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Mason CK, Adie SK, Shea MJ, Konerman MC, Thomas MP, McSparron JI, Iwashyna TJ, Prescott HC, Thompson AD. Post-intensive cardiac care outpatient long-term outreach clinic (PICCOLO clinic): Defining health care needs and outcomes among coronary care unit survivors. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 38:100363. [PMID: 38434252 PMCID: PMC10906849 DOI: 10.1016/j.ahjo.2024.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 03/05/2024]
Abstract
Objective Patients who survive critical illness endure complex physical and mental health conditions, referred to as post-intensive care syndrome (PICS). The University of Michigan's post-intensive cardiac care outpatient long-term outreach (PICCOLO) clinic is designed for patients recently admitted to the coronary care unit (CCU). The long-term goal of this clinic is to understand post-CCU patients' needs and design targeted interventions to reduce their morbidity and mortality post-discharge. As a first step toward this goal, we aimed to define the post-discharge needs of CCU survivors. Design setting particpants We retrospectively reviewed case-mix data (including rates of depression, PTSD, disability, and cognitive abnormalities) and health outcomes for patients referred to the PICCOLO clinic from July 1, 2018, through June 30, 2021 at Michigan Medicine. Results Of the 134 referred patients meeting inclusion criteria, 74 (55 %) patients were seen in the PICCOLO clinic within 30 days of discharge. Patients seen in the clinic frequently screened positive for depression (PHQ-2 score ≥3, 21.4 %) and cognitive impairment (MOCA <26, 38.8 %). Further, patients also reported high rates of physical difficulty (mean WHODAS 2.0 score 28.4 %, consistent with moderate physical difficulty). Consistent with medical intensive care unit (ICU) patients, CCU survivors experience PICS. Conclusion This work highlights the feasibility of an outpatient care model and the need to leverage information gathered from this care model to develop treatment strategies and pathways to address symptoms of PICS in CCU survivors, including depression, cognitive impairment, and physical disability.
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Affiliation(s)
- Christopher K. Mason
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Sara K. Adie
- Department of Pharmacy Service, University of Michigan, Ann Arbor, MI, United States of America
| | - Michael J. Shea
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America
| | - Matthew C. Konerman
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America
| | - Michael P. Thomas
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America
| | - Jakob I. McSparron
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Ann Arbor, MI, United States of America
| | - Theodore J. Iwashyna
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Johns Hopkins Medicine, Baltimore, MD, United States of America
| | - Hallie C. Prescott
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Ann Arbor, MI, United States of America
- VA Center for Clinical Management Research, Ann Arbor, MI, United States of America
| | - Andrea D. Thompson
- Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America
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Garg I, Gangu K, Zabel KM, Shuja H, Sohail AH, Nasrullah A, Sohail S, Combs SA, Sheikh AB. Trends in utilisation of palliative care services in COVID-19 patients and their impact on hospital resources in the USA: insights from the national inpatient sample. BMJ Support Palliat Care 2024:spcare-2023-004621. [PMID: 38135484 DOI: 10.1136/spcare-2023-004621] [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: 09/30/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Poor prognosis and lack of effective therapeutic options have made palliative care an integral part of the management of severe COVID-19. However, clinical studies on the role of palliative care in severe COVID-19 patients are lacking. The objective of our study was to evaluate the utility of palliative care in intubated COVID-19 patients and its impact on in-hospital outcomes. METHODS Rate of palliative care consult, patient-level variables (age, sex, race, income, insurance type), hospital-level variables (region, type, size) and in-hospital outcome variables (mortality, cost, disposition, complications) were recorded. RESULTS We retrospectively analysed 263 855 intubated COVID-19 patients using National Inpatient Sample database from 1 January 2020 to 31 December 2020. 65 325 (24.8%) patients received palliative care consult. Factors associated with an increased rate of palliative care consults included: female gender (p<0.001), older age (p<0.001), Caucasian race (p<0.001), high household income (p<0.001), Medicare insurance (p<0.001), admission to large-teaching hospitals (p<0.001), patients with underlying comorbidities, development of in-hospital complications and the need for intensive care procedures. Patients receiving palliative consults had shorter hospital length of stay (LOS) (p<0.001) and no difference in hospitalisation cost (p=0.15). CONCLUSIONS Palliative care utilisation rate in intubated COVID-19 patients was reflective of disease severity and disparities in healthcare access. Palliative care may help reduce hospital LOS. Our findings also highlight importance of improving access to palliative care services and its integration into the multidisciplinary management of severe COVID-19 patients.
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Affiliation(s)
- Ishan Garg
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Karthik Gangu
- The University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Hina Shuja
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Amir Humza Sohail
- NYU Langone Health, New York, New York, USA
- NYU Langone, NYU Grossman Long Island School of Medicine, New York, New York, USA
| | | | | | - Sara A Combs
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Abu Baker Sheikh
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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3
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Shirasaki K, Hifumi T, Nakanishi N, Nosaka N, Miyamoto K, Komachi MH, Haruna J, Inoue S, Otani N. Postintensive care syndrome family: A comprehensive review. Acute Med Surg 2024; 11:e939. [PMID: 38476451 PMCID: PMC10928249 DOI: 10.1002/ams2.939] [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: 09/28/2023] [Revised: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.
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Affiliation(s)
- Kasumi Shirasaki
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of Surgery RelatedKobe University Graduate School of MedicineKobeJapan
| | - Nobuyuki Nosaka
- Department of Intensive Care MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Kyohei Miyamoto
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Miyuki H. Komachi
- School of Clinical Medicine, Department of Psychiatry, Child and Adolescent Resilience and Mental HealthUniversity of CambridgeCambridgeUK
| | - Junpei Haruna
- Department of Intensive Care Medicine, School of MedicineSapporo Medical UniversityHokkaidoJapan
| | - Shigeaki Inoue
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Norio Otani
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
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Ferguson CE, Tatucu-Babet OA, Amon JN, Chapple LAS, Malacria L, Myint Htoo I, Hodgson CL, Ridley EJ. Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review. Nutr Res Rev 2023:1-14. [PMID: 38073417 DOI: 10.1017/s0954422423000288] [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: 01/11/2024]
Abstract
Quantification of oral intake within the hospital setting is required to guide nutrition care. Multiple dietary assessment methods are available, yet details regarding their application in the acute care setting are scarce. This scoping review, conducted in accordance with JBI methodology, describes dietary assessment methods used to measure oral intake in acute and critical care hospital patients. The search was run across four databases to identify primary research conducted in adult acute or critical care settings from 1st of January 2000-15th March 2023 which quantified oral diet with any dietary assessment method. In total, 155 articles were included, predominantly from the acute care setting (n = 153, 99%). Studies were mainly single-centre (n = 138, 88%) and of observational design (n = 135, 87%). Estimated plate waste (n = 59, 38%) and food records (n = 43, 28%) were the most frequent assessment methods with energy and protein the main nutrients quantified (n = 81, 52%). Validation was completed in 23 (15%) studies, with the majority of these using a reference method reliant on estimation (n = 17, 74%). A quarter of studies (n = 39) quantified completion (either as complete versus incomplete or degree of completeness) and four studies (2.5%) explored factors influencing completion. Findings indicate a lack of high-quality evidence to guide selection and application of existing dietary assessment methods to quantify oral intake with a particular absence of evidence in the critical care setting. Further validation of existing tools and identification of factors influencing completion is needed to guide the optimal approach to quantification of oral intake in both research and clinical contexts.
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Affiliation(s)
- Clare E Ferguson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Oana A Tatucu-Babet
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Jenna N Amon
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
| | - Lee-Anne S Chapple
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Lauren Malacria
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ivy Myint Htoo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Division of Clinical Trials and Cohort Studies, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Emma J Ridley
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Dietetics and Nutrition Department, Alfred Health, Melbourne, Victoria, Australia
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Jain S, Han L, Gahbauer EA, Leo-Summers L, Feder SL, Ferrante LE, Gill TM. Changes in Restricting Symptoms after Critical Illness among Community-Living Older Adults. Am J Respir Crit Care Med 2023; 208:1206-1215. [PMID: 37769149 PMCID: PMC10868351 DOI: 10.1164/rccm.202304-0693oc] [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: 04/12/2023] [Accepted: 09/28/2023] [Indexed: 09/30/2023] Open
Abstract
Rationale: Survivors of critical illness have multiple symptoms, but how restricting symptoms change after critical illness and whether these changes differ among vulnerable subgroups is unknown. Objectives: To evaluate changes in restricting symptoms over the six months after critical illness among older adults and to determine whether these changes differ by sex, multimorbidity, and individual- and neighborhood-level socioeconomic disadvantage. Methods: From a prospective longitudinal study of 754 community-living adults ⩾70 years old interviewed monthly (1998-2018), we identified 233 admissions from 193 participants to the ICU. The occurrence of 15 restricting symptoms, defined as those leading to restricted activity, were ascertained during interviews in the month before ICU admission (baseline) and each of the six months after hospital discharge. Measurements and Main Results: The occurrence and number of restricting symptoms increased more than threefold in the six months after a critical illness hospitalization (adjusted rate ratio [95% confidence interval], 3.1 [2.1-4.6] and 3.3 [2.1-5.3], respectively), relative to baseline. These increases were largest in the first month after hospitalization (adjusted rate ratio [95% confidence interval], 5.3 [3.8-7.3] and 5.4 [3.9-7.5], respectively] before declining and becoming nonsignificant in the third month. Increases in restricting symptoms did not differ significantly by sex, multimorbidity, or individual- or neighborhood-level socioeconomic disadvantage. Conclusions: Restricting symptoms increase substantially after a critical illness before returning to baseline three months after hospital discharge. Our findings highlight the need to incorporate symptom management into post-ICU care and for further investigation into whether addressing restricting symptoms can improve quality of life and functional recovery among older ICU survivors.
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Affiliation(s)
- Snigdha Jain
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Ling Han
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Evelyne A. Gahbauer
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Linda Leo-Summers
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Shelli L. Feder
- School of Nursing, Yale University, New Haven, Connecticut; and
- Pain Research, Informatics, Multiple Morbidities, and Education Center of Excellence, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lauren E. Ferrante
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut
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6
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Doherty C, Feder S, Gillespie-Heyman S, Akgün KM. Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU. J Intensive Care Med 2023:8850666231204305. [PMID: 37822226 DOI: 10.1177/08850666231204305] [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: 10/13/2023]
Abstract
Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness.
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Affiliation(s)
- Christine Doherty
- Department of Internal Medicine New Haven, Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shelli Feder
- Yale University School of Nursing, Orange, CT, USA
| | | | - Kathleen M Akgün
- Yale School of Medicine, New Haven, CT, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, VA-Connecticut and Yale University School of Medicine, New Haven, CT, USA
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7
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Showler L, Ali Abdelhamid Y, Goldin J, Deane AM. Sleep during and following critical illness: A narrative review. World J Crit Care Med 2023; 12:92-115. [PMID: 37397589 PMCID: PMC10308338 DOI: 10.5492/wjccm.v12.i3.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 06/08/2023] Open
Abstract
Sleep is a complex process influenced by biological and environmental factors. Disturbances of sleep quantity and quality occur frequently in the critically ill and remain prevalent in survivors for at least 12 mo. Sleep disturbances are associated with adverse outcomes across multiple organ systems but are most strongly linked to delirium and cognitive impairment. This review will outline the predisposing and precipitating factors for sleep disturbance, categorised into patient, environmental and treatment-related factors. The objective and subjective methodologies used to quantify sleep during critical illness will be reviewed. While polysomnography remains the gold-standard, its use in the critical care setting still presents many barriers. Other methodologies are needed to better understand the pathophysiology, epidemiology and treatment of sleep disturbance in this population. Subjective outcome measures, including the Richards-Campbell Sleep Questionnaire, are still required for trials involving a greater number of patients and provide valuable insight into patients’ experiences of disturbed sleep. Finally, sleep optimisation strategies are reviewed, including intervention bundles, ambient noise and light reduction, quiet time, and the use of ear plugs and eye masks. While drugs to improve sleep are frequently prescribed to patients in the ICU, evidence supporting their effectiveness is lacking.
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Affiliation(s)
- Laurie Showler
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Jeremy Goldin
- Sleep and Respiratory Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
| | - Adam M Deane
- Intensive Care Medicine, The Royal Melbourne Hospital, Parkville 3050, Victoria, Australia
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8
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Shih CY, Wang AY, Chang KM, Yang CC, Tsai YC, Fan CC, Chuang HJ, Thi Phuc N, Chiu HY. Dynamic prevalence of sleep disturbance among critically ill patients in intensive care units and after hospitalisation: A systematic review and meta-analysis. Intensive Crit Care Nurs 2023; 75:103349. [PMID: 36464604 DOI: 10.1016/j.iccn.2022.103349] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Sleep disturbance is a common complaint among critically ill patients in intensive care units and after hospitalisation. However, the prevalence of sleep disturbance among critically ill patients varies widely. OBJECTIVE To estimate the prevalence of sleep disturbance among critically ill patients in the intensive care unit and after hospitalisation. METHODS Electronic databases were searched from their inception until 15 August 2022. Only observational studies with cross-sectional, prospective, and retrospective designs investigating sleep disturbance prevalence among critically ill adults (aged ≥ 18 years) during intensive care unit stay and after hospitalisation were included. RESULTS We found 13 studies investigating sleep disturbance prevalence in intensive care units and 14 investigating sleep disturbance prevalence after hospitalisation, with 1,228 and 3,065 participants, respectively. The prevalence of sleep disturbance during an ICU stay was 66 %, and at two, three, six and ≥ 12 months after hospitalisation was 64 %, 49 %, 40 %, and 28 %, respectively. Studies using the Richards-Campbell Sleep Questionnaire detected a higher prevalence of sleep disturbance among patients in intensive care units than non-intensive care unit specific questionnaires; studies reported comparable sleep disturbance prevalence during intensive care stays for patients with and without mechanical ventilation. CONCLUSION Sleep disturbance is prevalent in critically ill patients admitted to an intensive care unit and persists for up to one year after hospitalisation, with prevalence ranging from 28 % to 66 %. The study results highlight the importance of implementing effective interventions as early as possible to improve intensive care unit sleep quality.
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Affiliation(s)
- Chun-Ying Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - An-Yi Wang
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kai-Mei Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chen Yang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ying-Chieh Tsai
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Chu-Chi Fan
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Han-Ju Chuang
- Department of Nursing, Cathay General Hospital, Taipei, Taiwan
| | - Nguyen Thi Phuc
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Nursing Department, Vinmec Times City Hospital, Vinmec HealthCare System, Hanoi, Viet Nam
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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9
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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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10
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Ito K, George N, Wilson J, Bowman J, Aaronson E, Ouchi K. Primary palliative care recommendations for critical care clinicians. J Intensive Care 2022; 10:20. [PMID: 35428371 PMCID: PMC9013119 DOI: 10.1186/s40560-022-00612-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Palliative care is an interdisciplinary care to optimize physical, psychosocial, and spiritual symptoms of patients and their families whose quality of life is impaired by serious, life-limiting illness. In 2021, the importance of providing palliative care in the intensive care unit (ICU) is well recognized by various studies to alleviate physical symptoms due to invasive treatments, to set patient-centered goals of care, and to provide end-of-life care. This paper summarizes the evidence known to date on primary palliative care delivered in the ICU settings. We will then discuss the potential benefits and harms of primary palliative care so that critical care clinicians are better equipped to decide what services might best improve the palliative care needs in their ICUs.
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11
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The Prevalence of Spiritual and Social Support Needs and Their Association With Postintensive Care Syndrome Symptoms Among Critical Illness Survivors Seen in a Post-ICU Follow-Up Clinic. Crit Care Explor 2022; 4:e0676. [DOI: 10.1097/cce.0000000000000676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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12
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Morel J, Infantino P, Gergelé L, Lapole T, Souron R, Millet GY. Prevalence of self-reported fatigue in intensive care unit survivors 6 months-5 years after discharge. Sci Rep 2022; 12:5631. [PMID: 35379874 PMCID: PMC8979153 DOI: 10.1038/s41598-022-09623-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/11/2022] [Indexed: 12/18/2022] Open
Abstract
Prolonged stays in intensive care units (ICU) are responsible for long-lasting consequences, fatigue being one of the more debilitating. Yet, fatigue prevalence for patients that have experienced ICU stays remains poorly investigated. This study aimed to evaluate fatigue prevalence and the level of physical activity in ICU survivors from 6 months to 5 years after ICU discharge using the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) and Godin questionnaires, respectively. Data from 351 ICU survivors (out of 1583 contacted) showed that 199 (57%) and 152 (43%) were considered as fatigued and non-fatigued, respectively. The median FACIT-F scores for fatigued versus non-fatigued ICU survivors were 21 (14–27) and 45 (41–48), respectively (p < 0.001). Time from discharge had no significant effect on fatigue prevalence (p = 0.30) and fatigued ICU survivors are less active (p < 0.001). In multivariate analysis, the only risk factor of being fatigued that was identified was being female. We reported a high prevalence of fatigue among ICU survivors. Sex was the only independent risk factor of being fatigued, with females being more prone to this symptom. Further studies should consider experimental approaches that help us understand the objective causes of fatigue, and to build targeted fatigue management interventions.
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Affiliation(s)
- Jérôme Morel
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.,Université de Lyon, UJM, Inter-university Laboratory of Human Movement Biology, EA 7424, 42023, Saint-Etienne, France
| | - Pascal Infantino
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Laurent Gergelé
- Ramsay Générale de Santé, Hôpital Privé de la Loire, Saint-Etienne, France
| | - Thomas Lapole
- Université de Lyon, UJM, Inter-university Laboratory of Human Movement Biology, EA 7424, 42023, Saint-Etienne, France
| | - Robin Souron
- Université de Lyon, UJM, Inter-university Laboratory of Human Movement Biology, EA 7424, 42023, Saint-Etienne, France.,Nantes Université, Movement-Interactions-Performance, MIP, UR 4334, 44000, Nantes, France
| | - Guillaume Y Millet
- Université de Lyon, UJM, Inter-university Laboratory of Human Movement Biology, EA 7424, 42023, Saint-Etienne, France. .,Institut Universitaire de France (IUF), LIBM, IRMIS, Campus Santé Innovations, 10 rue de la Marandière, 42270, Saint-Priest en Jarez, France.
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13
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Tanaka Y, Kato A, Ito K, Igarashi Y, Kinoshita S, Kizawa Y, Miyashita M. Attitudes of Physicians toward Palliative Care in Intensive Care Units: A Nationwide Cross-Sectional Survey in Japan. J Pain Symptom Manage 2022; 63:440-448. [PMID: 34656654 DOI: 10.1016/j.jpainsymman.2021.09.015] [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: 07/27/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Palliative care is an essential component of comprehensive care for patients with critical illnesses. In Japan, little is known about palliative care in intensive care units (ICUs), and palliative care approaches are not widespread. OBJECTIVE This study aimed to better understand the attitudes of physicians toward palliative care and the utilization and needs of specialized palliative care consultations in ICUs in Japan. METHODS A nationwide, self-administered questionnaire was distributed ICU physician directors in all hospitals with ICUs. RESULTS Questionnaires were distributed to 873 ICU physician directors; valid responses were received from 436 ICU physician director (50% response rate). Among the respondents, 94% (n = 411) felt that primary palliative care should be strengthened in ICUs; 89% (n = 386) wanted ICU physicians to collaborate with specialists, such as palliative care teams (PCTs); and 71% (n = 311) indicated the need for specialized palliative care consultations; however, only 38% (n = 166) actually consulted, and only 6% (n = 28) consulted more than 10 patients in the past year. Physicians most commonly consulted PCT for patients with serious end-of-life illness (24%) (n = 107), intractable pain (21%) (n = 92), and providing psychological support to family members (43%, n = 187). The potential barriers in providing primary and specialized palliative care included being unable to understand the patients' intentions (54%, n = 235), lack of knowledge and skills in palliative care (53%, n = 230), and inability to consult with PCTs in a timely manner (46%, n = 201). CONCLUSIONS These data suggest a need for primary palliative care education in ICUs and improved access to specialized palliative care consultations.
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Affiliation(s)
- Yuta Tanaka
- Department of Palliative Nursing, Health Sciences (Y.T., M.M.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Akane Kato
- Department of Adult and Geriatric Nursing, Health Sciences (A.K.), Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery (K.I.), Teikyo University School of Medicine, Itabasi-ku, Tokyo, Japan
| | - Yuko Igarashi
- Department of Palliative Medicine (Y.I., Y.K.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satomi Kinoshita
- College of Nursing, Kanto Gakuin University (S.K.), Yokohama Kanagawa, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine (Y.I., Y.K.), Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences (Y.T., M.M.), Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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14
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Hill JE, Twamley J, Breed H, Kenyon R, Casey R, Zhang J, Clegg A. Scoping review of the use of virtual reality in intensive care units. Nurs Crit Care 2021; 27:756-771. [PMID: 34783134 DOI: 10.1111/nicc.12732] [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: 10/10/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND A wide range of reviews have demonstrated the effectiveness and tolerability of Virtual Reality (VR) in a range of clinical areas and subpopulations. However, no previous review has explored the current maturity, acceptability, tolerability, and effectiveness of VR with intensive care patients. AIMS To identify the range of uses of VR for intensive care patients, classify their current phase of development, effectiveness, acceptability, and tolerability. METHODS A scoping review was conducted. A multi-database search was undertaken (inception to January 2021). Any type of study which examined the use of VR with the target application population of intensive care patients were included. Screening, data extraction, and assessment of quality were undertaken by a single reviewer. A meta-analysis and a descriptive synthesis were undertaken. RESULTS Six hundred and forty-seven records were identified, after duplicate removal and screening 21 studies were included (weak quality). The majority of studies for relaxation, delirium, and Post Traumatic Stress Disorder (PTSD) were at the early stages of assessing acceptability, tolerability, and initial clinical efficacy. Virtual Reality for relaxation and delirium were well-tolerated with completion rates of target treatment of 73.6%, (95% CI:51.1%-96%, I2 = 98.52%) 52.7% (95% CI:52.7%-100%, I2 = 96.8%). The majority of reasons for non-completion were due to external clinical factors. There were some potential benefits demonstrated for the use of VR for relaxation, delirium, and sleep. CONCLUSION Virtual Reality for intensive care is a new domain of research with the majority of areas of application being in the early stages of development. There is great potential for the use of VR in this clinical environment. Further robust assessment of effectiveness is required before any clinical recommendations can be made.
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Affiliation(s)
- James Edward Hill
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
| | - Jacqueline Twamley
- Intensive Care Nurse/Academic Research and Innovation Manager, Centre for Health Research and Innovation, NIHR Lancashire Clinical Research Facility, UK
| | - Hetty Breed
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - Roger Kenyon
- Community Engagement & Service User Support, University of Central Lancashire, Preston, UK
| | - Rob Casey
- Digital Therapy Solutions to Empower Stroke, Dementia, Parkinson's Rehabilitation, DancingMind Pte Ltd, Singapore
| | | | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
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15
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Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): an overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Rev Neurother 2021; 21:1159-1177. [PMID: 34519235 DOI: 10.1080/14737175.2021.1981289] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Post-intensive care syndrome (PICS) has only recently been recognized as a new clinical entity in patients surviving their intensive care unit (ICU) stay due to critical illness. With increasing survival rates of ICU patients worldwide, there is a rising interest regarding post-ICU recovery. AREAS COVERED First, based on the current literature a definition is provided of PICS, including the domains of impairments that comprise PICS along with the etiology and risk factors. Second, preventive measures and possible treatment strategies integrated in the follow-up care are described. Third, the authors will discuss the current SARS-Cov-2 pandemic and the increased risk of PICS in these post-ICU patients and their families. EXPERT OPINION PICS is a relatively new entity, which not only encompasses various physical, cognitive, and psychological impairments but also impacts global health due to long-lasting detrimental socioeconomic burdens. Importantly, PICS also relates to caregivers of post-ICU patients. Strategies to reduce this burden will not only be needed within the ICU setting but will also have to take place in an interdisciplinary, multifaceted approach in primary care settings. Additionally, the SARS-Cov-2 pandemic has a high burden on post-ICU patients and their relatives.
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Affiliation(s)
- Dharmanand Ramnarain
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Department of Intensive Care Medicine, Saxenburg Medisch Centrum Hardenberg, The Netherlands
| | - Emily Aupers
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Brenda den Oudsten
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands
| | - Annemarie Oldenbeuving
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disease (Corps), Tilburg University, Tilburg, The Netherlands.,Board, ADRZ (Admiraal De Ruyter Ziekenhuis), Goes, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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16
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Valsø Å, Rustøen T, Småstuen MC, Puntillo K, Skogstad L, Schou-Bredal I, Sunde K, Tøien K. Occurrence and characteristics of pain after ICU discharge: A longitudinal study. Nurs Crit Care 2021; 27:718-727. [PMID: 34382725 DOI: 10.1111/nicc.12701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pain is a serious problem for intensive care unit (ICU) patients, but we are lacking data on pain at the hospital ward after ICU discharge. AIMS AND OBJECTIVES To describe pain intensity, -interference with function and -location in patients up to 1 year after ICU discharge. To identify demographic and clinical variables and their association with worst pain intensity and pain interference. DESIGN A longitudinal descriptive secondary analysis of a randomized controlled trial on nurse-led follow-up consultations on post-traumatic stress and sense of coherence after ICU discharge. METHODS Pain intensity, -interference, and -location were measured using Brief Pain Inventory at the hospital ward and 3, 6, and 12 months after ICU discharge. For associations, data were analysed using multivariate linear mixed models for repeated measures. RESULTS Of 523 included patients, 68% reported worst pain intensity score above 0 (no pain) at the ward. Estimated means for worst pain intensity and -interference (from 0 to 10) after ICU discharge were 5.5 [CI 4.6-6.5] and 4.5 [CI 3.7-5.3], and decreased to 3.8 [CI 2.8-4.8] (P ≤ .001) and 2.9 [CI 2.1-3.7] after 12 months (P ≤ .001). Most common pain locations were abdomen (43%), lower lumbar back (28%), and shoulder/forearm (22%). At 12 months, post-traumatic stress (PTS) symptoms ≥25 (scale 10-70), female gender, shorter ICU stay, and more traumatic ICU memories were significantly associated with higher worst pain intensity. PTS symptoms ≥25, female gender, more traumatic ICU memories, younger age, and not having an internal medical diagnosis were significantly associated with higher pain interference. CONCLUSIONS Early after ICU discharge pain was present in 68% of patients. Thereafter, pain intensity and -interference declined, but pain intensity was still at a moderate level at 12 months. Health professionals should be aware of patients' pain and identify potentially vulnerable patients. IMPLICATION FOR PRACTICE Longitudinal assessment of factors associated with pain early after ICU discharge and the following year is a first step that could improve follow-up focus and contribute to reduced development of chronic pain.
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Affiliation(s)
- Åse Valsø
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Public Health, OsloMet-Oslo Metropolitan University of Oslo, Oslo, Norway
| | - Kathleen Puntillo
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Laila Skogstad
- Department of Research, Sunnaas Rehabilitation Hospital, Bjørnemyr, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Inger Schou-Bredal
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Unit for Breast- and Endocrine Surgery, Division Cancer, Oslo University Hospital, Oslo, Norway
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kirsti Tøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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17
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Bench S, Czuber-Dochan W, Shah A, Stayt L. Exploring adult critical illness survivors' experiences of fatigue: A qualitative study. J Adv Nurs 2021; 77:4836-4846. [PMID: 34363641 DOI: 10.1111/jan.14995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Abstract
AIMS To explore adult experiences of fatigue after discharge from an intensive care unit and identify potential management strategies. DESIGN An exploratory qualitative study. METHODS One to one audio-recorded semi-structured interviews with 17 adult survivors of critical illness in the United Kingdom, lasting up to 1 h, between September 2019 and January 2020. Anonymised and verbatim-transcribed interview data underwent a standard process of inductive thematic analysis as described by Braun and Clarke. FINDINGS Three themes were identified: fatigue is different for everyone; complex interrelating interactions; and personalised fatigue strategies. Fatigue was described as a distressing symptom, unique to the individual that causes an array of complex, often long-term interrelating impacts on the survivor and their wider family, made worse by a lack of understanding, empathy and support resources. Support from others, alongside interventions such as exercise, good nutrition, information and alternative therapies are used by survivors with variable degrees of success. CONCLUSIONS This qualitative study reports peoples' experiences of fatigue after critical illness. Findings highlight the significant impact it has on people's lives and those of their family and friends.
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Affiliation(s)
- Suzanne Bench
- Institute of Health and Social Care, London South Bank University, London, UK.,Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Akshay Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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18
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Vester LB, Holm A, Dreyer P. Patients' and relatives' experiences of post-ICU everyday life: A qualitative study. Nurs Crit Care 2021; 27:392-400. [PMID: 34258842 DOI: 10.1111/nicc.12682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND As advancements in intensive care treatment have resulted in decreased mortality rates, more attention has been given to the experience of life after critical illness. Despite an increase in literature describing the physical, psychological, and cognitive health problems arising after critical illness, there is a shortage of research exploring the lifeworld of patients and relatives, including its internal and external interplay in everyday life. Addressing this is essential for gaining insights into the experience of everyday life and recovery after critical illness. AIMS AND OBJECTIVES To explore patients' and relatives' experiences of everyday life after critical illness. DESIGN Data were collected using semi-structured interviews with 7 relatives and 12 patients. Interviews were audiotaped and transcribed verbatim. METHODS Drawing on the phenomenological-hermeneutic tradition, data were analysed using Ricoeur's theory of interpretation, as described by Dreyer and Pedersen. FINDINGS The lifeworld of everyday life was disclosed in the theme "Finding oneself after critical illness," described as an overall comprehensive understanding. This theme was divided into the subthemes (a) redefining the self, (b) reintegrating with family, and (c) resuming everyday life, which followed the trajectory of the three phases: the known past, the uncertain present, and the unknown future. CONCLUSION Critical illness and physical, psychological, and cognitive health problems create new and emerging difficulties in patients' and relatives' experiences of everyday life after intensive care. These experiences affect their understanding of themselves, their families, and their ability to resume pre-intensive care unit everyday life. IMPLICATIONS FOR PRACTICE The study underlines the need to supplement the affirmed domains in post-intensive care syndrome with a social domain to enhance family-centred care within the intensive care unit and across sectoral borders. Additionally, it highlights the need to develop rehabilitation strategies aimed at patients' and relatives' multifactorial health problems.
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Affiliation(s)
| | - Anna Holm
- Department of Intensive Care, Aarhus University Hospital, Aarhus N, Denmark
| | - Pia Dreyer
- Institute of Public Health, Section of Nursing, Aarhus University, Aarhus C, Denmark.,Department of Intensiv Care, Aarhus University Hospital, Aarhus N, Denmark.,Bergen University, Bergen, Norway
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19
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Albrich L, Chapple LAS, Nock A, Ridley EJ, Hickson M. Nutrition-related symptoms in adult survivors of critical illness who are eating orally: a scoping review protocol. JBI Evid Synth 2021; 18:1326-1333. [PMID: 32813382 DOI: 10.11124/jbisrir-d-19-00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will explore and map the current literature on the nutritional impact of symptoms reported by adult survivors of critical illness who are eating orally after discharge from the intensive care unit (ICU). INTRODUCTION Survivors of critical care often experience ICU-acquired weakness and poor functional recovery. It is plausible that nutrition interventions throughout their recovery could improve outcomes for these patients. Although a growing number of studies aim to explore the effect of nutrition delivered in the early phases of critical illness, this is also important post-ICU discharge, particularly in already nutritionally compromised patients presenting with muscle loss and fatigue. Therefore, the development of targeted nutrition interventions will be informed by a comprehensive insight into the physiological, physical, or psychological difficulties that critically ill patients experience after ICU discharge, which may impede oral intake. INCLUSION CRITERIA This review will consider primary research studies with adult patients 18 years and older, who are in the recovery phase after being critically ill, and eating orally. Studies must report on any symptoms related to the ability to eat, or represent nutrition inadequacy or utilization. METHODS A scoping review will be conducted in accordance with JBI methodology using a three-step search strategy of MEDLINE, Embase, CINAHL, AMED, Web of Science, Cochrane Database of Systematic Reviews, and JBI Evidence-based Practice Database to obtain primary research studies that meet the inclusion criteria. Duplicates will be removed, and study selection and data extraction will be conducted and cross-checked by two independent reviewers. Data synthesis will involve presenting the results in tabular form.
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Affiliation(s)
- Louise Albrich
- 1Nutrition and Dietetics, Yeovil District Hospital, Yeovil, UK 2Institute of Health and Community, University of Plymouth, Plymouth, UK 3The University of Plymouth Centre for Innovations in Health and Social Care: A JBI Centre of Excellence 4Discipline of Acute Care Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia 5Intensive Care Research, Royal Adelaide Hospital, Adelaide, Australia 6Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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20
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Advocating for a Loved One in the Setting of Uncertainty: A Mixed-Methods Study Among Caregivers of Sepsis Survivors at the Point of a Sepsis Readmission. Dimens Crit Care Nurs 2021; 40:36-50. [PMID: 33560634 DOI: 10.1097/dcc.0000000000000449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The trajectory of recovery after sepsis varies. Survivors may have considerable ongoing limitations, requiring a caregiver for a prolonged period. OBJECTIVES To learn about experiences, quality of life, coping, resilience, and social support of caregiver caring for survivors of sepsis. METHODS We conducted a convergent mixed-methods study, recruiting informal caregivers of patients who had survived sepsis in the past year and were readmitted to the intensive care unit with sepsis. Individual face-to-face, semistructured interviews and validated surveys on quality of life, coping, caregiver burden, resilience, and social support were administered to caregivers. Interview transcripts were analyzed using content analysis. Surveys were scored and summarized using descriptive statistics. RESULTS Caregivers were primarily middle-aged, White, and female. Half were spouses of their care recipient. Caregivers reported some deficits in mobility, pain, and anxiety/depression. Coping styles varied, with engaged coping being more prevalent. Most caregivers reported mild to moderate burden, all reported either normal or high resilience levels, and types of social support were similar. However, interviews and survey findings were not always consistent. Major themes that emerged from the analysis included (1) advocating for and protecting their loved one, (2) coping with caregiving, (3) uncertain future, (4) rewards of caregiving, and (5) need to optimize communication with family. DISCUSSION Caregivers of sepsis survivors are protective of their care recipient and use a variety of strategies to advocate for their loved one and to cope with the uncertainty involved in a new intensive care unit admission. More advocacy and support are needed for this population.
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21
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Bench S, Stayt L, Shah A, Dhiman P, Czuber-Dochan W. Prevalence and experience of fatigue in survivors of critical illness: a mixed-methods systematic review. Anaesthesia 2021; 76:1233-1244. [PMID: 33694157 DOI: 10.1111/anae.15441] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 12/11/2022]
Abstract
We conducted a mixed methods systematic review to investigate the prevalence, experience and management of fatigue in survivors of critical illness. We identified 76 studies investigating fatigue or vitality in adults discharged from an intensive care unit and split the extracted data into three datasets: vitality scores from the Short Form Health Survey-36 (n = 54); other quantitative data (n = 19); and qualitative data (n = 9). We assessed methodological quality using critical appraisal skills programme tools. We adopted a segregated approach to mixed-methods synthesis. In a final step, we attributed combined results to one of four qualitative themes: prevalence and severity; contributing factors; impacts on quality of life; and assessment and management. Prevalence of fatigue ranged from 13.8 to 80.9%. Short Form Health Survey-36 vitality scores were commonly used as a marker of fatigue. Vitality scores reached a nadir approximately one month following ICU discharge (mean (SD) 56.44 (32.30); 95%CI 52.92-59.97). They improved over time but seldom reached reference population scores. Associated biological, disease-related and psychological factors included age, poor pre-morbid status, sleep and psychological disturbance. Qualitative data highlight the profound negative impact of fatigue on survivors' quality of life. Survivors seldom had any information provided on the potential impact of fatigue. No fatigue assessment tools specific to critical illness or evidence-based interventions were reported. Fatigue is highly prevalent in survivors of critical illness, and negatively impacts recovery. Further research on developing fatigue assessment tools specifically for critically ill patients and evaluating the impact of pharmacological and non-pharmacology interventions is needed.
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Affiliation(s)
- S Bench
- School of Health and Social Care, London South Bank University, London, UK
| | - L Stayt
- Oxford Brookes University, Oxford, UK
| | - A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - P Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Czuber-Dochan
- Florence Nightingale School of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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22
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Souron R, Morel J, Gergelé L, Infantino P, Brownstein CG, Lapole T, Millet GY. Relationship between intensive care unit-acquired weakness, fatigability and fatigue: What role for the central nervous system? J Crit Care 2020; 62:101-110. [PMID: 33316555 DOI: 10.1016/j.jcrc.2020.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To provide a comprehensive review of studies that have investigated fatigue in intensive care unit (ICU) survivors and questions the potential link between intensive care unit-acquired weakness (ICUAW), fatigability and fatigue. We also question whether the central nervous system (CNS) may be the link between these entities. MATERIAL AND METHODS A narrative review of the literature that investigated fatigue in ICU survivors and review of clinical trials enabling understanding of CNS alterations in response to ICU stays. RESULTS Fatigue is a pervasive and debilitating symptom in ICU survivors that can interfere with rehabilitation. Due to the complex pathophysiology of fatigue, more work is required to understand the roles of ICUAW and/or fatigability in fatigue to provide a more holistic understanding of this symptom. While muscle alterations have been well documented in ICU survivors, we believe that CNS alterations developing early during the ICU stay may play a role in fatigue. CONCLUSIONS Fatigue should be considered and treated in ICU survivors. The causes of fatigue are likely to be specific to the individual. Understanding the role that ICUAW and fatigability may have in fatigue would allow to tailor individual treatment to prevent this persistent symptom and improve quality of life.
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Affiliation(s)
- Robin Souron
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France; Laboratory of Impact of Physical Activity on Health (IAPS), UR n°201723207F, University of Toulon, France
| | - Jérôme Morel
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France; Département d'anesthésie et réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France.
| | - Laurent Gergelé
- Ramsay Générale de Santé, Hôpital privé de la Loire, Saint Etienne, France
| | - Pascal Infantino
- Département d'anesthésie et réanimation, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Callum G Brownstein
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France.
| | - Thomas Lapole
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France
| | - Guillaume Y Millet
- Univ Lyon, UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023 Saint-Etienne, France.
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Fink EL, Maddux AB, Pinto N, Sorenson S, Notterman D, Dean JM, Carcillo JA, Berg RA, Zuppa A, Pollack MM, Meert KL, Hall MW, Sapru A, McQuillen PS, Mourani PM, Wessel D, Amey D, Argent A, de Carvalho WB, Butt W, Choong K, Curley MA, del Pilar Arias Lopez M, Demirkol D, Grosskreuz R, Houtrow AJ, Knoester H, Lee JH, Long D, Manning JC, Morrow B, Sankar J, Slomine BS, Smith M, Olson LM, Watson RS. A Core Outcome Set for Pediatric Critical Care. Crit Care Med 2020; 48:1819-1828. [PMID: 33048905 PMCID: PMC7785252 DOI: 10.1097/ccm.0000000000004660] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES More children are surviving critical illness but are at risk of residual or new health conditions. An evidence-informed and stakeholder-recommended core outcome set is lacking for pediatric critical care outcomes. Our objective was to create a multinational, multistakeholder-recommended pediatric critical care core outcome set for inclusion in clinical and research programs. DESIGN A two-round modified Delphi electronic survey was conducted with 333 invited research, clinical, and family/advocate stakeholders. Stakeholders completing the first round were invited to participate in the second. Outcomes scoring greater than 69% "critical" and less than 15% "not important" advanced to round 2 with write-in outcomes considered. The Steering Committee held a virtual consensus conference to determine the final components. SETTING Multinational survey. PATIENTS Stakeholder participants from six continents representing clinicians, researchers, and family/advocates. MEASUREMENTS AND MAIN RESULTS Overall response rates were 75% and 82% for each round. Participants voted on seven Global Domains and 45 Specific Outcomes in round 1, and six Global Domains and 30 Specific Outcomes in round 2. Using overall (three stakeholder groups combined) results, consensus was defined as outcomes scoring greater than 90% "critical" and less than 15% "not important" and were included in the final PICU core outcome set: four Global Domains (Cognitive, Emotional, Physical, and Overall Health) and four Specific Outcomes (Child Health-Related Quality of Life, Pain, Survival, and Communication). Families (n = 21) suggested additional critically important outcomes that did not meet consensus, which were included in the PICU core outcome set-extended. CONCLUSIONS The PICU core outcome set and PICU core outcome set-extended are multistakeholder-recommended resources for clinical and research programs that seek to improve outcomes for children with critical illness and their families.
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Affiliation(s)
- Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Aline B. Maddux
- Department of Pediatrics, Critical Care Medicine, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Neethi Pinto
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel Sorenson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daniel Notterman
- Department of Molecular Biology, Princeton University, Princeton, NJ, USA
| | - J. Michael Dean
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph A Carcillo
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Athena Zuppa
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Murray M Pollack
- Department of Pediatrics, Children’s National Hospital, Washington, DC, USA
| | - Kathleen L Meert
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Mark W Hall
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Anil Sapru
- Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA, USA
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children’s Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Peter M Mourani
- Department of Pediatrics, Critical Care Medicine, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - David Wessel
- Department of Pediatrics, Children’s National Hospital, Washington, DC, USA
| | - Deborah Amey
- Advocate, Collaborative Pediatric Critical Care Research Network Family Collaborative, Great Falls, Virginia, USA
| | - Andrew Argent
- Department of Paediatrics and Child Health, University of Cape Town, and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | | | - Warwick Butt
- Intensive Care Department of Paediatrics, The Royal Childrens Hospital, Melbourne, Australia
| | - Karen Choong
- Departments of Pediatrics and Critical Care, McMaster University, Ontario, Canada
| | - Martha A.Q. Curley
- Department of Family and Community Health (Nursing), Anesthesiology and Critical Care (Perelman School of Medicine), University of Pennsylvania; Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Demet Demirkol
- Istanbul University, Child Health Institute and Istanbul Faculty of Medicine, Department of Pediatric Intensive Care, Istanbul, Turkey
| | - Ruth Grosskreuz
- Department of Pediatrics, Critical Care Medicine, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Amy J. Houtrow
- Department of Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hennie Knoester
- Department of Paediatrics, Centrum Universiteit van Amsterdam, the Netherlands
| | - Jan Hau Lee
- Department of Pediatric Subspecialities, KK Women’s and Children’s Hospital, Singapore
| | - Debbie Long
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, and PCCRG, Centre for Children’s Health Research, The University of Queensland, Australia
| | - Joseph C. Manning
- Children and Young People Health Research, School of Health Sciences, University of Nottingham and Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Brenda Morrow
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, Chandigarh, India
| | - Beth S. Slomine
- Department of Neuropsychology, Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - McKenna Smith
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lenora M. Olson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - R. Scott Watson
- Department of Pediatrics, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, WA, USA
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Tate JA, Choi J. Positive Appraisal of Caregiving for Intensive Care Unit Survivors: A Qualitative Secondary Analysis. Am J Crit Care 2020; 29:340-349. [PMID: 32869072 DOI: 10.4037/ajcc2020953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND More than half of intensive care unit survivors require assistance from family caregivers after discharge. Caregiving is associated with negative consequences including poor health-related quality of life, psychosocial distress, and burden. Little is known about how family caregivers find satisfaction and meaning in their experience. OBJECTIVES To explore positive descriptions of the experiences of family caregivers of critically ill patients and to describe factors that family caregivers view as important to a positive caregiving experience from hospitalization to 4 months after discharge. METHODS Qualitative secondary analysis was performed on data from semistructured interviews conducted as part of a longitudinal study that examined physical and psychological responses to stress in a convenience sample of family caregivers of adult intensive care unit patients who underwent prolonged mechanical ventilation (≥ 4 days). Interviews were conducted at 4 time points: during the hospitalization and within 2 weeks, 2 months, and 4 months after discharge. RESULTS Participants (n = 41) reported factors that helped them positively appraise their caregiving experience in 113 interviews conducted face to face or via telephone. During patients' hospitalization, caregivers described changes in their role, with their primary responsibility being to advocate for the patient. They described how this experience fulfilled their identity and strengthened their relationship with the patient. Most family caregivers mentioned the importance of social support and prayer. CONCLUSIONS Family caregivers of intensive care unit patients can identify positive aspects of caregiving during the experience. Interventions to reframe the caregiving experience in a positive light are warranted.
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Affiliation(s)
- Judith A. Tate
- Judith A. Tate is an assistant professor at the Ohio State University College of Nursing, Columbus, Ohio
| | - JiYeon Choi
- JiYeon Choi is an assistant professor at Yonsei University College of Nursing, Mo-Im Kim Nursing Research Institute, Seoul, Korea. At the time of the study, Choi was at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Gosselin É, Richard-Lalonde M. Role of Family Members in Pain Management in Adult Critical Care. AACN Adv Crit Care 2020; 30:398-410. [PMID: 31951660 DOI: 10.4037/aacnacc2019275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This review describes family member involvement in intensive care unit pain assessment and management and generates implications for clinical practice, education, and future research. A literature review was performed in MEDLINE, PubMed, EMBASE, Cochrane, and CINAHL databases from their inception until April 30, 2019. Only 11 studies addressing the topic were identified, and the current quality of evidence is low. Family members can be involved in pain assessment by describing patients' pain behaviors and in pain management by selecting and delivering nonpharmacological interventions tailored to patients' needs, if the family members feel comfortable with this role. More-rigorous research is required to describe the role of family members in patients' pain assessment and management. Advancing knowledge in this field could improve patients' and family members' experiences with pain assessment and management in the intensive care unit.
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Affiliation(s)
- Émilie Gosselin
- Émilie Gosselin is a Postdoctoral Research Fellow, Ingram School of Nursing, McGill University, and Center for Nursing Research, Jewish General Hospital of Montreal, 680 Sherbrooke St West, Room 1838, Montreal, QC H3A 2M7, Canada . Mélissa Richard-Lalonde is a Doctoral Student, Ingram School of Nursing, McGill University
| | - Mélissa Richard-Lalonde
- Émilie Gosselin is a Postdoctoral Research Fellow, Ingram School of Nursing, McGill University, and Center for Nursing Research, Jewish General Hospital of Montreal, 680 Sherbrooke St West, Room 1838, Montreal, QC H3A 2M7, Canada . Mélissa Richard-Lalonde is a Doctoral Student, Ingram School of Nursing, McGill University
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Abstract
Surviving a critical illness can have long-term effects on both patients and families. These effects can be physical, emotional, cognitive, and social, and they affect both the patient and the family. Family members play a key role in helping their loved one recover, and this recovery process can take considerable time. Transferring out of an intensive care unit, and discharging home from a hospital, are important milestones, but they represent only the beginning of recovery and healing after a critical illness. Recognizing that these challenges exist both for patients and families is important to improve critical illness outcomes.
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27
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Balas MC, Pun BT, Pasero C, Engel HJ, Perme C, Esbrook CL, Kelly T, Hargett KD, Posa PJ, Barr J, Devlin JW, Morse A, Barnes-Daly MA, Puntillo KA, Aldrich JM, Schweickert WD, Harmon L, Byrum DG, Carson SS, Ely EW, Stollings JL. Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience. Crit Care Nurse 2019; 39:46-60. [PMID: 30710036 DOI: 10.4037/ccn2019927] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Although growing evidence supports the safety and effectiveness of the ABCDEF bundle (A, assess, prevent, and manage pain; B, both spontaneous awakening and spontaneous breathing trials; C, choice of analgesic and sedation; D, delirium: assess, prevent, and manage; E, early mobility and exercise; and F, family engagement and empowerment), intensive care unit providers often struggle with how to reliably and consistently incorporate this interprofessional, evidence-based intervention into everyday clinical practice. Recently, the Society of Critical Care Medicine completed the ICU Liberation ABCDEF Bundle Improvement Collaborative, a 20-month, nationwide, multicenter quality improvement initiative that formalized dissemination and implementation strategies and tracked key performance metrics to overcome barriers to ABCDEF bundle adoption. The purpose of this article is to discuss some of the most challenging implementation issues that Collaborative teams experienced, and to provide some practical advice from leading experts on ways to overcome these barriers.
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Affiliation(s)
- Michele C Balas
- Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus.
| | - Brenda T Pun
- Michele Balas is an associate professor, Center of Excellence in Critical and Complex Care, College of Nursing, and a nurse scientist, Wexner Medical Center, The Ohio State University, Columbus
| | - Chris Pasero
- Chris Pasero is a pain management clinical consultant, El Dorado Hills, California
| | - Heidi J Engel
- Heidi Engel is a physical therapist, Department of Rehabilitative Services, University of California, San Francisco
| | - Christiane Perme
- Christiane Perme is a physical therapist, Houston Methodist Hospital, Houston, Texas
| | - Cheryl L Esbrook
- Cheryl Esbrook is an occupational therapist, University of Chicago Medicine, Chicago, Illinois
| | - Tamra Kelly
- Tamra Kelly is a respiratory therapist, Sutter Health, Sacramento, California
| | - Ken D Hargett
- Ken Hargett is a respiratory therapist, Houston Methodist Hospital
| | - Patricia J Posa
- Patricia Posa is a population health clinical integration leader, Saint Joseph Mercy Health System, Ann Arbor, Michigan
| | - Juliana Barr
- Juliana Barr is a staff intensivist and anesthesiologist, VA Palo Alto Health Care System, Palo Alto, California, and an associate professor, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - John W Devlin
- John Devlin is a professor of pharmacy, Northeastern University, and a clinical scientist, Division of Pulmonary, Critical Care and Sleep Medicine, Tufts Medical Center, Boston, Massachusetts
| | | | - Mary Ann Barnes-Daly
- Mary Ann Barnes-Daly is a clinical performance improvement consultant, Sutter Health
| | - Kathleen A Puntillo
- Kathleen Puntillo is a professor of nursing emeritus, Department of Physiological Nursing, School of Nursing, University of California, San Francisco
| | - J Matthew Aldrich
- J. Matthew Aldrich is medical director, critical care medicine, and an associate clinical professor, University of California, San Francisco Medical Center, San Francisco
| | - William D Schweickert
- William Schweickert is an associate professor of clinical medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lori Harmon
- Lori Harmon is director of quality, Society of Critical Care Medicine, Mount Prospect, Illinois
| | - Diane G Byrum
- Diane Byrum is a quality implementation consultant, Innovative Solutions for Healthcare Education, LLC, Charlotte, North Carolina
| | - Shannon S Carson
- Shannon Carson is a critical care pulmonologist, University of North Carolina School of Medicine, Chapel Hill
| | - E Wesley Ely
- E. Wesley Ely is a professor of medicine, Vanderbilt University School of Medicine, and associate director, VA Tennessee Valley Geriatric Research Education Clinical Center, Nashville, Tennessee
| | - Joanna L Stollings
- Joanna Stollings is a clinical pharmacist, Department of Pharmaceutical Services, Vanderbilt University Medical Center
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28
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Jeong YJ, Kang J. Development and validation of a questionnaire to measure post-intensive care syndrome. Intensive Crit Care Nurs 2019; 55:102756. [PMID: 31522829 DOI: 10.1016/j.iccn.2019.102756] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/09/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to develop a Post-Intensive Care Syndrome Questionnaire (PICSQ) and assess the psychometric properties of PICSQ in intensive care unit survivors. METHODS PICSQ items were generated through relevant literature reviews, qualitative interviews among survivors, and multiple rounds of content validity evaluations by experts. Data were collected from 536 survivors at seven health care facilities in three cities of Korea from June to August 2018. The validity and reliability of PICSQ were assessed using exploratory factor analysis, confirmatory factor analysis, internal consistency and correlation coefficients. RESULTS The final PICSQ consisted of 18 items. Through exploratory factor analysis, three factors (mental, cognitive and physical) were derived. The reliability of PICSQ was represented by a Cronbach's α of 0.93, while the internal consistency of each factor was good (Cronbach's α = 0.84 to 0.90). The model fit of PICSQ was satisfactory and confirmatory factor analysis demonstrated good convergent and discriminant validity of the questionnaire. CONCLUSION Because PICSQ is valid and reliable, it is recommended for use in clinical practice and research to assess post-intensive care syndrome in intensive care survivors.
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Affiliation(s)
- Yeon Jin Jeong
- Department of Nursing, Dongju College, Busan, South Korea
| | - Jiyeon Kang
- College of Nursing, Dong-A University, Busan, South Korea.
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29
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Abstract
BACKGROUND As many as 70% of intensive care unit (ICU) survivors suffer from long-term physical, cognitive, and psychological impairments known as post-intensive care syndrome (PICS). We describe how the first ICU survivor clinic in the United States, the Critical Care Recovery Center (CCRC), was designed to address PICS using the principles of Agile Implementation (AI). METHODS The CCRC was designed using an eight-step process known as the AI Science Playbook. Patients who required mechanical ventilation or were delirious ≥48 hours during their ICU stay were enrolled in the CCRC. One hundred twenty subjects who completed baseline HABC-M CG assessments and had demographics collected were included in the analysis to identify baseline characteristics that correlated with higher HABC-M CG scores. A subset of patients and caregivers also participated in focus group interviews to describe their perceptions of PICS. RESULTS Quantitative analyses showed that the cognitive impairment was a major concern of caregivers. Focus group data also confirmed that caregivers of ICU survivors (n = 8) were more likely to perceive cognitive and mental health symptoms than ICU survivors (n = 10). Caregivers also described a need for ongoing psychoeducation about PICS, particularly cognitive and mental health symptoms, and for ongoing support from other caregivers with similar experiences. CONCLUSIONS Our study demonstrated how the AI Science Playbook was used to build the first ICU survivor clinic in the United States. Caregivers of ICU survivors continue to struggle with PICS, particularly cognitive impairment, months to years after discharge. Future studies will need to examine whether the CCRC model of care can be adapted to other complex patient populations seen by health-care professionals.
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30
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Bohannon RW. Patient-report as an option for describing muscle weakness: An integrative review. ISOKINET EXERC SCI 2019. [DOI: 10.3233/ies-182219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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31
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Kemp HI, Laycock H, Costello A, Brett SJ. Chronic pain in critical care survivors: a narrative review. Br J Anaesth 2019; 123:e372-e384. [PMID: 31126622 DOI: 10.1016/j.bja.2019.03.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 01/28/2023] Open
Abstract
Chronic pain is an important problem after critical care admission. Estimates of the prevalence of chronic pain in the year after discharge range from 14% to 77% depending on the type of cohort, the tool used to measure pain, and the time point when pain was assessed. The majority of data available come from studies using health-related quality of life tools, although some have included pain-specific tools. Nociceptive, neuropathic, and nociplastic pain can occur in critical care survivors, but limited information about the aetiology, body site, and temporal trajectory of pain is currently available. Older age, pre-existing pain, and medical co-morbidity have been associated with pain after critical care admission. No trials were identified of interventions to target chronic pain in survivors specifically. Larger studies, using pain-specific tools, over an extended follow-up period are required to confirm the prevalence, identify risk factors, explore any association between acute and chronic pain in this setting, determine the underlying pathological mechanisms, and inform the development of future analgesic interventions.
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Affiliation(s)
- Harriet I Kemp
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Helen Laycock
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Stephen J Brett
- Department of Surgery and Cancer, Imperial College London, London, UK
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32
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Vilīte B, Strīķe E, Rutka K, Leibuss R. Pain management in intensive care unit patients after cardiac surgery with sternotomy approach. Acta Med Litu 2019; 26:51-63. [PMID: 31281217 DOI: 10.6001/actamedica.v26i1.3956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Postoperative pain is a common problem among intensive care patients. Pain management includes pain assessment and documentation, patient care, and pharmacological treatment. Materials and methods The study used a prospective, cross-sectional design. Nineteen intensive care nurses and 72 intensive care patients after cardiac surgery with sternotomy approach were studied. Toronto Pain Management Inventory was used to assess nurses and the 2010 Revised American Pain Society Patient Outcome Questionnaire was used to assess the patients. A research protocol was used to document pharmacological treatment data and Visual Analog Scale (VAS) pain measurements. The pharmacological therapy data was available for 72 patients, but patient satisfaction measurements were acquired from 52 patients. Results Postoperative pain for intensive care patients after cardiac surgery is mostly mild (68.66%). Pain intensity had a tendency to decrease over time, from a mean VAS score of 4.66 two hours after extubation to a mean VAS score of 3.12 twelve hours after extubation. Mostly opioids (100%) and nonsteroidal anti-inflammatory drugs (NSAIDs, 77.8%) were used for pharmacological treatment, and treatment was adjusted according to pain levels and patient needs. Patient satisfaction regarding pain management in the first 24 hours after surgery was high (94.2%), even though the nurses' pain knowledge was average (X = 60.6 ± 7.3%). Conclusions An individualized pain management plan requires pain documentation and ensures high patient satisfaction. Pain levels after cardiac surgery with sternotomy approach are mostly mild and patient satisfaction is high.
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Affiliation(s)
- Baiba Vilīte
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Eva Strīķe
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Katrīna Rutka
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
| | - Roberts Leibuss
- Department of Cardio-anaesthesiology and Intensive Care, Pauls Stradiņš Clinical University Hospital, Rīga, Latvia.,Pauls Stradiņš Clinical University Hospital and Rīga Stradiņš University Rīga, Latvia
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Elliott R, Yarad E, Webb S, Cheung K, Bass F, Hammond N, Elliott D. Cognitive impairment in intensive care unit patients: A pilot mixed-methods feasibility study exploring incidence and experiences for recovering patients. Aust Crit Care 2019; 32:131-138. [DOI: 10.1016/j.aucc.2018.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/13/2018] [Accepted: 01/14/2018] [Indexed: 12/20/2022] Open
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Stamenkovic DM, Laycock H, Karanikolas M, Ladjevic NG, Neskovic V, Bantel C. Chronic Pain and Chronic Opioid Use After Intensive Care Discharge - Is It Time to Change Practice? Front Pharmacol 2019; 10:23. [PMID: 30853909 PMCID: PMC6395386 DOI: 10.3389/fphar.2019.00023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/10/2019] [Indexed: 12/12/2022] Open
Abstract
Almost half of patients treated on intensive care unit (ICU) experience moderate to severe pain. Managing pain in the critically ill patient is challenging, as their pain is complex with multiple causes. Pharmacological treatment often focuses on opioids, and over a prolonged admission this can represent high cumulative doses which risk opioid dependence at discharge. Despite analgesia the incidence of chronic pain after treatment on ICU is high ranging from 33-73%. Measures need to be taken to prevent the transition from acute to chronic pain, whilst avoiding opioid overuse. This narrative review discusses preventive measures for the development of chronic pain in ICU patients. It considers a number of strategies that can be employed including non-opioid analgesics, regional analgesia, and non-pharmacological methods. We reason that individualized pain management plans should become the cornerstone for critically ill patients to facilitate physical and psychological well being after discharge from critical care and hospital.
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Affiliation(s)
- Dusica M Stamenkovic
- Department of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia.,Medical Faculty, University of Defense, Belgrade, Serbia
| | - Helen Laycock
- Imperial College London, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Menelaos Karanikolas
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Nebojsa Gojko Ladjevic
- Center for Anesthesia, Clinical Center of Serbia, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vojislava Neskovic
- Department of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia.,Medical Faculty, University of Defense, Belgrade, Serbia
| | - Carsten Bantel
- Universitätsklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin, und Schmerztherapie, Universität Oldenburg, Klinikum Oldenburg, Oldenburg, Germany.,Imperial College London, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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35
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Impact of a Nurse Intervention to Improve Sleep Quality in Intensive Care Units: Results From a Randomized Controlled Trial. Dimens Crit Care Nurs 2019; 37:310-317. [PMID: 30273216 DOI: 10.1097/dcc.0000000000000319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients of adult intensive care units (ICUs) often suffer from a lack of sleep. Reducing anxiety by promoting adaptation to the ICU prior to admission may be an appropriate way to increase sleep quality. OBJECTIVE The aim of this study was to evaluate the impact on sleep quality of a brief nurse intervention. METHODS This was a pilot randomized controlled trial in Spain. Forty patients admitted in hospital for valve cardiac surgery were randomly allocated to (1) control group (n = 20), receiving usual care, and to (2) experimental group (EG, n = 20), receiving a nurse intervention the day before surgery and admission in the ICU. The intervention was based on Roy Adaptation Model. A trained nurse anticipated the stressful stimulus to patients in order to develop functional adaptive behaviors. A set of photographs and videos was used to illustrate the environment and assistance in the ICU. Sleep quality in the ICU was measured with the Richards-Campbell Sleep Questionnaire and usual sleep quality with the Pittsburgh Sleep Quality Index. RESULTS After the intervention, sleep quality was lower in the EG compared with the control group (-4 points in Richards-Campbell Sleep Questionnaire, P = .69). Adjustment for main confounders led this reduction to -1.9 points (P = .87) among patients in EG. Stratified analyses shown a positive impact for people who usually slept well (+5.2 points, P = .77), but negative for those who had previous poor sleep quality (-20.0 points, P = .24). CONCLUSION A nurse intervention prior to ICU admission did not increase patients' sleep quality. In addition, the intervention could have incremented anxiety over the patients who used to sleep poorly at their homes.
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Wintermann GB, Petrowski K, Weidner K, Strauß B, Rosendahl J. Impact of post-traumatic stress symptoms on the health-related quality of life in a cohort study with chronically critically ill patients and their partners: age matters. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:39. [PMID: 30736830 PMCID: PMC6368748 DOI: 10.1186/s13054-019-2321-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/11/2019] [Indexed: 12/25/2022]
Abstract
Background Survivors of an acute critical illness with continuing organ dysfunction and uncontrolled inflammatory responses are prone to become chronically critically ill. As mental sequelae, a post-traumatic stress disorder and an associated decrease in the health-related quality of life (QoL) may occur, not only in the patients but also in their partners. Currently, research on long-term mental distress in chronically critically ill patient-partner dyads, using appropriate dyadic analysis strategies (patients and partners being measured and linked on the same variables) and controlling for contextual factors, is lacking. Methods The present study investigates the interdependence of post-traumatic stress symptoms (PTSS) and the health-related QoL in n = 70 dyads of chronically critically ill patients and their partners, using the Actor-Partner-Interdependence Model (APIM) under consideration of contextual factors (age, gender, length of partnership). The Post-traumatic Stress Scale (PTSS-10) and Euro-Quality of Life (EQ-5D-3L) were applied in both the patients and their partners, within up to 6 months after the transfer from acute care ICU to post-acute ICU. Results Clinically relevant post-traumatic stress symptoms were reported by 17.1% of the patients and 18.6% of the partners. Both the chronically critically ill patients and their partners with more severe post-traumatic stress symptoms also showed a decreased health-related QoL. The latter was more pronounced in male partners compared to female partners or female patients. In younger partners (≤ 57 years), higher values of post-traumatic stress symptoms were associated with a decreased QoL in the patients. Conclusions Mental health screening and psychotherapeutic treatment options should be offered to both the chronically critically ill patients and their partners. Future research is required to address the special needs of younger patient-partner dyads, following protracted ICU treatment. Trial registration German Clinical Trials Register No. DRKS00003386. Registered 13 November 2011 Electronic supplementary material The online version of this article (10.1186/s13054-019-2321-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.
| | - Katja Petrowski
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany.,Institute of Medical Psychology and Medical Sociology, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.,Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
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Psychometric Properties of the Behavioral Pain Scale in Traumatic Brain Injury. Pain Manag Nurs 2018; 20:152-157. [PMID: 30528364 DOI: 10.1016/j.pmn.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 07/24/2018] [Accepted: 09/02/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pain assessment of patients with traumatic brain injury is a challenge because they are unable to self-report their pain experience. AIMS To investigate the psychometric properties of validity, reliability, and responsiveness of the Brazilian version of the Behavioral Pain Scale (BPS-Br) in patients with traumatic brain injury. METHODS This was an observational, cross-sectional, repeated-measure and analytical study. This study was developed at the medical and surgical ICUs in a high-complexity public hospital at Aracaju, Sergipe, Brazil. Thirty-seven adult patients with moderate or severe TBI were included. This study was completed with 444 independent observations, a pairwise comparison, and was performed simultaneously before, during, and after eye cleaning and endotracheal suctioning of 37 adult patients with moderate to severe traumatic brain injury. RESULTS The BPS-Br had good internal consistency (.7 ≤ α ≤ .9), good discriminant validity (p < .001), moderate to excellent reliability based on inter-rater agreement (intraclass correlation coefficient = 0.66-1.00; κ = 0.5-1.0), and high responsiveness (0.7-1.7). The upper limbs subscale had the highest score during the nociceptive procedure (1.8 ± 0.9). Deep sedation affected the increase of grading during painful procedures (p < .001). CONCLUSIONS Our results suggest the BPS-Br is a useful tool for clinical practice to evaluate the pain experienced by patients with traumatic brain injury. Further studies of different samples are needed to evaluate the benefits of systematic pain assessment of critically ill patients.
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Koutsioumpa E, Makris D, Theochari A, Bagka D, Stathakis S, Manoulakas E, Sgantzos M, Zakynthinos E. Effect of Transcutaneous Electrical Neuromuscular Stimulation on Myopathy in Intensive Care Patients. Am J Crit Care 2018; 27:495-503. [PMID: 30385541 DOI: 10.4037/ajcc2018311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Critical illness polyneuropathy or myopathy is a severe disorder that may adversely affect patients in the intensive care unit, resulting in reduced mobilization, decline in muscle mass, and prolonged recovery periods. OBJECTIVE To examine whether the application of trans-cutaneous electrical neuromuscular stimulation (TENMS) reduces the incidence or severity of myopathy related to critical illness in intensive care unit patients. METHODS A total of 80 patients aged 18 years or older with an intensive care unit stay of 96 hours or more and receipt of mechanical ventilation for 96 hours or more were initially enrolled in a prospective, open-label randomized controlled trial in a university hospital. Patients received either conventional physical therapy alone (control group) or conventional physical therapy plus TENMS (TENMS group) for 10 days. Myopathy was assessed histologically (by needle biopsy of the quadriceps muscles) on the 4th and 14th days of the intensive care unit stay. RESULTS Of the 68 patients who completed the study, 27 (40%) had myopathy on the 14th day: 11 patients in the TENMS group (9 mild, 1 moderate, and 1 severe) and 16 patients in the control group (13 mild, 2 moderate, and 1 severe). Patients who progressed from mild to moderate or severe myopathy between the 4th and 14th days had significantly lower body mass index (P = .001) and longer time periods with inadequate nutrition (P = .049) compared with the other patients. Mean (SD) Rankin scale scores at 6 months were 3.2 (1.8) and 3.8 (2.1) in the TENMS and control groups, respectively (P = .09). CONCLUSION TENMS had no significant impact on myopathy in the critically ill patients in this study.
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Affiliation(s)
- Evangelia Koutsioumpa
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Demosthenes Makris
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Athina Theochari
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitra Bagka
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Stathis Stathakis
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstratios Manoulakas
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Markos Sgantzos
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
| | - Epaminondas Zakynthinos
- Evangelia Koutsioumpa is a physiotherapist, Athina Theochari is a nurse, and Dimitra Bagka and Efstratios Manoulakas are physicians, intensive care unit, University General Hospital of Larissa, Thessaly, Greece. Demosthenes Makris and Epaminondas Zakynthinos are professors, intensive care medicine, Stathis Stathakis is a physician, Anatomy Section, and Markos Sgantzos is a professor, anatomy and history of medicine, Faculty of Health Sciences, University of Thessaly, Larissa, Greece
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Mascarenhas M, Beattie M, Roxburgh M, MacKintosh J, Clarke N, Srivastava D. Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit. BMJ Open Qual 2018; 7:e000304. [PMID: 30515466 PMCID: PMC6231094 DOI: 10.1136/bmjoq-2017-000304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/09/2018] [Accepted: 08/29/2018] [Indexed: 11/04/2022] Open
Abstract
Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff's reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.
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Affiliation(s)
| | - Michelle Beattie
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - Michelle Roxburgh
- Department of Nursing, University of the Highlands and Islands, Inverness, UK
| | - John MacKintosh
- Quality Improvement - Patient Safety, Raigmore Hospital, Inverness, UK, UK
| | - Noreen Clarke
- Intensive Care Unit, Raigmore Hospital, Inverness, UK
| | - Devjit Srivastava
- Department of Anaesthesia and Pain, Raigmore Hospital, Inverness, UK
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Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol 2018; 18:106. [PMID: 30111299 PMCID: PMC6094470 DOI: 10.1186/s12871-018-0574-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/03/2018] [Indexed: 12/15/2022] Open
Abstract
Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering when “curative” therapies are futile. In the Intensive Care Unit (ICU), critically ill patients receive life-sustaining therapies with the goal of restoring or maintaining organ function. Palliative Care in the ICU is a widely discussed topic and it is increasingly applied in clinics. It encompasses symptoms control and end-of-life management, communication with relatives and setting goals of care ensuring dignity in death and decision-making power. However, effective application of Palliative Care in ICU presupposes specific knowledge and training which anesthesiologists and critical care physicians may lack. Moreover, logistic issues such protocols for patients’ selection, application models and triggers for consultation of external experts are still matter of debate. The aim of this review is to provide the anesthesiologists and intensivists an overview of the aims, current evidence and practical advices about the application of palliative care in ICU.
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Affiliation(s)
- Sebastiano Mercadante
- Anesthesia and Intensive Care Unit and Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Via san Lorenzo 312, 90145, Palermo, Italy
| | - Cesare Gregoretti
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy
| | - Andrea Cortegiani
- Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency. Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
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Abstract
RATIONALE Sleep disturbance during intensive care unit (ICU) admission is common and severe. Sleep disturbance has been observed in survivors of critical illness even after transfer out of the ICU. Not only is sleep important to overall health and well being, but patients after critical illness are also in a physiologically vulnerable state. Understanding how sleep disturbance impacts recovery from critical illness after hospital discharge is therefore clinically meaningful. OBJECTIVES This Systematic Review aimed to summarize studies that identify the prevalence of and risk factors for sleep disturbance after hospital discharge for critical illness survivors. DATA SOURCES PubMed (January 4, 2017), MEDLINE (January 4, 2017), and EMBASE (February 1, 2017). DATA EXTRACTION Databases were searched for studies of critically ill adult patients after hospital discharge, with sleep disturbance measured as a primary outcome by standardized questionnaire or objective measurement tools. From each relevant study, we extracted prevalence and severity of sleep disturbance at each time point, objective sleep parameters (such as total sleep time, sleep efficiency, and arousal index), and risk factors for sleep disturbance. SYNTHESIS A total of 22 studies were identified, with assessment tools including subjective questionnaires, polysomnography, and actigraphy. Subjective questionnaire studies reveal a 50-66.7% (within 1 mo), 34-64.3% (>1-3 mo), 22-57% (>3-6 mo), and 10-61% (>6 mo) prevalence of abnormal sleep after hospital discharge after critical illness. Of the studies assessing multiple time points, four of five questionnaire studies and five of five polysomnography studies show improved aspects of sleep over time. Risk factors for poor sleep varied, but prehospital factors (chronic comorbidity, pre-existing sleep abnormality) and in-hospital factors (severity of acute illness, in-hospital sleep disturbance, pain medication use, and ICU acute stress symptoms) may play a role. Sleep disturbance was frequently associated with postdischarge psychological comorbidities and impaired quality of life. CONCLUSIONS Sleep disturbance is common in critically ill patients up to 12 months after hospital discharge. Both subjective and objective studies, however, suggest that sleep disturbance improves over time. More research is needed to understand and optimize sleep in recovery from critical illness.
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Choi J, Lingler JH, Donahoe MP, Happ MB, Hoffman LA, Tate JA. Home discharge following critical illness: A qualitative analysis of family caregiver experience. Heart Lung 2018; 47:401-407. [PMID: 29731146 PMCID: PMC6026552 DOI: 10.1016/j.hrtlng.2018.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/08/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Few studies have longitudinally explored the experience and needs of family caregivers of ICU survivors after patients' home discharge. METHODS Qualitative content analysis of interviews drawn from a parent study that followed family caregivers of adults ICU survivors for 4 months post-ICU discharge. RESULTS Family caregivers (n = 20, all white, 80% woman) viewed home discharge as positive progress, but reported having insufficient time to transition from family visitor to the active caregiver role. Caregivers expressed feelings of relief during the steady recovery of family members' physical and cognitive function. However, the slow pace of improvement conflicted with their expectations. Even after patients achieved independent physical function, emotional needs persisted and these issues contributed to caregivers' anxiety, worry, and view that recovery was incomplete. CONCLUSION Family caregivers of ICU survivors need information and skills to help managing patients' care needs, pacing expectations with actual patients' progress, and caregivers' health needs.
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Affiliation(s)
- JiYeon Choi
- Department of Acute and Tertiary Care, University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA; Yonsei University College of Nursing, Seoul, Republic of Korea.
| | - Jennifer H Lingler
- Department of Health and Community Systems, University of Pittsburg, School of Nursing, Pittsburgh, PA, USA
| | - Michael P Donahoe
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Mary Beth Happ
- Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Leslie A Hoffman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Judith A Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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Wintermann GB, Rosendahl J, Weidner K, Strauß B, Hinz A, Petrowski K. Self-reported fatigue following intensive care of chronically critically ill patients: a prospective cohort study. J Intensive Care 2018; 6:27. [PMID: 29744108 PMCID: PMC5930426 DOI: 10.1186/s40560-018-0295-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 12/12/2022] Open
Abstract
Background Protracted treatment on intensive care unit (ICU) sets the patients at increased risk for the development of chronic critical illness (CCI). Muscular and cardio-respiratory deconditioning are common long-term sequelae, going along with a state of chronic fatigue. At present, findings regarding the frequency, long-term course, and associated factors of self-reported fatigue following ICU treatment of CCI patients are lacking. Methods CCI patients with the diagnosis of critical illness polyneuropathy/myopathy (CIP/CIM) were assessed at three time points. Four weeks following the discharge from ICU at acute care hospital (t1), eligibility for study participation was asserted. Self-reported fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20) via telephone contact at 3 (t2, n = 113) and 6 months (t3, n = 91) following discharge from ICU at acute care hospital. Results At both 3 and 6 months, nearly every second CCI patient showed clinically relevant fatigue symptoms (t2/t3: n = 53/n = 51, point prevalence rates: 46.9%/45.1%). While total fatigue scores remained stable in the whole sample, female patients showed a decrease from 3 to 6 months. The presence of a coronary heart disease, the perceived fear of dying at acute care ICU, a diagnosis of major depression, and the perceived social support were confirmed as significant correlates of fatigue at 3 months. At 6 months, male gender, the number of medical comorbidities, a diagnosis of major depression, and a prior history of anxiety disorder could be identified. A negative impact of fatigue on the perceived health-related quality of life could be ascertained. Conclusions Nearly every second CCI patient showed fatigue symptoms up to 6 months post-ICU. Patients at risk should be informed about fatigue, and appropriate treatment options should be offered to them. Trial registration The present study was registered retrospectively at the German Clinical Trials Register (date of registration: 13th of December 2011; registration number: DRKS00003386). Date of enrolment of the first participant to the present trial: 09th of November 2011.
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Affiliation(s)
- Gloria-Beatrice Wintermann
- 1Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden Fetscherstraße 74, 01307 Dresden, Germany
| | - Jenny Rosendahl
- Center for Sepsis Control and Care, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.,Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- 1Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden Fetscherstraße 74, 01307 Dresden, Germany
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Andreas Hinz
- 4Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Katja Petrowski
- 1Department of Psychotherapy and Psychosomatic Medicine, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden Fetscherstraße 74, 01307 Dresden, Germany
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Aslakson RA, Reinke LF, Cox C, Kross EK, Benzo RP, Curtis JR. Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes. J Palliat Med 2018; 20:329-343. [PMID: 28379812 DOI: 10.1089/jpm.2016.0567] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Palliative care is a medical specialty and philosophy of care that focuses on reducing suffering among patients with serious illness and their family members, regardless of disease diagnosis or prognosis. As critical illness or moderate to severe pulmonary disease confers significant disease-related symptom burdens, palliative care and palliative care specialists can aid in reducing symptom burden and improving quality of life among these patients and their family members. OBJECTIVE The objective of this article is to review the existing gaps in evidence for palliative care in pulmonary disease and critical illness and to use an interdisciplinary working group convened by the National Institutes of Health and the National Palliative Care Research Center to develop a research agenda to address these gaps. METHODS We completed a narrative review of the literature concerning the integration of palliative care into pulmonary and/or critical care. The review was based on recent systematic reviews on these topics as well as a summary of relevant articles identified through hand search. We used this review to identify gaps in current knowledge and develop a research agenda for the future. RESULTS We identified key areas of need and knowledge gaps that should be addressed to improve palliative care for patients with pulmonary and critical illness. These areas include developing and validating patient- and family-centered outcomes, identifying the key components of palliative care that are effective and cost-effective, developing and evaluating different models of palliative care delivery, and determining the effectiveness and cost-effectiveness of palliative care interventions. CONCLUSIONS The goal of this research agenda is to encourage researchers, clinicians, healthcare systems, and research funders to identify research that can address these gaps and improve the lives of patients with pulmonary and critical illness and their family members.
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Affiliation(s)
- Rebecca A Aslakson
- 1 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine , Baltimore, Maryland.,2 Department of Oncology and Palliative Care Program in the Kimmel Comprehensive Cancer Center at Johns Hopkins , Baltimore, Maryland.,3 Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Lynn F Reinke
- 4 Department of Veterans Affairs, Puget Sound Healthcare System , Seattle, Washington.,5 Department of Biobehavioral Nursing and Health Systems, University of Washington , Seattle, Washington
| | - Christopher Cox
- 6 Department of Medicine, Duke University , Durham, North Carolina
| | - Erin K Kross
- 7 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.,8 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
| | - Roberto P Benzo
- 9 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester, Minnesota
| | - J Randall Curtis
- 7 Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington , Seattle, Washington.,8 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
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Langerud AK, Rustøen T, Brunborg C, Kongsgaard U, Stubhaug A. Prevalence, Location, and Characteristics of Chronic Pain in Intensive Care Survivors. Pain Manag Nurs 2018; 19:366-376. [PMID: 29455923 DOI: 10.1016/j.pmn.2017.11.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND A growing number of studies have addressed the long-term consequences of intensive care unit (ICU) treatment, but few have studied the prevalence of chronic pain and pain characteristics longitudinally. AIMS The goal of the work described here was to investigate the prevalence and characteristics of chronic pain in ICU survivors 3 months and 1 year after ICU discharge and to identify risk factors for chronic pain 1 year after ICU discharge. DESIGN The design used was an explorative and longitudinal study. SETTING/PATIENTS The patients in this work had stayed >48 hours in two mixed ICUs in Oslo University Hospital, a tertiary referral hospital. METHODS Patients completed a survey questionnaire 3 months and 1 year after ICU discharge. Pain was assessed using the Brief Pain Inventory-Short Form. RESULTS At 3 months after discharge, 58 of 118 ICU survivors (49.2%) reported pain, and at 1 year after discharge, 34 of 89 survivors (38.2%) reported pain. The most common sites of pain at 3 months were the shoulder and abdomen; the shoulder remained the second most common site at 1 year. There was an increase in the interference of pain with daily life at 1 year. Possible risk factors for chronic pain at 1 year were increased severity of illness, organ failure, ventilator time >12 days, and ICU length of stay >15 days. The most common sites of pain were not linked to the admission diagnosis. CONCLUSIONS These findings may enable health care providers to improve care and rehabilitation for this patient group.
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Affiliation(s)
- Anne Kathrine Langerud
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, University of Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Ulf Kongsgaard
- Faculty of Medicine, University of Oslo, Norway; Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Norway
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Langerud AK, Rustøen T, Småstuen MC, Kongsgaard U, Stubhaug A. Intensive care survivor-reported symptoms: a longitudinal study of survivors' symptoms. Nurs Crit Care 2017; 23:48-54. [PMID: 29243344 DOI: 10.1111/nicc.12330] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/30/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is growing interest in potential long-term outcomes following intensive care, but few researchers have studied the prevalence of multiple symptoms or the association between pain and other symptoms. AIMS To investigate the prevalence of anxiety, depression, fatigue, sleep disturbance and post-traumatic stress symptoms (PTSS) among intensive care survivors 3 months and 1 year after being discharged from an intensive care unit (ICU) and to determine whether pain is associated with higher prevalence of these symptoms 3 months and 1 year after ICU stay. STUDY DESIGN Exploratory, longitudinal cohort of intensive care survivors from two mixed ICUs in a tertiary referral hospital in Norway. METHODS Intensive care survivors completed surveys at 3 months (n = 118) and 1 year (n = 89) after ICU discharge. Clinical Trials: NCT02279212. RESULTS Prevalence rates of intensive care survivors' symptoms were pain 58 (49·2%), anxiety/depression 24/118 (20·8%), fatigue 18/118(15·3%), PTSS 15 (12·8%) and sleep disturbance 58/118 (49·2%) at 3 months after ICU discharge (n = 118). Prevalence rates at 1 year (n = 89) changed only slightly to pain 34 (38·2%), anxiety/depression 17 (20·0%), fatigue 12 (13·8%), PTSS 13 (15·1%) and sleep disturbance 40/89 (46·5%). Associations were strong between pain and presence of sleep disturbance, anxiety/depression, PTSS and fatigue. CONCLUSIONS Intensive care survivors have multiple symptoms and the prevalence rates of these symptoms remained almost unchanged from 3 months to 1 year after ICU discharge. The presence of pain was associated with high odds for the presence of sleep disturbance, anxiety/depression, PTSS and fatigue, compared to a no-pain group. ICU survivors may benefit from targeted interventions designed to alleviate the symptom burden. RELEVANCE TO CLINICAL PRACTICE Knowledge about ICU survivor's prevalence and risk for having multiple symptoms may help health care professionals to give better care, if needed, to the ICU survivors.
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Affiliation(s)
- Anne Kathrine Langerud
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Post-operative and Critical Care, Division of Emergencies and Critical Care Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Oslo, Norway.,Institute of Health and Society, Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Ulf Kongsgaard
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Audun Stubhaug
- Department of Pain Management and Reserch, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Attitudes towards end-of-life issues in intensive care unit among Italian anesthesiologists: a nation-wide survey. Support Care Cancer 2017; 26:1773-1780. [DOI: 10.1007/s00520-017-4014-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023]
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48
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Cajanding RJM. Causes, assessment and management of fatigue in critically ill patients. ACTA ACUST UNITED AC 2017; 26:1176-1181. [DOI: 10.12968/bjon.2017.26.21.1176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ruff JM Cajanding
- Staff Nurse, Liver Intensive Therapy Unit, Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London
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49
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Abstract
Despite advances in surgical critical care, critical illness remains traumatic and has long-term adverse sequelae. Unrealistic expectations and erroneous assumptions about outcomes acceptable to patients have been identified as drivers of goal-discordant treatment. Goal setting in the ICU begins with compassionately delivered, accurate, and honest prognostic information. Through skilled communication and shared decision making, clinicians forge a mutual understanding of patient values and priorities and the role of therapeutic options in achieving patient goals. Ensuring that treatment is goal-concordant and meets physical, psychosocial, existential, and spiritual needs is crucial for attaining optimal patient and caregiver outcomes, independent of survival.
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Affiliation(s)
- Ana Berlin
- Department of Surgery, Rutgers New Jersey Medical School, Medical Science Building G-506, 185 South Orange Avenue, Newark, NJ 07103, USA.
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Blair KTA, Eccleston SD, Binder HM, McCarthy MS. Improving the Patient Experience by Implementing an ICU Diary for Those at Risk of Post-intensive Care Syndrome. J Patient Exp 2017; 4:4-9. [PMID: 28725854 PMCID: PMC5513660 DOI: 10.1177/2374373517692927] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The critical care literature in the US has recently brought attention to the impact an ICU experience can have long after the patient survives critical illness, particularly if delirium was present. Current recommendations to mitigate post-intensive care syndrome (PICS) are embedded in patient and family-centered care and aim to promote family presence in the ICU, provide support for decision-making, and enhance communication with the health-care team. Evidence-based interventions are few in number but include use of an ICU diary to minimize the psychological and emotional sequelae affecting patients and family members in the months following the ICU stay. In this paper we describe our efforts to implement an ICU diary and solicit feedback on its role in fostering teamwork and communication between patients, family members, and ICU staff. Next steps will involve a PICS follow-up clinic where trained staff will coordinate specialty referrals and perform long-term monitoring of mental health and other quality of life outcomes.
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Affiliation(s)
- K Taylor A Blair
- Critical Care Nursing Section, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
| | - Sarah D Eccleston
- Center for Nursing Science & Clinical Inquiry, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
| | - Hannah M Binder
- Critical Care Nursing Section, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
| | - Mary S McCarthy
- Center for Nursing Science & Clinical Inquiry, Department of Inpatient Services, Madigan Army Medical Center, Tacoma, WA, USA
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