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Tejero-Aranguren J, García Del Moral R, Poyatos-Aguilera ME, Colmenero M. Family burden after critical illness: the forgotten caregivers. Med Intensiva 2024; 48:69-76. [PMID: 37783615 DOI: 10.1016/j.medine.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To determine the incidence of primary caregiver burden in a cohort of family members of critically ill patients admitted to ICU and to identify risk factors related to its development in both the patient and the family member. DESIGN Prospective observational cohort study was conducted for 24 months. SETTING Hospital Universitario Clínico San Cecilio, Granada. PATIENTS The sample was the primary caregivers of all patients with risk factors for development of PICS (Post-Intensive Care Syndrome). INTERVENTIONS The follow-up protocol consisted of evaluation 3 months after discharge from the ICU in a specific consultation. MAIN VARIABLES OF INTEREST The scales used in patients were Barthel, SF-12, HADS, Pfeiffer, IES-6 and in relatives the Apgar and Zarit. RESULTS A total of 93 patients and caregivers were included in the follow-up. 15 relatives did not complete the follow-up questionnaires and were excluded from the study. The incidence of PICS-F (Family Post Intensive Care Syndrome) defined by the presence of primary caregiver burden in our cohort of patients is 34.6% (n=27), 95% CI 25.0-45.7. The risk factors for the development of caregiver burden are the presence of physical impairment, anxiety or post-traumatic stress in the patient, with no relationship found with the characteristics studied in the family member. CONCLUSIONS One out of 3 relatives of patients with risk factors for the development of PICS presents at 3 months caregiver burden. This is related to factors dependent on the patient's state of health.
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Affiliation(s)
| | - Raimundo García Del Moral
- POD Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain; Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Manuel Colmenero
- Unidad de Cuidados Intensivos, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Ibs. Granada, Spain
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Prohaska CC, Sottile PD, Nordon-Craft A, Gallagher MD, Burnham EL, Clark BJ, Ho M, Kiser TH, Vandivier RW, Liu W, Schenkman M, Moss M. Patterns of utilization and effects of hospital-specific factors on physical, occupational, and speech therapy for critically ill patients with acute respiratory failure in the USA: results of a 5-year sample. Crit Care 2019; 23:175. [PMID: 31097017 PMCID: PMC6524324 DOI: 10.1186/s13054-019-2467-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/05/2019] [Indexed: 05/30/2023]
Abstract
Background Timely initiation of physical, occupational, and speech therapy in critically ill patients is crucial to reduce morbidity and improve outcomes. Over a 5-year time interval, we sought to determine the utilization of these rehabilitation therapies in the USA. Methods We performed a retrospective cohort study utilizing a large, national administrative database including ICU patients from 591 hospitals. Patients over 18 years of age with acute respiratory failure requiring invasive mechanical ventilation within the first 2 days of hospitalization and for a duration of at least 48 h were included. Results A total of 264,137 patients received invasive mechanical ventilation for a median of 4.0 [2.0–8.0] days. Overall, patients spent a median of 5.0 [3.0–10.0] days in the ICU and 10.0 [7.0–16.0] days in the hospital. During their hospitalization, 66.5%, 41.0%, and 33.2% (95% CI = 66.3–66.7%, 40.8–41.2%, 33.0–33.4%, respectively) received physical, occupational, and speech therapy. While on mechanical ventilation, 36.2%, 29.7%, and 29.9% (95% CI = 36.0–36.4%, 29.5–29.9%, 29.7–30.1%) received physical, occupational, and speech therapy. In patients receiving therapy, their first physical therapy session occurred on hospital day 5 [3.0–8.0] and hospital day 6 [4.0–10.0] for occupational and speech therapy. Of all patients, 28.6% (95% CI = 28.4–28.8%) did not receive physical, occupational, or speech therapy during their hospitalization. In a multivariate analysis, patients cared for in the Midwest and at teaching hospitals were more likely to receive physical, occupational, and speech therapy (all P < 0.05). Of patients with identical covariates receiving therapy, there was a median of 61%, 187%, and 70% greater odds of receiving physical, occupational, and speech therapy, respectively, at one randomly selected hospital compared with another (median odds ratio 1.61, 2.87, 1.70, respectively). Conclusions Physical, occupational, and speech therapy are not routinely delivered to critically ill patients, particularly while on mechanical ventilation in the USA. The utilization of these therapies varies according to insurance coverage, geography, and hospital teaching status, and at a hospital level. Electronic supplementary material The online version of this article (10.1186/s13054-019-2467-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Clare C Prohaska
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA. .,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA.
| | - Peter D Sottile
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA
| | - Amy Nordon-Craft
- Department of Physical Therapy, University of Colorado Hospital, Aurora, CO, 80045, USA
| | | | - Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA
| | - Brendan J Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA
| | - Michael Ho
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, 80045, USA
| | - R William Vandivier
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA
| | - Wenhui Liu
- VA Eastern Colorado Health Care System, Aurora, CO, 80045, USA
| | - Margaret Schenkman
- Department of Physical Therapy, University of Colorado Hospital, Aurora, CO, 80045, USA
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA
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