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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review. Aust Crit Care 2024; 37:354-368. [PMID: 37684157 DOI: 10.1016/j.aucc.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
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Affiliation(s)
- Lynsey Sutton
- Clinical Nurse Specialist, Wellington Intensive Care Unit, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Riddiford Street, Newtown, Wellington 6021, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
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Haines KJ, Hibbert E, Skinner EH, Leggett N, Holdsworth C, Ali Abdelhamid Y, Bates S, Bicknell E, Booth S, Carmody J, Deane AM, Emery K, Farley KJ, French C, Krol L, MacLeod-Smith B, Maher L, Paykel M, Iwashyna TJ. In-person peer support for critical care survivors: The ICU REcovery Solutions cO-Led through surVivor Engagement (ICURESOLVE) pilot randomised controlled trial. Aust Crit Care 2024:S1036-7314(24)00022-5. [PMID: 38360469 DOI: 10.1016/j.aucc.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Peer support is a promising intervention to mitigate post-ICU disability, however there is a paucity of rigorously designed studies. OBJECTIVES The objective of this study was to establish feasibility of an in-person, co-designed, peer-support model. METHODS Prospective, randomised, adaptive, single-centre pilot trial with blinded outcome assessment, conducted at a university-affiliated hospital in Melbourne, Australia. Intensive care unit survivors (and their nominated caregiver, where survivor and caregiver are referred to as a dyad), >18 years of age, able to speak and understand English and participate in phone surveys, were eligible. Participants were randomised to the peer-support model (six sessions, fortnightly) or usual care (no follow-up or targeted information). Two sequential models were piloted: 1. Early (2-3 weeks post hospital discharge) 2. Later (4-6 weeks post hospital discharge). Primary outcome was feasibility of implementation measured by recruitment, intervention attendance, and outcome completion. Secondary outcomes included post-traumatic stress and social support. RESULTS Of the 231 eligible patients, 80 participants were recruited. In the early model we recruited 38 participants (28 patients, 10 carers; 18 singles, 10 dyads), with an average (standard deviation) age of 60 (18) years; 55 % were female. Twenty-two participants (58 %) were randomised to intervention. Participants in the early intervention model attended a median (interquartile range) of 0 (0-1) sessions (total 24 sessions), with 53% (n = 20) completing the main secondary outcome of interest (Impact of Event Scale) at the baseline and 37 % (n = 14) at the follow-up. For the later model we recruited 42 participants (32 patients, 10 carers; 22 singles, 10 dyads), with an average (standard deviation) age of 60.4 (15.4) years; 50 % were female. Twenty-one participants (50 %) were randomised to intervention. The later intervention model attended a median (interquartile range) of 1 (0-5) sessions (total: 44 sessions), with the main secondary outcome impact of events scale (IES-R) completed by 41 (98 %) participants at baseline and 29 (69 %) at follow-up. CONCLUSIONS In this pilot trial, a peer-support model that required in-person attendance delivered in a later posthospital phase of recovery appeared more feasible than an early model. Further research should investigate alternative modes of intervention delivery to improve feasibility (ACTRN12621000737831).
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Affiliation(s)
- Kimberley J Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia.
| | - Elizabeth Hibbert
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Nina Leggett
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Clare Holdsworth
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Yasmine Ali Abdelhamid
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Samantha Bates
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Erin Bicknell
- Department of Physiotherapy, Melbourne Health, Melbourne, Australia
| | - Sarah Booth
- Department of Social Work, Western Health, Melbourne, Australia
| | - Jacki Carmody
- Department of Psychology, Western Health, Melbourne, Australia
| | - Adam M Deane
- Department of Intensive Care, Melbourne Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Kate Emery
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - K J Farley
- Department of Intensive Care, Western Health, Melbourne, Australia
| | - Craig French
- Department of Intensive Care, Western Health, Melbourne, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia
| | - Lauren Krol
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | | | - Lynne Maher
- Ko Awatea, Health System Innovation and Improvement, Counties Manukau Health, Auckland, New Zealand
| | - Melanie Paykel
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Theodore J Iwashyna
- Pulmonary and Critical Care Medicine, School of Medicine, John Hopkins University, Baltimore, MD, United States
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Mesina RS, Rustøen T, Hagen M, Laake JH, Hofsø K. Long-term functional disabilities in intensive care unit survivors: A prospective cohort study. Aust Crit Care 2024:S1036-7314(23)00197-2. [PMID: 38171986 DOI: 10.1016/j.aucc.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Functional disabilities are common in intensive care unit (ICU) survivors and may affect their ability to live independently. Few previous studies have investigated long-term functional outcomes with health status before ICU admission (pre-ICU health), and they are limited to specific patient groups. OBJECTIVES The objective of this study was to investigate the prevalence of functional disabilities and examine pre-ICU health variables as possible predictive factors of functional disabilities 12 months after ICU admission in a mixed population of ICU survivors. METHODS This prospective cohort study was conducted in six ICUs in Norway. Data on pre-ICU health were collected as soon as possible after ICU admission using patients, proxies, and patient electronic health records and at 12 months after ICU admission. Self-reported functional status was assessed using the Katz Index of independence in personal activities of daily living (P-ADL) and the Lawton instrumental activities of daily living scale (I-ADL). RESULTS A total of 220 of 343 (64%) ICU survivors with data on pre-ICU health completed the questionnaires at 12 months and reported the following functional disabilities at 12 months: 31 patients (14.4%) reported P-ADL dependencies (new in 16 and persisting in 15), and 80 patients (36.4%) reported I-ADL dependencies (new in 41 and persisting in 39). In a multivariate analysis, worse baseline P-ADL and I-ADL scores were associated with dependencies in P-ADLs (odds ratio [OR]: 1.87; 95% confidence interval [CI]: 1.14-3.06) and I-ADLs (OR: 1.52; 95% CI: 1.03-2.23), respectively, at 12 months. Patients who were employed were less likely to report I-ADL dependencies at 12 months (OR: 0.34; 95% CI: 0.12-0.95). CONCLUSION In a subsample of ICU survivors, patients reported functional disabilities 12 months after ICU admission, which was significantly associated with their pre-ICU functional status. Early screening of pre-ICU functional status may help identify patients at risk of long-term functional disabilities. ICU survivors with pre-ICU functional disabilities may find it difficult to improve their functional status.
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Affiliation(s)
- Renato S Mesina
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern NO-0316, Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, P.O. Box 1078, Blindern NO-0316, Oslo, Norway
| | - Milada Hagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Public Health, Faculty of Nursing Science, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass N-0130, Oslo, Norway
| | - Jon Henrik Laake
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Anaesthesiology and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen N-0424, Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P. O. Box 4950, Nydalen N-0424, Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggt. 15b, 0456, Oslo, Norway
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Imanaka R, Ouchi A, Sakuramoto H, Aikawa G, Hoshino T, Enomoto Y, Shimojo N, Inoue Y. Survey of sensory impairment in critically ill patients after intensive care unit discharge: An ambidirectional cohort study. Aust Crit Care 2024; 37:12-17. [PMID: 38182531 DOI: 10.1016/j.aucc.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 09/20/2023] [Accepted: 09/23/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Sensory impairment affects the quality of life after intensive care. However, no studies have comprehensively examined sensory impairment after intensive care. OBJECTIVES This study aimed to investigate sensory impairment in critically ill patients. METHODS This ambidirectional cohort study was conducted in the intensive care unit (ICU) of a university hospital between April 2017 and January 2020. Patients who survived despite invasive mechanical ventilation for >48 h, with a discharge period of >6 months, participated in the study. A questionnaire was sent to consenting patients to investigate the presence or absence of sensory impairment at that time, and treatment-related data were collected from their medical records. RESULTS Of 75 eligible patients, 62 responded to our survey. Twenty-seven (43.6%) patients had some sensory impairment. Nine (14.5%) patients had chronic pain after ICU discharge, 4 (6.5%) had chronic pain and visual impairment, 3 (4.8%) had visual impairment only, and 3 (4.8%) had chronic pain and taste impairment. The most common overlapping symptom was a combination of chronic pain. CONCLUSIONS Critically ill patients who survived and were discharged from the ICU accounted for 43.6% of patients with complaints of sensory impairment in the chronic phase. The results of this study suggest the need for follow-up and treatment of possible sensory impairment following ICU discharge.
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Affiliation(s)
- Ryota Imanaka
- Department of Nursing, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika Hitachi, Ibaraki, 319-1295, Japan.
| | - Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyusyu International College of Nursing, 1-1 Asty Munakata, Fukuoka, 811-4157, Japan.
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika Hitachi, Ibaraki, 319-1295, Japan.
| | - Tetsuya Hoshino
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Nobutake Shimojo
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
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Zhou M, Zhang J, Xu Z, Gu H, Chen Z, Ding Y. Incidence of and risk factors for post-intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional, prospective study. Aust Crit Care 2022:S1036-7314(22)00096-0. [PMID: 36104256 DOI: 10.1016/j.aucc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients transferred from the respiratory intensive care unit (ICU) can experience post-intensive care syndrome (PICS), which comprises cognitive, psychological, and physical disorders that seriously affect the quality of life. Therefore, it was necessary to explore the incidence of and the risk factors for PICS among respiratory ICU patients. OBJECTIVES This study evaluated PICS among respiratory ICU patients and explored the risk factors for PICS. METHODS This cross-sectional, prospective study was performed at one hospital in China. Using convenience sampling, 125 respiratory ICU patients from August 2018 to June 2019 were recruited for the study. The Mini-Mental State Examination, Confusion Assessment Method for the Intensive Care Unit, Hospital Anxiety and Depression Scale, Medical Research Council Scale, activities of daily living scale, Pittsburgh Sleep Quality Index, and the 14-item fatigue scale were used to comprehensively assess the patients' cognitive status, psychological status, and physiological status when entering the ICU and 2 weeks after leaving the ICU. Factors affecting PICS were measured using researcher-created questionnaires of patients' general information and disease-related information. RESULTS Fifteen patients were lost to follow-up. Fifty-nine patients had PICS (incidence rate, 53.6%). Logistic regression showed that risk factors for PICS were age, invasive mechanical ventilation, noninvasive ventilator-assisted ventilation, and coronary heart disease (P < 0.05). CONCLUSION The PICS incidence was high. Older age, longer invasive mechanical ventilation times, longer noninvasive ventilator times, and coronary heart disease were risk factors for PICS. ICU medical workers in China should pay more attention on PICS, know the risk factors, and implement preventive measures.
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Kim SJ, Park K, Kim K. Post-intensive care syndrome and health-related quality of life in long-term survivors of intensive care unit. Aust Crit Care 2022:S1036-7314(22)00088-1. [PMID: 35843808 DOI: 10.1016/j.aucc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/04/2022] [Accepted: 06/11/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE The objective of this study was to provide preliminary data for improving the health-related quality of life of long-term intensive care unit survivors by identifying the relationship between health-related quality of life and post-intensive care syndrome. METHODS Using a descriptive correlation research design, data from patients who visited the outpatient department for continuous treatment after discharge from the intensive care unit were analysed. Post-intensive care syndrome was measured by physical, cognitive, and mental problems. Data were collected from 1st August to 31st December, 2019, and 121 intensive care unit survivors participated in the study. RESULTS Health-related quality of life showed a negative correlation with physical, mental, and cognitive problems. The factors associated with health-related quality of life were physical and mental problems, education level, sedatives and neuromuscular relaxants, and marital status. CONCLUSIONS To improve the health-related quality of life of intensive care unit survivors, post-intensive care syndrome prevention is important, and a systematic strategy is required through a long-term longitudinal trace study. In addition, intensive care unit nurses and other healthcare professionals need to provide early interventions to reduce post-intensive care syndrome.
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Affiliation(s)
- Seung-Jun Kim
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, South Korea
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Abstract
Survivors of acute respiratory distress syndrome (ARDS) experience challenges that persist well beyond the time of hospital discharge. Impairment in physical function, cognitive function, and mental health are common and may last for years. The current coronavirus disease 2019 pandemic is drastically increasing the incidence of ARDS worldwide, and long-term impairments will remain lasting effects of the pandemic. Evaluation of the ARDS survivor should be comprehensive, and common domains of impairment that have emerged from long-term outcomes research over the past 2 decades should be systematically evaluated.
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Affiliation(s)
- Jessica A Palakshappa
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jennifer T W Krall
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Lanazha T Belfield
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - D Clark Files
- Section of Pulmonary, Critical Care, Allergy and Critical Care, Wake Forest University School of Medicine, 2 Watlington Hall, 1 Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Knudson KA, Funk M, Redeker NS, Andrews LK, Whittemore R, Mangi AA, Sadler LS. An unbelievable ordeal: The experiences of adult survivors treated with extracorporeal membrane oxygenation. Aust Crit Care 2021; 35:391-401. [PMID: 34474961 DOI: 10.1016/j.aucc.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a rescue treatment option for adult patients with severe cardiac dysfunction or respiratory failure. While short-term patient outcomes, such as in-hospital mortality and complications, have been widely described, little is known about the illness or recovery experience from the perspectives of survivors. Subjective reports of health are important indicators of the full, long-term impact of critical illness and treatment with ECMO on survivors' lives. OBJECTIVE The objective of this study was to describe the experiences and needs of adults treated with ECMO, from onset of illness symptoms through the process of survivorship. METHODS This study was guided by the qualitative method of interpretive description. We conducted in-depth, semistructured interviews with 16 adult survivors of ECMO who were treated at two participating regional ECMO centres in the northeast United States. Additional data were collected from demographic questionnaires, field notes, memos, and medical record review. Development of interview guides and data analysis were informed by the Family Management Style Framework. Qualitative data were analysed using thematic analysis techniques. RESULTS The sample (n = 16) included 75% male participants; ages ranged from 23 to 65 years. Duration from hospital discharge to interviews ranged from 11 to 90 (M = 54; standard deviation = 28) months. Survivors progressed through three stages: Trauma and Vulnerability, Resiliency and Recovery, and Survivorship. Participants described short- and long-term impacts of the ECMO experience: all experienced physical challenges, two-thirds had at least one psychological or cognitive difficulty, and 25% were unable to return to work. All were deeply influenced by their own specific contexts, family support, and interactions with healthcare providers. CONCLUSIONS The ECMO experience is traumatic and complex. Recovery requires considerable time, perseverance, and support. Long-term sequelae include impairments in cognitive, mental, emotional, physical, and social health. Survivors could likely benefit from specialised posthospital health services that include integrated, comprehensive follow-up care.
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Affiliation(s)
- Krista A Knudson
- Institute for Translational Medicine, University of Chicago, 5841 S. Maryland Ave, W511, MC7100, Chicago, IL, 60637, United States; Rush University, 600 S. Paulina St, Chicago, IL, 60612, United States; Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516-7399, United States.
| | - Marjorie Funk
- Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516-7399, United States.
| | - Nancy S Redeker
- Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516-7399, United States.
| | - Laura K Andrews
- Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516-7399, United States.
| | - Robin Whittemore
- Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516-7399, United States.
| | - Abeel A Mangi
- Yale School of Medicine, 300 Cedar Street, New Haven, CT, 06511, United States; MedStar Heart and Vascular Institute, Suite 6D-15, 110 Irving Street NW, Washington, DC, 20010, United States.
| | - Lois S Sadler
- Yale School of Nursing, P.O. Box 27399, West Haven, CT, 06516-7399, United States.
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Abstract
Post-intensive care syndrome is a detrimental cluster of symptoms that can have a negative impact on life after discharge from the intensive care unit (ICU). The use of patient diaries while hospitalized in the ICU has been reported to help survivors and families create memories and fill in gaps from their hospitalization. A review of the literature revealed that patient selection, diary content, family involvement, and staff perceptions are essential to the implementation of a diary program. Understanding the importance and impact diaries can have on survivors increases compliance and sustainability of this program.
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Abstract
Diaries are written for patients in intensive care units by staff and relatives, especially when patients experience a disorder of their consciousness, such as delirium. Diary entries are written in common language, describing the situation of the patient. The diary can be read by the patient and the family and support the coping and understanding of what happened. It can function as a tool for supporting communication about different experiences and views of critical illness.
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Affiliation(s)
- Peter Nydahl
- Nursing Research, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus V40, Kiel 24105, Germany.
| | - Teresa Deffner
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07743 Jena, Germany
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Cook K, Bartholdy R, Raven M, von Dohren G, Rai S, Haines K, Ramanan M. A national survey of intensive care follow-up clinics in Australia. Aust Crit Care 2020; 33:533-537. [PMID: 32430169 DOI: 10.1016/j.aucc.2020.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/11/2020] [Accepted: 03/18/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Intensive care follow-up clinics (ICFCs) have been implemented internationally with the aim to address the growing number of patients living with sequalae of critical illness and intensive care. However, data on Australian intensive care follow-up practice are rare. OBJECTIVES The primary objective was to determine the proportion of Australian intensive care units (ICUs) that offer a dedicated ICFC to ICU survivors, with the intention of improving long-term outcomes of critical illness. Secondary objectives were to identify models of ICU follow-up and barriers to the implementation of ICFCs. METHODS A custom-designed, pilot-tested 12-question online survey was sent to the nurse unit managers and medical directors of all 167 Australian ICUs listed in the database of the Australian and New Zealand Intensive Care Society. Outcome measures included proportion of ICUs offering ICFCs, details on types of follow-up services with staffing, funding source, and reasons for not providing ICU follow-up. RESULTS One hundred seven of the 167 ICUs contacted responded to the survey. Of these, two (2%) operated a dedicated ICFC. Both ICFCs were nursing-led, with one receiving dedicated funding and the other being unfunded. Three units (3%) conducted routine outpatient follow-up by telephone; one of these services was doctor-led, and two were nurse-led. Four units (4%) were performing outpatient follow-up as part of research studies only. Among the units not operating an ICFC, the main reason given for not doing so were financial constraints (58%), followed by lack of clinical need (19%) and perceived lack of evidence (11%). CONCLUSION In Australia, only two ICUs operated an ICFC. Only one outpatient follow-up service received dedicated funding, and financial constraints were the main reason given for units not offering outpatient follow-up services.
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Affiliation(s)
- Katrina Cook
- Department of Intensive Care, Caboolture Hospital, Australia.
| | - Roland Bartholdy
- Department of Intensive Care, Caboolture Hospital, Australia; Department of Anaesthesia, Princess Alexandra Hospital, Brisbane, Australia; LifeFlight Queensland, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Monique Raven
- Department of Intensive Care, Redcliffe Hospital, Australia
| | | | - Sumeet Rai
- Department of Intensive Care, Canberra Hospital, Canberra, Australia; Australian National University, Canberra, Australia
| | - Kimberley Haines
- Department of Physiotherapy, Western Health, Melbourne, Australia; The University of Melbourne, Melbourne, Australia; ANZICS Research Centre, Melbourne, Australia
| | - Mahesh Ramanan
- Department of Intensive Care, Caboolture Hospital, Australia; Department of Intensive Care, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; The George Institute, University of New South Wales, Sydney, Australia
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Parry S, Denehy L, Granger C, McGinley J, Files DC, Berry M, Dhar S, Bakhru R, Larkin J, Puthucheary Z, Clark R, Morris P. The fear and risk of community falls in patients following an intensive care admission: An exploratory cohort study. Aust Crit Care 2019; 33:144-150. [PMID: 31495638 DOI: 10.1016/j.aucc.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/03/2019] [Accepted: 04/24/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Muscle weakness and impairments in physical functioning are well-recognised sequelae after critical illness. Whether individuals have a higher risk of community falls and a fear of falling has not been examined amongst individuals after critical illness. OBJECTIVES The objective of this study was to explore the prevalence of falls, fear of falling, and fall risk in intensive care unit (ICU) survivors over a 6-month period after hospital discharge. METHODS This was a nested exploratory study within a medical ICU. Fall prevalence was measured in line with established guidelines over 6 months after ICU discharge. Fear of falling and prediction of fall risk were assessed at 2, 4, and 6 months after discharge. RESULTS Twelve individuals were included. Half of the cohort (n = 6) had at least one fall, with one-third sustaining more than one fall. There were 17 falls reported across the six individuals. Injuries requiring medical intervention were reported with five falls. Almost one-third were classified as 'moderate' to 'severe' injurious falls. Loss of balance and fatigue were reported as the main contributors to the falls. All individuals who had a fall reported a severe fear of falling at 2 months. Individuals classified as having 'moderate' to 'high' risk of falls at 2 months were more likely to have at least one fall. CONCLUSIONS This study suggests that ICU survivors may have a high fall risk, fear of falling, and fall prevalence, which can result in significant injury.
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Affiliation(s)
- Selina Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - Catherine Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia; Department of Physiotherapy, Royal Melbourne Hospital, Victoria, Australia
| | - Jennifer McGinley
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia
| | - D Clark Files
- Pulmonary, Critical Care, Allergy and Immunology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Berry
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Sanjay Dhar
- Section on Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
| | - Rita Bakhru
- Pulmonary, Critical Care, Allergy and Immunology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Jane Larkin
- Department of Physiotherapy, Royal Melbourne Hospital, Victoria, Australia
| | - Zudin Puthucheary
- Royal Free Hospital, NHS Foundation Trust, London, United Kingdom; Centre for Health and Human Performance, University College Hospital London, United Kingdom
| | - Ross Clark
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Queensland, Australia
| | - Peter Morris
- Section on Pulmonary, Critical Care and Sleep Medicine, University of Kentucky, Lexington, KY, USA
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13
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Rai S, Anthony L, Needham DM, Georgousopoulou EN, Sudheer B, Brown R, Mitchell I, van Haren F. Barriers to rehabilitation after critical illness: a survey of multidisciplinary healthcare professionals caring for ICU survivors in an acute care hospital. Aust Crit Care 2019; 33:264-271. [PMID: 31402265 DOI: 10.1016/j.aucc.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/04/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND There is scant literature on the barriers to rehabilitation for patients discharged from the intensive care unit (ICU) to acute care wards. OBJECTIVES The objective of this study was to assess ward-based rehabilitation practices and barriers and assess knowledge and perceptions of ward clinicians regarding health concerns of ICU survivors. METHODS, DESIGN, SETTING, AND PARTICIPANTS This was a single-centre survey of multidisciplinary healthcare professionals caring for ICU survivors in an Australian tertiary teaching hospital. MAIN OUTCOME MEASURES The main outcome measures were knowledge of post-intensive care syndrome (PICS) amongst ward clinicians, perceptions of ongoing health concerns with current rehabilitation practices, and barriers to inpatient rehabilitation for ICU survivors. RESULTS The overall survey response rate was 35% (198/573 potential staff). Most respondents (66%, 126/190) were unfamiliar with the term PICS. A majority of the respondents perceived new-onset physical weakness, sleep disturbances, and delirium as common health concerns amongst ICU survivors on acute care wards. There were multifaceted barriers to patient mobilisation, with inadequate multidisciplinary staffing, lack of medical order for mobilisation, and inadequate physical space near the bed as common institutional barriers and patient frailty and cardiovascular instability as the commonly perceived patient-related barriers. A majority of the surveyed ward clinicians (66%, 115/173) would value education on health concerns of ICU survivors to provide better patient care. CONCLUSION There are multiple potentially modifiable barriers to the ongoing rehabilitation of ICU survivors in an acute care hospital. Addressing these barriers may have benefits for the ongoing care of ICU survivors.
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Affiliation(s)
- Sumeet Rai
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia.
| | - Lakmali Anthony
- Australian National University Medical School, Canberra, Australia
| | - Dale M Needham
- Critical Care Physical Medicine and Rehabilitation Program, John Hopkins Hospital, Baltimore, MD, USA; John Hopkins University School of Medicine and School of Nursing, Baltimore, MD, USA
| | | | - Bindu Sudheer
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian Catholic University, Watson, Canberra, Australia
| | - Rhonda Brown
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Imogen Mitchell
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; Australian National University Medical School, Canberra, Australia
| | - Frank van Haren
- Canberra Hospital Intensive Care Unit, Garran, Canberra, Australia; University of Canberra, Bruce, Canberra, Australia
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14
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Abstract
The Society of Critical Care Medicine has released updated recommendations for care of the family in neonatal, pediatric, and adult intensive care units. Translation of the recommendations into practice may benefit from a supporting theoretical framework. Facilitated sensemaking is a mid-range theory built from the same literature that formed the basis for recommendations within the guidelines. The process of facilitated sensemaking may be used to help nurses adopt the SCCM recommendations into practice through the development of caring relationships, promoting family presence, teaching family engagement strategies, and supporting families with communication, information gathering, and participation in decision-making.
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Affiliation(s)
- Judy E Davidson
- Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California, San Diego Health, 200 W Arbor Drive 8929, San Diego, CA 92103 . Sidney Zisook is Distinguished Professor, Department of Psychiatry, University of California, San Diego, and San Diego Veteran's Administration Health Care System, San Diego, California
| | - Sidney Zisook
- Judy E. Davidson is Evidence-Based Practice and Research Nurse Liaison, University of California, San Diego Health, 200 W Arbor Drive 8929, San Diego, CA 92103 . Sidney Zisook is Distinguished Professor, Department of Psychiatry, University of California, San Diego, and San Diego Veteran's Administration Health Care System, San Diego, California
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