
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lionel Naccache
- Département de Neurophysiologie, Sorbonne Université, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, France
- Institut du Cerveau et de la Moelle Épinière, ICM, PICNIC Lab, Paris, France
| | - Paolo Navalesi
- Department of Medicine, University of Padua, Padua, Italy
- Institute of Anesthesia and Intensive Care, Padua University Hospital, Padua, Italy
| | - Paolo Pelosi
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Richard Schwartzstein
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Wolfram Windisch
- Department of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln, Witten/Herdecke University, Cologne, Germany
| | - Leo Heunks
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005, Paris, France
- Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, 75013, Paris, France
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Schmidt KFR, Gensichen JS, Schroevers M, Kaufmann M, Mueller F, Schelling G, Gehrke-Beck S, Boede M, Heintze C, Wensing M, Schwarzkopf D. Trajectories of post-traumatic stress in sepsis survivors two years after ICU discharge: a secondary analysis of a randomized controlled trial. Crit Care 2024; 28:35. [PMID: 38287438 PMCID: PMC10823628 DOI: 10.1186/s13054-024-04815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Post-traumatic stress has been identified as a frequent long-term complication in survivors of critical illnesses after sepsis. Little is known about long-term trajectories of post-traumatic stress and potentially modifiable risk factors following the ICU stay. Study objective was to explore and compare different clinical trajectories of post-traumatic stress symptoms in sepsis survivors up to two years after discharge from ICU. METHODS Data on post-traumatic stress symptoms by means of the Post-traumatic Symptom Scale (PTSS-10) were collected in sepsis survivors at one, six, 12 and 24 months after discharge from ICU. Data on chronic psychiatric diagnoses prior ICU were derived from the primary care provider's health records, and data on intensive care treatment from ICU documentation. Trajectories of post-traumatic symptoms were identified ex post, discriminating patterns of change and k-means clustering. Assignment to the trajectories was predicted in multinomial log-linear models. RESULTS At 24 months, all follow-up measurements of the PTSS-10 were completed in N = 175 patients. Three clusters could be identified regarding clinical trajectories of PTSS levels: stable low symptoms (N = 104 patients [59%]), increasing symptoms (N = 45 patients [26%]), and recovering from symptoms (N = 26 patients [15%]). Patients with initially high post-traumatic symptoms were more likely to show a decrease (OR with 95% CI: 1.1 [1.05, 1.16]). Females (OR = 2.45 [1.11, 5.41]) and patients reporting early traumatic memories of the ICU (OR = 4.04 [1.63, 10]) were at higher risk for increasing PTSS levels. CONCLUSION Post-traumatic stress is a relevant long-term burden for sepsis patients after ICU stay. Identification of three different trajectories within two years after ICU discharge highlights the importance of long-term observation, as a quarter of patients reports few symptoms at discharge yet an increase in symptoms in the two years following. Regular screening of ICU survivors on post-traumatic stress should be considered even in patients with few symptoms and in particular in females and patients reporting traumatic memories of the ICU.
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Affiliation(s)
- Konrad F R Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany.
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany.
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany.
| | - Jochen S Gensichen
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University Munich, D-80336, Munich, Germany
| | - Maya Schroevers
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, NL-9700 AB, Groningen, The Netherlands
| | - Martina Kaufmann
- Office of Good Scientific Practice, Charité University Medicine, D-10117, Berlin, Germany
| | - Friederike Mueller
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Department of Child and Youth Psychiatry, Psychosomatics and Psychotherapy, Asklepios Hospital Luebben, D-15907, Luebben, Germany
| | - Gustav Schelling
- Department of Anesthesiology, University Hospital of the Ludwig-Maximilians-University Munich, D-80336, Munich, Germany
| | - Sabine Gehrke-Beck
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany
| | - Monique Boede
- Institute of General Practice and Family Medicine, Jena University Hospital, D-07743, Jena, Germany
| | - Christoph Heintze
- Institute of General Practice and Family Medicine, Charité University Medicine, Charitéplatz 1, D-10117, Berlin, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, D-69120, Heidelberg, Germany
| | - Daniel Schwarzkopf
- Center of Sepsis Control and Care (CSCC), Jena University Hospital, D-07747, Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, D-07747, Jena, Germany
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Bates A, Golding H, Rushbrook S, Highfield J, Pattison N, Baldwin D, Grocott MPW, Cusack R. Mixed-methods randomised study exploring the feasibility and acceptability of eye-movement desensitisation and reprocessing for improving the mental health of traumatised survivors of intensive care following hospital discharge: protocol. BMJ Open 2024; 14:e081969. [PMID: 38286705 PMCID: PMC10826543 DOI: 10.1136/bmjopen-2023-081969] [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: 11/10/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Post-traumatic symptoms are common among patients discharged from intensive care units (ICUs), adversely affecting well-being, increasing healthcare utilisation and delaying return to work. Non-pharmacological approaches (eg, music, therapeutic touch and patient diaries) have been suggested as candidate interventions and trauma-focused psychological interventions have been endorsed by international bodies. Neither category of intervention is supported by definitive evidence of long-term clinical effectiveness in patients who have been critically ill. This study assesses the feasibility and acceptability of using eye-movement desensitisation and reprocessing (EMDR) to improve the mental health of ICU survivors. METHODS AND ANALYSIS EMERALD is a multicentre, two-part consent, pilot feasibility study, recruiting discharged ICU survivors from three hospitals in the UK. We are gathering demographics and measuring post-traumatic symptoms, anxiety, depression and quality of life at baseline. Two months after discharge, participants are screened for symptoms of post-traumatic stress disorder (PTSD) using the Impact of Events Scale-Revised (IES-R). Patients with IES-R scores<22 continue in an observation arm for 12 month follow-up. IES-R scores≥22 indicate above-threshold PTSD symptoms and trigger invitation to consent for part B: a randomised controlled trial (RCT) of EMDR versus usual care, with 1:1 randomisation. The study assesses feasibility (recruitment, retention and intervention fidelity) and acceptability (through semistructured interviews), using a theoretical acceptability framework. Clinical outcomes (PTSD, anxiety, depression and quality of life) are collected at baseline, 2 and 12 months, informing power calculations for a definitive RCT, with quantitative and qualitative data convergence guiding RCT refinements. ETHICS AND DISSEMINATION This study has undergone external expert peer review and is funded by the National Institute for Health and Care Research (grant number: NIHR302160). Ethical approval has been granted by South Central-Hampshire A Research Ethics Committee (IRAS number: 317291). Results will be disseminated through the lay media, social media, peer-reviewed publication and conference presentation. TRIAL REGISTRATION NUMBER NCT05591625.
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Affiliation(s)
- Andrew Bates
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Golding
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | | | - Natalie Pattison
- University of Hertfordshire, Hatfield, UK
- East and North Hertfordshire NHS Trust, Stevenage, UK
| | - David Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Michael P W Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Cusack
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
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Stedman W, Donaldson L, Garside T, Green S, Donoghoe SF, Whitfield VE, Bass F, Delaney A, Hammond N. The feasibility and acceptability of a physician-led ICU follow-up service: A prospective cohort study. Aust Crit Care 2024; 37:3-11. [PMID: 38065794 DOI: 10.1016/j.aucc.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 10/11/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Increased recognition of post-intensive care syndrome has led to widespread development of intensive care follow-up services internationally. OBJECTIVE The objective of this study was to determine the feasibility and acceptability of an intensive care unit (ICU) follow-up clinic in Australia for patients and their caregivers and to describe satisfaction with this service. METHODS This was a prospective cohort study in a mixed tertiary ICU in Australia. Eligible patients were adults admitted to the ICU for 7 days or more and/or ventilated for 48 h or more, as well as their primary caregiver. Patients and their primary caregivers were invited to attend a follow-up clinic 4-8 weeks after hospital discharge. The clinic appointment was attended by an ICU physician and nurse, with multidisciplinary support. Feasibility and acceptability were defined as the proportion of clinic attendance and frequency of interventions initiated at the clinic. Satisfaction was measured by a 5-point satisfaction survey (very dissatisfied to very satisfied). The burden of ongoing disease was reported via multiple validated instruments. RESULTS From April 2020-July 2021, 386 patients met the inclusion criteria. Only 146 patients were approached for consent due to site staffing limitations. Eighty-three patients and 32 caregivers consented to attend the clinic. Seventy percent (54/77) of patients attended scheduled appointments and 50% (16/32) of caregivers. For patients, 23 medical referrals were made, 8 patients had medication changes, and 10 patients were offered social work support. Satisfaction surveys were completed by 65% (35/54) of attending patients; 97% (34) patients reported either being 'very satisfied' or 'satisfied' with the service. All responding caregivers (10) were either 'very satisfied' or 'satisfied' with the clinic. CONCLUSION There were a large number of patients meeting the inclusion criteria to the ICU follow-up clinic, and clinic attendance was moderate for patients but lower for caregivers. Reported satisfaction with the service was high for both patients and their caregiver.
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Affiliation(s)
- Wade Stedman
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia.
| | - Lachlan Donaldson
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia
| | - Tessa Garside
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Australia
| | - Sarah Green
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Pharmacy Department, Royal North Shore Hospital, Sydney, Australia
| | - Stephanie F Donoghoe
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Victoria E Whitfield
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Frances Bass
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia; Northern Clinical School, Sydney Medical School, University of Sydney, Australia
| | - Naomi Hammond
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Critical Care Program, The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Australia
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Papini S, Iturralde E, Lu Y, Greene JD, Barreda F, Sterling SA, Liu VX. Development and validation of a machine learning model using electronic health records to predict trauma- and stressor-related psychiatric disorders after hospitalization with sepsis. Transl Psychiatry 2023; 13:400. [PMID: 38114475 PMCID: PMC10730505 DOI: 10.1038/s41398-023-02699-6] [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: 04/25/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023] Open
Abstract
A significant minority of individuals develop trauma- and stressor-related disorders (TSRD) after surviving sepsis, a life-threatening immune response to infections. Accurate prediction of risk for TSRD can facilitate targeted early intervention strategies, but many existing models rely on research measures that are impractical to incorporate to standard emergency department workflows. To increase the feasibility of implementation, we developed models that predict TSRD in the year after survival from sepsis using only electronic health records from the hospitalization (n = 217,122 hospitalizations from 2012-2015). The optimal model was evaluated in a temporally independent prospective test sample (n = 128,783 hospitalizations from 2016-2017), where patients in the highest-risk decile accounted for nearly one-third of TSRD cases. Our approach demonstrates that risk for TSRD after sepsis can be stratified without additional assessment burden on clinicians and patients, which increases the likelihood of model implementation in hospital settings.
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Affiliation(s)
- Santiago Papini
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, USA.
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Yun Lu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - John D Greene
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Fernando Barreda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Vincent X Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Tronstad O, Flaws D, Patterson S, Holdsworth R, Garcia-Hansen V, Rodriguez Leonard F, Ong R, Yerkovich S, Fraser JF. Evaluation of the sensory environment in a large tertiary ICU. Crit Care 2023; 27:461. [PMID: 38012768 PMCID: PMC10683296 DOI: 10.1186/s13054-023-04744-8] [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: 09/05/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND ICU survival is improving. However, many patients leave ICU with ongoing cognitive, physical, and/or psychological impairments and reduced quality of life. Many of the reasons for these ongoing problems are unmodifiable; however, some are linked with the ICU environment. Suboptimal lighting and excessive noise contribute to a loss of circadian rhythms and sleep disruptions, leading to increased mortality and morbidity. Despite long-standing awareness of these problems, meaningful ICU redesign is yet to be realised, and the 'ideal' ICU design is likely to be unique to local context and patient cohorts. To inform the co-design of an improved ICU environment, this study completed a detailed evaluation of the ICU environment, focussing on acoustics, sound, and light. METHODS This was an observational study of the lighting and acoustic environment using sensors and formal evaluations. Selected bedspaces, chosen to represent different types of bedspaces in the ICU, were monitored during prolonged study periods. Data were analysed descriptively using Microsoft Excel. RESULTS Two of the three monitored bedspaces showed a limited difference in lighting levels across the day, with average daytime light intensity not exceeding 300 Lux. In bedspaces with a window, the spectral power distribution (but not intensity) of the light was similar to natural light when all ceiling lights were off. However, when the ceiling lights were on, the spectral power distribution was similar between bedspaces with and without windows. Average sound levels in the study bedspaces were 63.75, 56.80, and 59.71 dBA, with the single room being noisier than the two open-plan bedspaces. There were multiple occasions of peak sound levels > 80 dBA recorded, with the maximum sound level recorded being > 105 dBA. We recorded one new monitor or ventilator alarm commencing every 69 s in each bedspace, with only 5% of alarms actioned. Acoustic testing showed poor sound absorption and blocking. CONCLUSIONS This study corroborates other studies confirming that the lighting and acoustic environments in the study ICU were suboptimal, potentially contributing to adverse patient outcomes. This manuscript discusses potential solutions to identified problems. Future studies are required to evaluate whether an optimised ICU environment positively impacts patient outcomes.
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Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia.
| | - Dylan Flaws
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- Department of Mental Health, Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Sue Patterson
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- School of Dentistry, University of Queensland, Brisbane, Australia
| | - Robert Holdsworth
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
| | - Veronica Garcia-Hansen
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Francisca Rodriguez Leonard
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Ruth Ong
- School of Architecture and Built Environment, Faculty of Engineering, Queensland University of Technology, Brisbane, Australia
| | - Stephanie Yerkovich
- Menzies School of Health Research and Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - John F Fraser
- Critical Care Research Group, Level 3 Clinical Sciences Building, The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Castro-Avila A, Merino-Osorio C, González-Seguel F, Camus-Molina A, Muñoz-Muñoz F, Leppe J. Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study. PLoS One 2023; 18:e0294631. [PMID: 37972091 PMCID: PMC10653414 DOI: 10.1371/journal.pone.0294631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. METHODS Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure. RESULTS We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P50 [P25-P75]: 55 [44-63] vs 61 [51-71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up. CONCLUSIONS There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%). CLINICAL TRIAL REGISTRATION NCT04979897 (clinicaltrials.gov).
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Affiliation(s)
- Ana Castro-Avila
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - Catalina Merino-Osorio
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Felipe González-Seguel
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Jaime Leppe
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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Cambriel A, Choisy B, Hedou J, Bonnet MP, Fellous S, Lefevre JH, Voron T, Gaudillière D, Kin C, Gaudillière B, Verdonk F. Impact of preoperative uni- or multimodal prehabilitation on postoperative morbidity: meta-analysis. BJS Open 2023; 7:zrad129. [PMID: 38108466 PMCID: PMC10726416 DOI: 10.1093/bjsopen/zrad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Postoperative complications occur in up to 43% of patients after surgery, resulting in increased morbidity and economic burden. Prehabilitation has the potential to increase patients' preoperative health status and thereby improve postoperative outcomes. However, reported results of prehabilitation are contradictory. The objective of this systematic review is to evaluate the effects of prehabilitation on postoperative outcomes (postoperative complications, hospital length of stay, pain at postoperative day 1) in patients undergoing elective surgery. METHODS The authors performed a systematic review and meta-analysis of RCTs published between January 2006 and June 2023 comparing prehabilitation programmes lasting ≥14 days to 'standard of care' (SOC) and reporting postoperative complications according to the Clavien-Dindo classification. Database searches were conducted in PubMed, CINAHL, EMBASE, PsycINFO. The primary outcome examined was the effect of uni- or multimodal prehabilitation on 30-day complications. Secondary outcomes were length of ICU and hospital stay (LOS) and reported pain scores. RESULTS Twenty-five studies (including 2090 patients randomized in a 1:1 ratio) met the inclusion criteria. Average methodological study quality was moderate. There was no difference between prehabilitation and SOC groups in regard to occurrence of postoperative complications (OR = 1.02, 95% c.i. 0.93 to 1.13; P = 0.10; I2 = 34%), total hospital LOS (-0.13 days; 95% c.i. -0.56 to 0.28; P = 0.53; I2 = 21%) or reported postoperative pain. The ICU LOS was significantly shorter in the prehabilitation group (-0.57 days; 95% c.i. -1.10 to -0.04; P = 0.03; I2 = 46%). Separate comparison of uni- and multimodal prehabilitation showed no difference for either intervention. CONCLUSION Prehabilitation reduces ICU LOS compared with SOC in elective surgery patients but has no effect on overall complication rates or total LOS, regardless of modality. Prehabilitation programs need standardization and specific targeting of those patients most likely to benefit.
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Affiliation(s)
- Amélie Cambriel
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin Choisy
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Julien Hedou
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Marie-Pierre Bonnet
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesia and Critical Care, Trousseau Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
- Obstetrical Perinatal and Paediatric Epidemiology Research Team, Université Paris Cité, CRESS, EPOPé, INSERM, INRA, Paris, France
| | - Souad Fellous
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie H Lefevre
- Sorbonne University and Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibault Voron
- Sorbonne University and Department of Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dyani Gaudillière
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Cindy Kin
- Division of General Surgery, Department of Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Brice Gaudillière
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Franck Verdonk
- Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- GRC 29, DMU DREAM, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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Pant U, Vyas K, Meghani S, Park T, Norris CM, Papathanassoglou E. Screening tools for post-intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review. Aust Crit Care 2023; 36:863-871. [PMID: 36464526 DOI: 10.1016/j.aucc.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/21/2022] [Accepted: 09/27/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evidence suggests that intensive care unit (ICU) survivors often suffer long-term complications such as post-intensive care syndrome (PICS) and post-traumatic stress disorder (PTSD) from critical illness and ICU stay. PICS and PTSD affect both ICU survivors and their families, which overburdens the healthcare systems. Lack of evidence on the comparative psychometric properties of assessment tools is a major barrier in evidence-based screening for post-ICU symptomatology and health-related quality of life. OBJECTIVES We aimed to identify existing tools for screening PTSD and PICS in ICU survivors and their families and to examine evidence on the validity, reliability, sensitivity, and specificity of existing tools, as reflected in published peer-reviewed studies. METHOD A scoping review based on literature searches (CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Health and Psychosocial Instruments, Dissertations and Theses Global, and Google Scholar) and predefined eligibility criteria was conducted according to current scoping review guidelines. FINDINGS We identified 44 studies reporting on the development and assessment of psychometric properties of PICS/PTSD in ICU survivors or families globally. We identified five tools addressing all three aspects of PICS manifestations, one tool for both physical and mental aspects of PICS, and fivefive tools for quality-of-life assessment in ICU survivors. Altogether, 25 tools assess only one aspect of PICS: five for cognitive impairment, seven for physical impairment, and 13 for mental health impairment and PTSD in ICU survivors. However, only two tools were found for PICS-family assessment. Other findings include (i) unclear validity and often limited feasibility of tools, (ii) low diagnostic accuracy of cognitive assessment tools, and (iii) evidence of appropriate psychometric properties and feasibility of psychological health assessment tools. CONCLUSION These results have implications for the selection and implementation of the assessment methods as a means for promoting meaningful patient-centred clinical outcomes to minimise long-term sequelae, reduce the rate of rehospitalisation, and optimise recovery after ICU discharge.
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Affiliation(s)
- Usha Pant
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Krooti Vyas
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Shaista Meghani
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Tanya Park
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB T6G 1C9, Canada.
| | - Colleen M Norris
- Professor, Faculty of Nursing, Scientific Director, Cardiovascular Health and Stroke Strategic Clinical Network, Adjunct Professor Faculty of Medicine & Dentistry and School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada.
| | - Elizabeth Papathanassoglou
- Professor, Faculty of Nursing, University of Alberta, Scientific Director, Neurosciences Rehabilitation & Vision Strategic Clinical Network™ Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada.
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Higa KC, Mayer K, Quinn C, Jubina L, Suarez-Pierre A, Colborn K, Jolley SE, Enfield K, Zwischenberger J, Sevin CM, Rove JY. Sounding the Alarm: What Clinicians Need to Know about Physical, Emotional, and Cognitive Recovery After Venoarterial Extracorporeal Membrane Oxygenation. Crit Care Med 2023; 51:1234-1245. [PMID: 37163480 PMCID: PMC11210608 DOI: 10.1097/ccm.0000000000005900] [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] [Indexed: 05/12/2023]
Abstract
OBJECTIVE We summarize the existing data on the occurrence of physical, emotional, and cognitive dysfunction associated with postintensive care syndrome (PICS) in adult survivors of venoarterial extracorporeal membrane oxygenation (VA-ECMO). DATA SOURCES MEDLINE, Cochrane Library, EMBASE, Web of Science, and CINAHL databases were searched. STUDY SELECTION Peer-reviewed studies of adults receiving VA-ECMO for any reason with at least one measure of health-related quality of life outcomes or PICS at long-term follow-up of at least 6 months were included. DATA EXTRACTION The participant demographics and baseline characteristics, in-hospital outcomes, long-term health outcomes, quality of life outcome measures, and prevalence of PICS were extracted. DATA SYNTHESIS Twenty-seven studies met inclusion criteria encompassing 3,271 patients who were treated with VA-ECMO. The studies were limited to single- or two-center studies. Outcomes variables and follow-up time points evaluated were widely heterogeneous which limits comprehensive analysis of PICS after VA-ECMO. In general, the longer-term PICS-related outcomes of survivors of VA-ECMO were worse than the general population, and approaching that of patients with chronic disease. Available studies identified high rates of abnormal 6-minute walk distance, depression, anxiety, and posttraumatic stress disorder that persisted for years. Half or fewer survivors return to work years after discharge. Only 2 of 27 studies examined cognitive outcomes and no studies evaluated cognitive dysfunction within the first year of recovery. No studies evaluated the impact of targeted interventions on these outcomes. CONCLUSIONS Survivors of VA-ECMO represent a population of critically ill patients at high risk for deficits in physical, emotional, and cognitive function related to PICS. This systematic review highlights the alarming reality that PICS and in particular, neurocognitive outcomes, in survivors of VA-ECMO are understudied, underrecognized, and thus likely undertreated. These results underscore the imperative that we look beyond survival to focus on understanding the burden of survivorship with the goal of optimizing recovery and outcomes after these life-saving interventions. Future prospective, multicenter, longitudinal studies in recovery after VA-ECMO are justified.
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Affiliation(s)
- Kelly C Higa
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA
| | - Kirby Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Christopher Quinn
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Lindsey Jubina
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| | | | - Kathryn Colborn
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Sarah E Jolley
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Kyle Enfield
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, VA
| | - Joseph Zwischenberger
- Division of Cardiothoracic Surgery, Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Carla M Sevin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Jessica Y Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO
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Bates A, Golding H, Rushbrook S, Shapiro E, Pattison N, Baldwin DS, Grocott MPW, Cusack R. A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19. J Intensive Care Soc 2023; 24:309-319. [PMID: 37744073 PMCID: PMC9679313 DOI: 10.1177/17511437221136828] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design. Method We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression. Results We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was -8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression. Conclusion Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways. Trial registration ClinicalTrials.gov: NCT04455360.
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Affiliation(s)
- Andrew Bates
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hannah Golding
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
| | - Sophie Rushbrook
- Intensive Psychological Therapies Service, Dorset Healthcare University National Health Service Foundation Trust, Poole, UK
| | - Elan Shapiro
- Independent EMDR Europe Consultant Practitioner, Haifa, Israel
| | - Natalie Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Michael P W Grocott
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rebecca Cusack
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Cuninghame S, Jerath A, Gorsky K, Sivajohan A, Francoeur C, Withington D, Burry L, Cuthbertson BH, Orser BA, Martin C, Owen AM, Slessarev M. Effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults: a systematic review and meta-analysis. Br J Anaesth 2023; 131:314-327. [PMID: 37344338 DOI: 10.1016/j.bja.2023.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/17/2023] [Accepted: 05/04/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Sedation of critically ill patients with inhaled anaesthetics may reduce lung inflammation, time to extubation, and ICU length of stay compared with intravenous (i.v.) sedatives. However, the impact of inhaled anaesthetics on cognitive and psychiatric outcomes in this population is unclear. In this systematic review, we aimed to summarise the effect of inhaled anaesthetics on cognitive and psychiatric outcomes in critically ill adults. METHODS We searched MEDLINE, EMBASE, and PsycINFO for case series, retrospective, and prospective studies in critically ill adults sedated with inhaled anaesthetics. Outcomes included delirium, psychomotor and neurological recovery, long-term cognitive dysfunction, ICU memories, anxiety, depression, post-traumatic stress disorder (PTSD), and instruments used for assessment. RESULTS Thirteen studies were included in distinct populations of post-cardiac arrest survivors (n=4), postoperative noncardiac patients (n=3), postoperative cardiac patients (n=2), and mixed medical-surgical patients (n=4). Eight studies reported delirium incidence, two neurological recovery, and two ICU memories. One study reported on psychomotor recovery, long-term cognitive dysfunction, anxiety, depression, and PTSD. A meta-analysis of five trials found no difference in delirium incidence between inhaled and i.v. sedatives (relative risk 0.95 [95% confidence interval: 0.59-1.54]). Compared with i.v. sedatives, inhaled anaesthetics were associated with fewer hallucinations and faster psychomotor recovery but no differences in other outcomes. There was heterogeneity in the instruments used and timing of these assessments. CONCLUSIONS Based on the limited evidence available, there is no difference in cognitive and psychiatric outcomes between adults exposed to volatile sedation or intravenous sedation in the ICU. Future studies should incorporate outcome assessment with validated tools during and after hospital stay. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42021236455.
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Affiliation(s)
- Sean Cuninghame
- Department of Medicine, Western University, London, ON, Canada
| | - Angela Jerath
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Schulich Heart Program, Sunnybrook Research Institute, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Kevin Gorsky
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Asaanth Sivajohan
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Conall Francoeur
- Centre de Recherche CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Davinia Withington
- Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Lisa Burry
- Departments of Pharmacy and Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Brian H Cuthbertson
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada
| | - Beverley A Orser
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Claudio Martin
- Department of Medicine, Western University, London, ON, Canada
| | - Adrian M Owen
- Western Institute for Neuroscience, Western University, London, ON, Canada; Department of Psychology and Department of Physiology and Pharmacology, Western University, London, Canada
| | - Marat Slessarev
- Department of Medicine, Western University, London, ON, Canada; Western Institute for Neuroscience, Western University, London, ON, Canada.
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Ghezzi ES, Sharman RLS, Selvanayagam JB, Psaltis PJ, Sanders P, Astley JM, Knayfati S, Batra V, Keage HAD. Burden of mood symptoms and disorders in implantable cardioverter defibrillator patients: a systematic review and meta-analysis of 39 954 patients. Europace 2023; 25:euad130. [PMID: 37311667 PMCID: PMC10264222 DOI: 10.1093/europace/euad130] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/23/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death. Anxiety, depression, and post-traumatic stress disorder (PTSD) are underappreciated symptoms. We aimed to systematically synthesize prevalence estimates of mood disorders and symptom severities, pre- and post-ICD insertions. Comparisons were made with control groups, as well as within ICD patients by indication (primary vs. secondary), sex, shock status, and over time. METHODS Databases (Medline, PsycINFO, PubMed, and Embase) were searched without limits from inception to 31 August 2022; 4661 articles were identified, 109 (39 954 patients) of which met criteria. RESULTS Random-effects meta-analyses revealed clinically relevant anxiety in 22.58% (95%CI 18.26-26.91%) of ICD patients across all timepoints following insertion and depression in 15.42% (95%CI 11.90-18.94%). Post-traumatic stress disorder was seen in 12.43% (95%CI 6.90-17.96%). Rates did not vary relative to indication group. Clinically relevant anxiety and depression were more likely in ICD patients who experienced shocks [anxiety odds ratio (OR) = 3.92 (95%CI 1.67-9.19); depression OR = 1.87 (95%CI 1.34-2.59)]. Higher symptoms of anxiety were seen in females than males post-insertion [Hedges' g = 0.39 (95%CI 0.15-0.62)]. Depression symptoms decreased in the first 5 months post-insertion [Hedges' g = 0.13 (95%CI 0.03-0.23)] and anxiety symptoms after 6 months [Hedges' g = 0.07 (95%CI 0-0.14)]. CONCLUSION Depression and anxiety are highly prevalent in ICD patients, especially in those who experience shocks. Of particular concern is the prevalence of PTSD following ICD implantation. Psychological assessment, monitoring, and therapy should be offered to ICD patients and their partners as part of routine care.
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Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Rhianna L S Sharman
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Joseph B Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, GPO Box 2100, Adelaide SA 5001, Australia
- Department of Medicine, School of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
| | - Peter J Psaltis
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia
| | - Prashanthan Sanders
- Lifelong Health Theme, South Australian Health and Medical Research Institute, North Terrace, Adelaide SA 5000, Australia
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide SA 5005, Australia
- Department of Cardiology, Royal Adelaide Hospital, Port Road, Adelaide SA 5000, Australia
| | - Jack M Astley
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Sara Knayfati
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Vrinda Batra
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, GPO Box 2741, Adelaide SA 5000, Australia
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Kürtüncü M, Kurt A, Arslan N. The Experiences of COVID-19 Patients in Intensive Care Units: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2023; 87:504-518. [PMID: 34120515 PMCID: PMC10583477 DOI: 10.1177/00302228211024120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This exploratory qualitative study explores the experiences of COVID-19 patients in intensive care units and after discharge. Semi- structured telephone interviews were conducted with 18 COVID-19 patients admitted to and discharged from intensive care units between March and September in 2020. The themes of this study were determined as "feelings about the illness and intensive care," "psychological and physical damages," "nurses' efforts and the importance of care.", and "protecting health and life". COVID-19 patients in intensive care units may experience permanent physical and psychological damages. The findings suggest that the first step in carrying out interventions in the intensive care units is to ensure that continuous communication with patients is maintained so that their orientation to the new circumstances can be achieved. Nursing interventions to patients missing their families can have compensated for the loss of family support and care during their critical illness.
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Affiliation(s)
- Meltem Kürtüncü
- Nursing Department, Faculty of Health Sciences, Zonguldak Bülent Ecevit University, Turkey
| | - Aylin Kurt
- Nursing Department, Faculty of Health Sciences, Bartın University, Turkey
| | - Nurten Arslan
- Nursing Department, Zonguldak Bülent Ecevit University, Turkey
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Yu Y, Li Y, Han D, Gong C, Wang L, Li B, Yao R, Zhu Y. Effect of Dexmedetomidine on Posttraumatic Stress Disorder in Patients Undergoing Emergency Trauma Surgery: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2318611. [PMID: 37326991 PMCID: PMC10276303 DOI: 10.1001/jamanetworkopen.2023.18611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/01/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Posttraumatic stress disorder (PTSD) is common in people who have experienced trauma, especially those hospitalized for surgery. Dexmedetomidine may reduce or reverse the early consolidation and formation of conditioned fear memory and prevent the occurrence of postoperative PTSD. Objective To evaluate the effects of intraoperative and postoperative low-dose intravenous pumping dexmedetomidine on PTSD among patients with trauma undergoing emergency surgery. Design, Setting, and Participants This double-blind, randomized clinical trial was conducted from January 22 to October 20, 2022, with follow-up 1 month postoperatively, in patients with trauma undergoing emergency surgery at 4 hospital centers in Jiangsu Province, China. A total of 477 participants were screened. The observers were blinded to patient groupings, particularly for subjective measurements. Interventions Dexmedetomidine or placebo (normal saline) was administered at a maintenance dose of 0.1 μg/kg hourly from the start of anesthesia until the end of surgery and at the same rate after surgery from 9 pm to 7 am on days 1 to 3. Main Outcomes and Measures The primary outcome was the difference in the incidence of PTSD 1 month after surgery in the 2 groups. This outcome was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (CAPS-5). The secondary outcomes were the pain score within 48 hours and 1 month postoperatively; incidence of postoperative delirium, nausea, and pruritus; subjective sleep quality; anxiety; and occurrence of adverse events. Results A total of 310 patients (154 in the normal saline group and 156 in the dexmedetomidine group) were included in the modified intention-to-treat analysis (mean [SD] age, 40.2 [10.3] years; 179 men [57.7%]). The incidence of PTSD was significantly lower in the dexmedetomidine group than in the control group 1 month postoperatively (14.1% vs 24.0%; P = .03). The participants in the dexmedetomidine group had a significantly lower CAPS-5 score than those in the control group (17.3 [5.3] vs 18.9 [6.6]; mean difference, 1.65; 95% CI, 0.31-2.99; P = .02). After adjusting for potential confounders, the patients in the dexmedetomidine group were less likely to develop PTSD than those in the control group 1 month postoperatively (adjusted odds ratio, 0.51; 95% CI, 0.27-0.94; P = .03). Conclusions and Relevance In this randomized clinical trial, the administration of intraoperative and postoperative dexmedetomidine reduced the incidence of PTSD among patients with trauma. The findings of this trial support the use of dexmedetomidine in emergency trauma surgery. Trial Registration Chinese Clinical Trial Register Identifier: ChiCTR2200056162.
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Affiliation(s)
- Youjia Yu
- Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, Suzhou, China
| | - Yan Li
- Department of Anesthesiology, Suzhou Xiangcheng People’s Hospital, Suzhou, China
| | - Dan Han
- Department of Anesthesiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Chuhao Gong
- Department of Anesthesiology, Xuzhou Renci Hospital, Xuzhou, China
| | - Liwei Wang
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
| | - Beiping Li
- Department of Anesthesiology, Xuzhou First People’s Hospital, Xuzhou, China
| | - Rui Yao
- Department of Anesthesiology, Xuzhou First People’s Hospital, Xuzhou, China
| | - Yangzi Zhu
- Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
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Herrmann J, Müller K, Notz Q, Hübsch M, Haas K, Horn A, Schmidt J, Heuschmann P, Maschmann J, Frosch M, Deckert J, Einsele H, Ertl G, Frantz S, Meybohm P, Lotz C. Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients. Sci Rep 2023; 13:6785. [PMID: 37100832 PMCID: PMC10133285 DOI: 10.1038/s41598-023-33783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/19/2023] [Indexed: 04/28/2023] Open
Abstract
Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.
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Affiliation(s)
- Johannes Herrmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Kerstin Müller
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Quirin Notz
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Martha Hübsch
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Kirsten Haas
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Anna Horn
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Julia Schmidt
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Peter Heuschmann
- Institute for Clinical Epidemiology and Biometry, Julius-Maximilians-University Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Wuerzburg, Würzburg, Germany
| | - Jens Maschmann
- University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Matthias Frosch
- University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center Würzburg (CHFC), University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany
| | - Christopher Lotz
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Julius-Maximilians-University Wuerzburg, Würzburg, Germany.
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany.
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Lima TCDS, Coste SC, Fernandes MIAP, Barbato-Ferreira DA, Colosimo EA, Del Fabbro M, Ribeiro Sobrinho AP, Côrtes MIDS, Bastos JV. Prevalence of traumatic dental injuries in emergency dental services: A systematic review and meta-analysis. Community Dent Oral Epidemiol 2023; 51:247-255. [PMID: 35165912 DOI: 10.1111/cdoe.12733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to perform a systematic review and meta-analysis regarding the prevalence of traumatic dental injuries (TDI) in emergency dental services. METHODS Seven electronic and two grey literature databases were searched, up to December 2021, for studies that reported the TDI prevalence among dental emergencies. The Joanna Briggs Institute critical appraisal checklist for prevalence studies, and The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach were used to assess the risk of bias and quality of evidence respectively. The R software was used to perform a proportion meta-analysis on a random-effects model to estimate the pooled prevalence and respective 95% CI. RESULTS From a total of 1476 studies identified after excluding duplicates, 38 met the inclusion criteria, and another five were identified through hand searching, summing 43 included observational studies with a total sample of 209099 individuals searching for emergency dental care. The overall pooled prevalence of TDI was 15.4% (95% CI: 11%-21%, I² = 100%). Paediatric dental emergency services and age group from 0 to 21 years presented the highest prevalence, 29% (95% CI: 22%-38%, I² = 99.5%) and 24% (95% CI: 15%-35%, I² = 98%) respectively. CONCLUSIONS The overall pooled prevalence of TDI in emergency dental services was 15.4%, and 24% in the age group under 21 years. Considering the impact of prompt and correct emergency care in the long-term prognosis of TDI, such knowledge is relevant to organize emergency healthcare and support public policies in this area.
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Affiliation(s)
- Thiago César da Silva Lima
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas, Belo Horizonte, Brazil
| | - Sylvia Cury Coste
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas, Belo Horizonte, Brazil
| | | | | | - Enrico Antônio Colosimo
- Statistics Department, Institute of Exact Sciences, Universidade Federal de Minas, Belo Horizonte, Brazil
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di, Milano, Italy
| | | | | | - Juliana Vilela Bastos
- Restorative Dentistry Department, School of Dentistry, Universidade Federal de Minas, Belo Horizonte, Brazil
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Eaton TL, Lewis A, Donovan HS, Davis BC, Butcher BW, Alexander SA, Iwashyna TJ, Scheunemann LP, Seaman J. Examining the needs of survivors of critical illness through the lens of palliative care: A qualitative study of survivor experiences. Intensive Crit Care Nurs 2023; 75:103362. [PMID: 36528461 DOI: 10.1016/j.iccn.2022.103362] [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: 03/29/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To examine the needs of adult survivors of critical illness through a lens of palliative care. RESEARCH METHODOLOGY A qualitative study of adult survivors of critical illness using semi-structured interviews and framework analysis. SETTING Participants were recruited from the post-intensive care unit clinic of a mid-Atlantic academic medical center in the United States. FINDINGS Seventeen survivors of critical illness aged 34-80 (median, 66) participated in the study. The majority of patients were female (64.7 %, n = 11) with a median length of index ICU stay of 12 days (interquartile range [IQR] 8-19). Interviews were conducted February to March 2021 and occurred a median of 20 months following the index intensive care stay (range, 13-33 months). We identified six key themes which align with palliative care principles: 1) persistent symptom burden; 2) critical illness as a life-altering experience; 3) spiritual changes and significance; 4) interpreting/managing the survivor experience; 5) feelings of loss and burden; and 6) social support needs. CONCLUSION Our findings suggest that palliative care components such as symptom management, goals of care discussions, care coordination, and spiritual and social support may assist in the assessment and treatment of survivors of critical illness.
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Affiliation(s)
- Tammy L Eaton
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA; National Clinician Scholars Program (NCSP), Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Anna Lewis
- School of Public Health, Department of Health Policy and Management, University of Pittsburgh, PA, USA; Care Management Department, University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, PA, USA
| | - Heidi S Donovan
- Department of Health & Community Systems, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA; Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, PA, USA
| | - Brian C Davis
- School of Law, Duquesne University, Pittsburgh, PA, USA
| | - Brad W Butcher
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sheila A Alexander
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theodore J Iwashyna
- Department of Medicine, Division of Pulmonary & Critical Care, University of Michigan, Ann Arbor, MI, USA; Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Leslie P Scheunemann
- Division of Geriatric Medicine and Gerontology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer Seaman
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Melkam M, Tinsae T, Andualem F, Nakie G. Post-traumatic stress disorder and associated factors among adults exposed to stress in Ethiopia: A meta-analysis and systematic review. SAGE Open Med 2023; 11:20503121231160884. [PMID: 36949825 PMCID: PMC10026129 DOI: 10.1177/20503121231160884] [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: 10/20/2022] [Accepted: 02/13/2023] [Indexed: 03/19/2023] Open
Abstract
Objective Post-traumatic stress disorder is a complex psychiatric disorder that develops after exposure to traumatic events, such as violent physical assaults, accidents, rape, natural disasters, and conflicts, stranger than usual human experiences. The typical presentation of intrusive thoughts, the persistence of the trauma, the avoidance of pertinent stimuli, emotional numbness, and physiological hyperarousal are the characteristics of this anxiety symptom. Despite the presence of a study conducted on this problem, the pooled effect, particularly in Ethiopia, is not known; therefore, this study assessed the allover burden of post-traumatic stress disorder. Method The available study was extracted and conducted on post-traumatic stress disorder and its associated factors in Ethiopia by three independent authors. The data were analyzed by using STATA version 11 after extraction was done on a Microsoft Excel spreadsheet. The random-effect model was used to estimate the pooled effect size of post-traumatic stress disorder and its effect in the previous studies with 95% confidence intervals. Funnel plots analysis and Egger regression tests were conducted to detect the presence of publication bias. A subgroup analysis and a sensitivity analysis were done. Result Thirteen (13) studies were included with a total of 5874 study participants in this meta-analysis and systematic reviews. The pooled prevalence of post-traumatic stress disorder in Ethiopia was 39.28% with a 95% confidence interval (26.54, 52.01). Poor social support (adjusted odds ratio = 2.86; 95% confidence interval (1.81, 4.53)), being female (adjusted odds ratio = 1.89; 95% confidence interval (1.53, 2.34)), presence of previous mental illness (adjusted odds ratio = 4.72; 95% confidence interval (2.62, 8.36)), and witness (adjusted odds ratio = 2.01; 95% confidence interval (1.30, 3.11)) were associated with post-traumatic stress disorder. Conclusion The burden of post-traumatic stress disorder in this meta-analysis and systematic review is high; therefore, immediate intervention is needed for those specific traumatized individuals.
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Affiliation(s)
- Mamaru Melkam
- Department of Psychiatry, University of Gondar
College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, University of Gondar
College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, University of Gondar
College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, University of Gondar
College of Medicine and Health Sciences, Gondar, Ethiopia
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Sokoll PR, Migliavaca CB, Siebert U, Schmid D, Arvandi M. Prevalence of Mycoplasma genitalium infection among HIV PrEP users: a systematic review and meta-analysis. Sex Transm Infect 2023:sextrans-2022-055687. [PMID: 36759179 DOI: 10.1136/sextrans-2022-055687] [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: 11/07/2022] [Accepted: 01/28/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES To summarise the prevalence of Mycoplasma genitalium (MG) and antibiotic-resistant MG infection among HIV pre-exposure prophylaxis (PrEP) users. METHODS We searched MEDLINE, Embase, Web of Science and Global Index Medicus up to 30 September 2022. We included studies reporting the prevalence of MG and/or antibiotic-resistant MG infection among PrEP users. Two reviewers independently searched for studies and extracted data. A systematic review with random-effects meta-analysis was performed to quantitatively summarise the results of included studies. The critical appraisal of included studies was conducted with the Joanna Briggs Institute checklist for prevalence studies and the quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 15 studies were included in the systematic review, with 2341 individuals taking PrEP. Studies were conducted in high-income level countries between 2014 and 2019. Median age of participants varied from 23.5 to 40 years. The majority were men (85%) and among them, 93% were men who have sex with men. To identify MG, urine samples were analysed in 14 studies, rectal or anal swabs in 12 studies, oral or pharyngeal swabs in 9 studies, and urethral or vaginal in 3 studies. The pooled point prevalence of MG among PrEP users was 16.7% (95% CI 13.6% to 20.3%; 95% prediction interval (95% PI) 8.2% to 31.1%). The pooled point prevalence of macrolide-resistant infections was 82.6% (95% CI 70.1% to 90.6%; 95% PI 4.7% to 99.8%) and the prevalence of fluoroquinolone-resistant infections was 14.3% (95% CI 1.8% to 42.8%). Individuals taking PrEP have a higher chance of being infected with MG compared with those not taking PrEP (OR 2.30; 95% CI 1.6 to 3.4). The quality of evidence was very low to moderate. CONCLUSION We observed a high prevalence of MG and its macrolide resistance among PrEP users, highlighting the need to reinforce prevention strategies against sexually transmitted infections in this population. PROSPERO REGISTRATION NUMBER CRD42022310597.
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Affiliation(s)
- Paulo Roberto Sokoll
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Celina Borges Migliavaca
- Health Technology Assessment Institute (IATS), Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA). Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Daniela Schmid
- Division for Quantitative Methods in Public Health and Health Services Research, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making and Heath Technology Assessment, Department for Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Zhao Q, Xiao J, Liu X, Liu H. The nomogram to predict the occurrence of sepsis-associated encephalopathy in elderly patients in the intensive care units: A retrospective cohort study. Front Neurol 2023; 14:1084868. [PMID: 36816550 PMCID: PMC9932587 DOI: 10.3389/fneur.2023.1084868] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Background Sepsis-associated encephalopathy (SAE) is a critical and common problem in elderly patients with sepsis, which is still short of efficient predictive tools. Therefore, this study aims to screen the risk factors and establish a useful predictive nomogram for SAE in elderly patients with sepsis in the intensive care unit (ICU). Patients and methods Elderly patients (age ≥ 65 years) with sepsis were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Data from demographics and laboratory examinations were collected on the first day of admission to the ICU. SAE was defined by two criteria in the presence of sepsis: ① a Glasgow Coma Scale (GCS) score of < 15 or ② delirium. Differences in demographics and laboratory tests were calculated between SAE and non-SAE groups. Participants were randomly divided into a training set and a validation set without replacement at a ratio of 6:4. A predictive nomogram was constructed in the training set by logistic regression analysis and then validated. The predictive capability of the nomogram was demonstrated by receiver operating characteristic (ROC) analysis and calibration curve analysis. Results A total of 22,361 patients were selected, of which 2,809 patients (12.7%) died in the hospital and 8,290 patients (37.1%) had SAE. In-hospital mortality in the SAE group was higher than that in the non-SAE group (18.8 vs. 8.9%, p < 0.001). Based on the results of logistic regression analysis, a nomogram integrating age, Na+, Sequential Organ Failure Assessment (SOFA) score, heart rate, and body temperature were constructed. The area under the curve (AUC) of the nomogram was 80.2% in the training set and 80.9% in the validation set. Calibration curve analysis showed a good predictive capacity of the nomogram. Conclusion SAE is an independent risk of in-hospital mortality in elderly patients in the intensive care unit. The nomogram has an excellent predictive capability of SAE and helps in clinical practice.
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Affiliation(s)
- Qing Zhao
- Department of Diagnosis and Treatment of Cadres, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jianguo Xiao
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaoli Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hui Liu
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China,*Correspondence: Hui Liu ✉
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Skinner JP, Moran LV. Persistent effects of COVID-19 in patients hospitalized during the first wave of the pandemic: The impact of persistent fatigue on quality of life in a cross-sectional study. J Med Virol 2023; 95:e28491. [PMID: 36832543 DOI: 10.1002/jmv.28491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/02/2022] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
COVID-19 can affect physical and mental health long after acute infection. In this descriptive study, 48 individuals hospitalized for COVID-19 between April and May 2020 were interviewed regarding their experience with COVID-19 after hospitalization. The mean age of participants was 51.1 (±11.91) years (range 25-65 years) and 26 (54.2%) were men. Individuals had a mean of 1.2 (±0.94) comorbidities associated with more severe COVID-19, with hypertension (37.5%) being most common. Nineteen (39.6%) individuals required treatment in the intensive care unit. Participants were interviewed a median time of 553 days (IQR, 405.5-589.0) after discharge from the hospital. Thirty-seven (77.1%) individuals had 5 or more persistent symptoms at time of interview with only 3 (6.3%) experiencing none. The most reported persistent symptoms were fatigue (79.2%), difficulty breathing (68.8%), and muscle weakness (60.4%). Poor quality of life was experienced by 39 (81.3%) participants and 8 (16.7%) had a posttraumatic stress disorder (PTSD) score within the clinical range for diagnosis. For multivariable analyses, persistent fatigue was significantly predicted by number of symptoms during acute COVID-19 (t = 4.4, p < 0.001). Number of symptoms during acute COVID-19 was also significantly associated with persistent dyspnea (t = 3.4, p = 0.002). Higher scores on the Chalder fatigue scale after COVID-19 was significantly associated with poor quality of life (t = 2.6, p = 0.01) and PTSD symptomatology (t = 2.9, p = 0.008). More research is needed to highlight the wide range of resources those suffering from Long COVID require long after discharge.
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Affiliation(s)
- Joseph P Skinner
- Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA
| | - Lauren V Moran
- Division of Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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