Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study

How and when post intensive care syndrome-family is measured: A scoping review

OBJECTIVES

Family members of Intensive Care Unit (ICU) patients can experience mental health difficulties. These are collectively described as Post Intensive Care Syndrome-Family (PICS-F). There are no standardised outcome measures to benchmark the impact of PICS-F. This scoping review aimed to map and characterise interventions, outcomes, and outcome instruments related to PICS-F.

METHODS

Eight databases were searched in June 2023: Pubmed, CINAHL, Ovid Medline, EMBASE, PsycInfo, AMED, Emcare and Cochrane. The grey literature was also searched. Studies published after 2012 related to PICS-F were included. Search strategy included: (Population) family members of adult ICU patients, (Concept) PICS-F, (Context) ICU settings. Frequency analysis of outcomes was performed, and instruments were mapped to describe the characteristics.

RESULTS

Of the identified 4848 records, 46 papers representing 44 unique studies met the inclusion criteria and were retained for analysis. In total, 8008 family members were represented across 15 countries in four continents worldwide. The number of studies reporting PICS-F interventions increased rapidly over the past 12 years and were performed in ICUs treating mixed conditions. Studies were randomised control trials (n = 33), before-and-after design (n = 6) and non-randomised trials (n = 5). A total of 18 outcome instruments were used measuring predominantly anxiety, with complicated grief measured only once. The identified instruments were mostly validated for clinical and disease specific populations but not validated among relatives of ICU patients.

CONCLUSION

There is a plethora of instruments measuring PICS-F outcomes. No core outcome set is currently available for PICS-F. To reduce heterogeneity of how PICS-F is measured, a core outcome set with validated measurements is recommended to allow benchmarking and to document the impact of PICS-F interventions.

IMPLICATIONS FOR CLINICAL PRACTICE

Recognising PICS-F symptoms and understanding how to assess them could help clinicians to develop interventions to improve family outcomes. Validated instruments are needed to evaluate these interventions.

Family Burden of ICU Survivors and Correlations with Patient Quality of Life and Psychometric Scores – A Pilot Study

Introduction

Post intensive care syndrome (PICS) affects an increasing number of critical illness survivors and their families, with serious physical and psychological sequelae. Since little is known about the burden of critical illness on ICU survivor families, we conducted a prospective observational study aiming to assess this, and investigate correlations of the patients’ psychometric and health-related quality of life (HRQOL) scores with family burden.

Materials and Methods

Twenty-nine patients were evaluated in the presence of a family member. Participants were assessed with the use of validated scales for anxiety, depression, post-traumatic stress disorder, cognitive decline, and the family burden scale (FBS).

Results

High burden was present in 27.6% of family members. Statistically significant correlations were observed between the FBS score and trait anxiety, depression, and the physical and psychological components of HRQOL.

Conclusions

Our results suggest that family burden following critical illness is common, suggesting that its assessment should be incorporated in the evaluation of PICS-family in large observational studies.

[Ways of supporting relatives in intensive care units : Overview and update]

Hintergrund

Angehörige von kritisch Kranken auf der Intensivstation („intensive care unit“, ICU) sind in einer herausfordernden Situation: Sie befinden sich häufig in einer existenziellen Krise mit einer großen emotionalen Belastung, gleichzeitig sind sie oftmals aktiv in therapeutische Entscheidungen mit eingebunden. Die Besuchsrestriktionen während der Pandemie aufgrund der Coronaviruserkrankung 2019 (COVID-19) haben viele Rahmenbedingungen für die Angehörigenbegleitung geändert und so die Betreuung von Angehörigen schwieriger gemacht.

Ziel

Ziel der Publikation ist die Darstellung der aktuellen und neuen Entwicklungen in der Angehörigenbegleitung von kritisch Kranken auf Intensivstationen im Rahmen einer narrativen Übersichtsarbeit.

Ergebnisse

In den letzten Jahren wurden zahlreiche Maßnahmen und Projekte zur Angehörigenbegleitung entwickelt, die sich den folgenden 6 Bereichen zuordnen lassen: 1) Anwesenheit der Angehörigen, 2) proaktive Einbindung in die Betreuung, 3) strukturierte Kommunikation und Information sowie Onlineangebote, 4) multidisziplinäre Zusammenarbeit, 5) Aufgaben der Organisationsleitung und 6) Follow-up-Angebote. Die Evidenz und der derzeitige Implementierungsstand der Maßnahmen sind international und national sehr heterogen.

Schlussfolgerungen

Maßnahmen zur Angehörigenbetreuung sind vielfältig und können zum Teil auch unter Besuchsrestriktionen umgesetzt werden. Neuere Entwicklungen im digitalen Bereich ermöglichen zunehmend auch virtuelle Besuche und einen ergänzenden Informationsaustausch zwischen dem Team der ICU und den Angehörigen.

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as "new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization". A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.