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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. Am Heart J Plus 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Albrecht S, Nusser-Müller-Busch R. [Multiple factors contributing to dysphagia : Extended tasks for the interprofessional team in the intensive care unit]. Med Klin Intensivmed Notfmed 2024; 119:56-62. [PMID: 37943309 DOI: 10.1007/s00063-023-01075-y] [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] [Accepted: 09/26/2023] [Indexed: 11/10/2023]
Abstract
A stay in the intensive care unit (ICU) can be associated with complications and lead to secondary problems, known as post intensive care syndrome (PICS). They can prolong inpatient stays, increase ICU mortality and lead to long-term problems. One secondarily acquired problem in intensive care is dysphagia. This article highlights various influencing factors on dysphagia. Some require an extended interprofessional treatment concept that goes beyond strictly speech and swallowing therapist treatment.
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Affiliation(s)
- Sindy Albrecht
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland.
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
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3
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Kumar N. Advances in post intensive care unit care: A narrative review. World J Crit Care Med 2023; 12:254-263. [DOI: 10.5492/wjccm.v12.i5.254] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
As the treatment options, modalities and technology have grown, mortality in intensive care unit (ICU) has been on the decline. More and more patients are being discharged to wards and in the care of their loved ones after prolonged treatment at times and sometimes in isolation. These survivors have a lower life expectancy and a poorer quality of life. They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services, the so-called post intensive care syndrome (PICS). But it is not only the patient who is the sufferer. The mental health of the loved ones and family members may also be affected, which is termed as PICS-family. In this review, we shall be reviewing the definition, epidemiology, clinical features, diagnosis and evaluation, treatment and follow up of PICS. We shall also focus on measures to prevent, rehabilitate and understand the ICU stay from patients’ perspective on how to redesign the ICU, post ICU care needs for a better patient outcome.
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Affiliation(s)
- Nishant Kumar
- Department of Anaesthesiology and Critical Care, Lady Hardinge Medical College and Associated Hospitals, New Delhi 110001, India
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4
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Yoshihiro S, Taito S, Yamauchi K, Kina S, Terayama T, Tsutsumi Y, Kataoka Y, Unoki T. Follow-up focused on psychological intervention initiated after intensive care unit in adult patients and informal caregivers: a systematic review and meta-analysis. PeerJ 2023; 11:e15260. [PMID: 37312876 PMCID: PMC10259442 DOI: 10.7717/peerj.15260] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/28/2023] [Indexed: 06/15/2023] Open
Abstract
Psychological dysfunction is one of the considerable health-related outcomes among critically-ill patients and their informal caregivers. Follow-up of intensive care unit (ICU) survivors has been conducted in a variety of different ways, with different timing after discharge, targets of interest (physical, psychological, social) and measures used. Of diverse ICU follow-up, the effects of follow-ups which focused on psychological interventions are unknown. Our research question was whether follow-up with patients and their informal caregivers after ICU discharge improved mental health compared to usual care. We published a protocol for this systematic review and meta-analysis in https://www.protocols.io/ (https://dx.doi.org/10.17504/protocols.io.bvjwn4pe). We searched PubMed, Cochrane Library, EMBASE, CINAHL and PsycInfo from their inception to May 2022. We included randomized controlled trials for follow-ups after ICU discharge and focused on psychological intervention for critically ill adult patients and their informal caregivers. We synthesized primary outcomes, including depression, post-traumatic stress disorder (PTSD), and adverse events using the random-effects method. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the certainty of evidence. From the 10,471 records, we identified 13 studies (n = 3, 366) focusing on patients and four (n = 538) focusing on informal caregivers. ICU follow-up for patients resulted in little to no difference in the prevalence of depression (RR 0.89, 95% CI [0.59-1.34]; low-certainty evidence) and PTSD (RR 0.84, 95% CI [0.55-1.30]; low-certainty evidence) among patients; however, it increased the prevalence of depression (RR 1.58 95% CI [1.01-2.46]; very low-certainty evidence), PTSD (RR 1.36, 95% CI [0.91-2.03]; very low-certainty evidence) among informal caregivers. The evidence for the effect of ICU follow-up on adverse events among patients was insufficient. Eligible studies for informal caregivers did not define any adverse event. The effect of follow-ups after ICU discharge that focused on psychological intervention should be uncertain.
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Affiliation(s)
- Shodai Yoshihiro
- Department of Pharmaceutical Services, Hiroshima University Hospital, Hiroshima, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Kota Yamauchi
- Division of Rehabilitation, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Shunsuke Kina
- Division of Rehabilitation, Nakagami Hospital, Okinawa, Japan
| | - Takero Terayama
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Yusuke Tsutsumi
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Emergency Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Department of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology Section, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
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Johnson KR, Temeyer JP, Schulte PJ, Nydahl P, Philbrick KL, Karnatovskaia LV. Aloud real- time reading of intensive care unit diaries: A feasibility study. Intensive Crit Care Nurs 2023; 76:103400. [PMID: 36706496 DOI: 10.1016/j.iccn.2023.103400] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Memories of frightening/delusional intensive care unit experiences are a major risk factor for subsequent psychiatric morbidity of critical illness survivors; factual memories are protective. Systematically providing factual information during initial memory consolidation could mitigate the emotional character of the formed memories. We explored feasibility and obtained stakeholder feedback of a novel approach to intensive care unit diaries whereby entries were read aloud to the patients right after they were written to facilitate systematic real time orientation and formation of factual memories. RESEARCH METHODOLOGY Prospective interventional pilot study involving reading diary entries aloud. We have also interviewed involved stakeholders for feedback and collected exploratory data on psychiatric symptoms from patients right after the intensive care stay. SETTING Various intensive care units in a single academic center. MAIN OUTCOME MEASURES Feasibility was defined as intervention delivery on ≥80% of days following patient recruitment. Content analysis was performed on stakeholder interview responses. Questionnaire data were compared for patients who received real-time reading to the historical cohort who did not. RESULTS Overall, 57% (17 of 30) of patients achieved the set feasibility threshold. Following protocol adjustment, we achieved 86% feasibility in the last subset of patients. Patients reported the intervention as comforting and appreciated the reorientation aspect. Nurses overwhelmingly liked the idea; most common concern was not knowing what to write. Some therapists were unsure whether reading entries aloud might overwhelm the patients. There were no significant differences in psychiatric symptoms when compared to the historic cohort. CONCLUSION We encountered several implementation obstacles; once these were addressed, we achieved set feasibility target for the last group of patients. Reading diary entries aloud was welcomed by stakeholders. Designing a trial to assess efficacy of the intervention on psychiatric outcomes appears warranted. IMPLICATIONS FOR CLINICAL PRACTICE There is no recommendation to change current practice as benefits of the intervention are unproven.
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Affiliation(s)
- Kimberly R Johnson
- Department of Pulmonary and Critical Care, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Joseph P Temeyer
- Department of Nursing, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Phillip J Schulte
- Department of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Peter Nydahl
- Department of Anesthesia and Critical Care, Arnold-Heller-Str. 3, University Hospital Schleswig-Holstein, Kiel 24105, Germany
| | - Kemuel L Philbrick
- Department of Psychiatry and Psychology, 200 First St SW, Mayo Clinic, Rochester, MN 55905, USA
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6
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Onrust M, Visser A, van Veenendaal N, Dieperink W, Luttik ML, Derksen MHG, van der Voort PHJ, van der Meulen IC. Physical, social, mental and spiritual functioning of COVID-19 intensive care unit-survivors and their family members one year after intensive care unit-discharge: A prospective cohort study. Intensive Crit Care Nurs 2023; 75:103366. [PMID: 36528460 PMCID: PMC9726690 DOI: 10.1016/j.iccn.2022.103366] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 10/14/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the long-term functioning of patients who survived a COVID-19-related admission to the intensive care unit and their family members, in the physical, social, mental and spiritual domain. DESIGN A single-centre, prospective cohort study with a mixed-methods design. SETTING The intensive care unit of the University Medical Center Groningen in the Netherlands. MAIN OUTCOME MEASURES To study functioning 12 months after intensive care discharge several measurements were used, including a standardised list of physical problems, the Clinical Frailty Scale, the Medical Outcomes Study Short-Form General Health Survey, the McMaster Family Assessment Device, the Hospital Anxiety and Depression Scale, and the Spiritual Needs Questionnaire, as well as open questions and interviews with survivors and their family members. RESULTS A total of 56 survivors (77%) returned the 12-month questionnaire, whose median age was 62 (inter-quartile range [IQR]: 55.0-68.0). Moreover, 67 family members (66%) returned the 12-month questionnaire, whose median age was 58 (IQR: 43-66). At least one physical problem was reported by 93% of the survivors, with 22% reporting changes in their work-status. Both survivors (84%) and their family members (85%) reported at least one spiritual need. The need to feel connected with family was the strongest. The main theme was 'returning to normal' in the interviews with survivors and 'if the patient is well, I am well' in the interviews with family members. CONCLUSIONS One year after discharge, both COVID-19 intensive care survivors and their family members positively evaluate their health-status. Survivors experience physical impairments, and their family members' well-being is strongly impacted by the health of the survivor.
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Affiliation(s)
- Marisa Onrust
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands.
| | - Anja Visser
- University of Groningen, Faculty of Theology and Religious Studies, Department of Comparative Study of Religion, the Netherlands.
| | - Nadine van Veenendaal
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, the Netherlands.
| | - Willem Dieperink
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, the Netherlands.
| | - Marie Louise Luttik
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, the Netherlands.
| | | | - Peter H J van der Voort
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; TIAS School for Business and Society, Tilburg University, Tilburg, the Netherlands.
| | - Ingeborg C van der Meulen
- University of Groningen, University Medical Center Groningen, Department of Critical Care, the Netherlands; Research Group Nursing Diagnostics, Hanze University of Applied Science Groningen, Groningen, the Netherlands.
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7
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Mart MF, Ely EW, Tolle JJ, Patel MB, Brummel NE. Physiologic responses to exercise in survivors of critical illness: an exploratory pilot study. Intensive Care Med Exp 2022; 10:35. [PMID: 36008625 PMCID: PMC9410741 DOI: 10.1186/s40635-022-00461-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background ICU survivors suffer from impaired physical function and reduced exercise capacity, yet the underlying mechanisms are poorly understood. The goal of this exploratory pilot study was to investigate potential mechanisms of exercise limitation using cardiopulmonary exercise testing (CPET) and 6-min walk testing (6MWT). Methods We enrolled adults aged 18 years or older who were treated for respiratory failure or shock in medical, surgical, or trauma ICUs at Vanderbilt University Medical Center (Nashville, TN, United States). We excluded patients with pre-existing cardiac dysfunction, a contraindication to CPET, or the need for supplemental oxygen at rest. We performed CPET and 6MWT 6 months after ICU discharge. We measured standard CPET parameters in addition to two measures of oxygen utilization during exercise (VO2-work rate slope and VO2 recovery half-time). Results We recruited 14 participants. Low exercise capacity (i.e., VO2Peak < 80% predicted) was present in 11 out of 14 (79%) with a median VO2Peak of 12.6 ml/kg/min [9.6–15.1] and 6MWT distance of 294 m [240–433]. In addition to low VO2Peak, CPET findings in survivors included low oxygen uptake efficiency slope, low oxygen pulse, elevated chronotropic index, low VO2-work rate slope, and prolonged VO2 recovery half-time, indicating impaired oxygen utilization with a hyperdynamic heart rate and ventilatory response, a pattern seen in non-critically ill patients with mitochondrial myopathies. Worse VO2-work rate slope and VO2 recovery half-time were strongly correlated with worse VO2Peak and 6MWT distance, suggesting that exercise capacity was potentially limited by impaired muscle oxygen utilization. Conclusions These exploratory data suggest ICU survivors may suffer from impaired muscular oxygen metabolism due to mitochondrial dysfunction that impairs exercise capacity long-term. These findings should be further characterized in future studies that include direct assessments of muscle mitochondrial function in ICU survivors.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 Medical Center North, Nashville, TN, 37232, USA. .,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA. .,Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 Medical Center North, Nashville, TN, 37232, USA.,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA
| | - James J Tolle
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 Medical Center North, Nashville, TN, 37232, USA
| | - Mayur B Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA.,Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nathan E Brummel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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8
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van der Merwe E, Paruk F. Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector. South Afr J Crit Care 2022; 38. [PMID: 36284926 DOI: 10.7196/SAJCC.2022.v38i2.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. OBJECTIVES This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. METHODS A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). RESULTS Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. CONCLUSION This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. CONTRIBUTIONS OF THE STUDY This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.
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Waak M, Harnischfeger J, Ferguson A, Gibbons K, Nguyen KH, Long D. Every child, every day, back to play: the PICUstars protocol - implementation of a nurse-led PICU liberation program. BMC Pediatr 2022; 22:279. [PMID: 35562671 PMCID: PMC9102243 DOI: 10.1186/s12887-022-03232-2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As admissions to paediatric intensive care units (PICU) rise and mortality rates decline, the focus is shifting from survival to quality of survivorship. There is paucity of internationally accepted guidelines to manage complications like over-sedation, delirium, and immobility in the paediatric setting. These have a strong adverse impact on PICU recovery including healthcare costs and long-term functional disability. The A2F bundle (ABCDEF), or ICU Liberation, was developed to operationalise the multiple evidence-based guidelines addressing ICU-related complications and has been shown to improve clinical outcomes and health-care related costs in adult studies. However, there is little data on the effect of ICU Liberation bundle implementation in PICU. METHODS PICU-STARS will be a single centre before-and-after after trial and implementation study. It is designed to evaluate if the multidimensional, nurse-led ICU Liberation model of care can be applied to the PICU and if it is successful in minimising PICU-related problems in a mixed quaternary PICU. In a prospective baseline measurement, the present practises of care in the PICU will be assessed in order to inform the adaptation and implementation of the PICU Liberation bundle. To assess feasibility, implementation outcomes, and intervention effectiveness, the implementation team will use the Consolidated Framework for Implementation Research (CIFR) and process assessment (mixed methods). The implementation process will be evaluated over time, with focus groups, interviews, questionnaires, and observations used to provide formative feedback. Over time, the barriers and enablers for successful implementation will be analysed, with recommendations based on "lessons learned." All outcomes will be reported using standard descriptive statistics and analytical techniques, with appropriate allowance for patient differentials in severity and relevant characteristics. DISCUSSION The results will inform the fine-tune of the Liberation bundle adaptation and implementation process. The expected primary output is a detailed adaptation and implementation guideline, including clinical resources (and investment) required, to adopt PICU-STARS in other children's hospitals. PATIENT AND PUBLIC INVOLVEMENT STATEMENT The authors thank the PICU education and Liberation Implementation team, and our patients and families for their inspiration and valuable comments on protocol drafts. Results will be made available to critical care survivors, their caregivers, relevant societies, and other researchers. TRIAL REGISTRATION ACTRN, ACTRN382863 . Registered 19/10/2021 - Retrospectively registered. STUDY STATUS recruiting.
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Affiliation(s)
- M Waak
- Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland, 4101, Australia. .,Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia.
| | - J Harnischfeger
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - A Ferguson
- Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - K Gibbons
- Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland, 4101, Australia
| | - K H Nguyen
- Centre for Applied Health Economics, School of Medicine and Griffith Health Institute, Griffith University, Brisbane, QLD, 4131, Australia.,Centre for Health Service Research, Faculty of Medicine, University of Queensland, QLD, Herston, 4006, Australia
| | - D Long
- Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland, 4101, Australia.,Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia.,School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
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10
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Harris BR, Beesley SJ, Hopkins RO, Hirshberg EL, Wilson E, Butler J, Oniki TA, Kuttler KG, Orme JF, Brown SM. Heart rate variability and subsequent psychological distress among family members of intensive care unit patients. J Int Med Res 2021; 49:3000605211057829. [PMID: 34846178 PMCID: PMC8649465 DOI: 10.1177/03000605211057829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective To determine whether heart rate variability (HRV; a physiological measure of
acute stress) is associated with persistent psychological distress among
family members of adult intensive care unit (ICU) patients. Methods This prospective study investigated family members of patients admitted to a
study ICU. Participants’ variability in heart rate tracings were measured by
low frequency (LF)/high frequency (HF) ratio and detrended fluctuation
analysis (DFA). Questionnaires were completed 3 months after enrollment to
ascertain outcome rates of anxiety, depression, and post-traumatic stress
disorder (PTSD). Results Ninety-nine participants were enrolled (median LF/HF ratio, 0.92
[interquartile range, 0.64–1.38]). Of 92 participants who completed the
3-month follow-up, 29 (32%) had persistent anxiety. Logistic regression
showed that LF/HF ratio (odds ratio [OR] 0.85, 95% confidence interval [CI]
0.43, 1.53) was not associated with 3-month outcomes. In an exploratory
analysis, DFA α (OR 0.93, 95% CI 0.87, 0.99), α1 (OR 0.97, 95% CI
0.94, 0.99), and α2 (OR 0.94, 95% CI 0.88, 0.99) scaling
components were associated with PTSD development. Conclusion Almost one-third of family members experienced anxiety at three months after
enrollment. HRV, measured by LF/HF ratio, was not a predictor of psychologic
distress, however, exploratory analyses indicated that DFA may be associated
with PTSD outcomes.
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Affiliation(s)
- Benjamin Re Harris
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sarah J Beesley
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ramona O Hopkins
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Psychology Department and Neuroscience Center, 6756Brigham Young University, Brigham Young University, Provo, UT, USA
| | - Eliotte L Hirshberg
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
| | - Emily Wilson
- Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jorie Butler
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Geriatrics and Psychology, University of Utah and Salt Lake City Veterans Administration Hospital, Salt Lake City, UT, USA
| | - Thomas A Oniki
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Care Transformation Information Systems, 7061Intermountain Healthcare, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Kathryn G Kuttler
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Care Transformation Information Systems, 7061Intermountain Healthcare, Intermountain Healthcare, Salt Lake City, UT, USA
| | - James F Orme
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Samuel M Brown
- Center for Humanizing Critical Care, 7061Intermountain Healthcare, Intermountain Healthcare, Murray, UT, USA.,Pulmonary and Critical Care Medicine, 98078Intermountain Medical Center, 98078Intermountain Medical Center, Salt Lake City, UT, USA.,Pulmonary and Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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11
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Kosilek RP, Schmidt K, Baumeister SE, Gensichen J. Frequency and risk factors of post-intensive care syndrome components in a multicenter randomized controlled trial of German sepsis survivors. J Crit Care 2021; 65:268-273. [PMID: 34280656 DOI: 10.1016/j.jcrc.2021.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-intensive care syndrome (PICS) is a combination of cognitive, psychiatric and physical impairments in survivors of critical illness and intensive care. There is little data on long-term co-occurrence of associated impairments. METHODS Analysis of data from 289 sepsis survivors from a German multicenter RCT. Impairments associated with PICS (depression, PTSD, cognitive impairment, chronic pain, neuropathic symptoms, dysphagia) during 24 months follow-up are used to explore the frequency and risk factors of PICS components in three classification models. RESULTS The majority of participants showed impairments in 2-3 of 6 domains during follow-up. The overall frequency of PICS according to the classification models ranged from 32.9% to 98.6%. In regression analyses, there were no significant effects in selected ICU-related exposures or covariates for PICS classification models. Regarding individual components, only higher age and longer duration of ICU treatment and mechanical ventilation showed significant positive associations with the occurrence of cognitive impairment during follow-up, as did male gender and higher age for dysphagia. CONCLUSIONS Almost all study participants showed impairments associated with PICS in at least one domain. The proposed classification models for PICS appear to be too broad to identify specific risk factors beyond its individual components.
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Affiliation(s)
- R P Kosilek
- Institute of General Practice and Family Medicine, LMU Klinikum, Munich, Germany.
| | - K Schmidt
- Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - S E Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Augsburg, Germany; Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - J Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Munich, Germany
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12
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Miyamoto K, Shibata M, Shima N, Nakashima T, Kida M, Matsumoto H, Oka N, Yazaki A, Uchigaki A, Takemoto A, Kato S. Combination of delirium and coma predicts psychiatric symptoms at twelve months in critically ill patients: A longitudinal cohort study. J Crit Care 2021; 63:76-82. [PMID: 33618284 DOI: 10.1016/j.jcrc.2021.01.007] [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: 09/23/2020] [Revised: 12/15/2020] [Accepted: 01/17/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE We aimed to determine any associations between delirium and comas during intensive care unit (ICU) stay, and long-term psychiatric symptoms and disability affecting activity of daily living (ADL). MATERIALS AND METHODS In this prospective observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. We assessed psychiatric symptoms and disability affecting ADL at three and twelve months after ICU discharge. RESULTS Among the 81 and the 47 patients that responded to the questionnaires at three and twelve months, 22 (27%) and 13 (28%) patients experienced delirium, respectively. During their ICU stay, 28 (35%) and 21 (45%) had been in comas, respectively. At three and twelve months, 51 (63%) and 23 (49%) of patients experienced composite psychiatric symptoms or disability affecting ADL, respectively. After adjusting predefined confounders, the combination of delirium and comas was an independent risk factor for the presence of composite psychiatric symptoms or disability affecting ADL (adjusted odds ratio [aOR] 3.38; 1.10-10.38 at three months; aOR 8.28; 1.48-46.46 at twelve months). CONCLUSIONS In critically ill adults, combination of delirium and comas during ICU stay is a predictor of psychiatric symptoms or ADL disability. TRIAL REGISTRATION UMIN Clinical Trial Registry no. UMIN000023743, September 1, 2016.
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Affiliation(s)
- Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan.
| | - Mami Shibata
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Nozomu Shima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Maki Kida
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Haruka Matsumoto
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
| | - Natsuki Oka
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Akina Yazaki
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Akiko Uchigaki
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Aya Takemoto
- Department of Nursing, Wakayama Medical University Hospital, 811-1 Kimiidera, Wakayama City 641-8510, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama City 641-8509, Wakayama, Japan
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13
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Sivanathan L, Wunsch H, Vigod S, Hill A, Pinto R, Scales DC. Mental illness after admission to an intensive care unit. Intensive Care Med 2019; 45:1550-1558. [PMID: 31482222 DOI: 10.1007/s00134-019-05752-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 06/09/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Survivors of critical illness may be at higher risk of developing subsequent mental illness. We sought to determine the risk of new mental illness diagnoses across a large population of intensive care unit (ICU) survivors compared with hospitalized patients. METHODS Population-based study (2005-2015) conducted in adults hospitalized in Ontario, Canada. The primary exposure was ICU admission for ≥ 48 h; secondary exposures were ICU procedures including mechanical ventilation and duration of ICU. The primary outcome was mental illness diagnosed during the year after hospital discharge. To account for case mix differences between ICU and other hospitalized patients, sensitivity analyses were conducted restricting to six pre-specified diagnoses that can lead to hospitalization with or without ICU. RESULTS 1,847,462 patients survived hospitalization, of whom 121,101 were admitted to ICU for ≥ 48 h. ICU patients had a higher rate of new mental illness diagnoses in the year after discharge compared to hospitalized patients (17 vs. 15%, adjusted hazard ratio (aHR) 1.08, 95% CI 1.07-1.10). In analyses restricted to pre-specified most responsible diagnoses, the increased risk associated with ICU was only significant for patients with pneumonia. Among ICU survivors, exposure to mechanical ventilation (aHR: 1.08; 95% CI 1.05-1.12) or longer ICU stays (aHR: 1.004 per day; 95% CI 1.003-1.005) increased the risk of new mental illness diagnosis. CONCLUSIONS ICU was associated with a marginally increased risk of mental illness diagnosis after hospitalization that was often no longer apparent when reason for admission was considered. Patients exposed to mechanical ventilation or longer ICU stays may be at higher risk of subsequent mental illnesses.
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Affiliation(s)
- Lavarnan Sivanathan
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada.
| | - Hannah Wunsch
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, 12th Floor, 123 Edward Street, Toronto, ON, M5G 1E2, Canada.,ICES, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - Simone Vigod
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Women's College Hospital, Toronto, ON, Canada
| | - Andrea Hill
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - Damon C Scales
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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14
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Sevin CM, Bloom SL, Jackson JC, Wang L, Ely EW, Stollings JL. Comprehensive care of ICU survivors: Development and implementation of an ICU recovery center. J Crit Care 2019; 46:141-148. [PMID: 29929705 DOI: 10.1016/j.jcrc.2018.02.011] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [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: 11/30/2017] [Revised: 02/17/2018] [Accepted: 02/20/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To describe the design and initial implementation of an Intensive Care Unit Recovery Center (ICU-RC) in the United States. MATERIALS AND METHODS A prospective, observational feasibility study was undertaken at an academic hospital between July 2012 and December 2015. Clinical criteria were used to develop the ICU-RC, identify patients at high risk for post intensive care syndrome (PICS), and offer them post-ICU care. RESULTS 218/307 referred patients (71%) survived to hospital discharge; 62 (28% of survivors) were seen in clinic. Median time from discharge to ICU-RC visit was 29days. At initial evaluation, 64% of patients had clinically meaningful cognitive impairment. Anxiety and depression were present in 37% and 27% of patients, respectively. One in three patients was unable to ambulate independently; median 6min walk distance was 56% predicted. Of 47 previously working patients, 7 (15%) had returned to work. Case management and referral services were provided 142 times. The median number of interventions per patient was 4. CONCLUSIONS An ICU-RC identified a high prevalence of cognitive impairment, anxiety, depression, physical debility, lifestyle changes, and medication-related problems warranting intervention. Whether an ICU-RC can improve ICU recovery in the US should be investigated in a systematic way.
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Affiliation(s)
- Carla M Sevin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Sarah L Bloom
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - James C Jackson
- Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, United States; Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, United States; Center for Health Services Research, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Li Wang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - E Wesley Ely
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States; Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, United States
| | - Joanna L Stollings
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, United States
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15
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McPeake JM, Henderson P, Darroch G, Iwashyna TJ, MacTavish P, Robinson C, Quasim T. Social and economic problems of ICU survivors identified by a structured social welfare consultation. Crit Care 2019; 23:153. [PMID: 31046813 PMCID: PMC6498562 DOI: 10.1186/s13054-019-2442-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 04/15/2019] [Indexed: 11/12/2022]
Affiliation(s)
- J M McPeake
- Glasgow Royal Infirmary, ICU, NHS Greater Glasgow and Clyde, Glasgow, G31 2ER, UK. .,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
| | - P Henderson
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - G Darroch
- Glasgow Royal Infirmary, ICU, NHS Greater Glasgow and Clyde, Glasgow, G31 2ER, UK
| | - T J Iwashyna
- Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA
| | - P MacTavish
- Glasgow Royal Infirmary, ICU, NHS Greater Glasgow and Clyde, Glasgow, G31 2ER, UK
| | - C Robinson
- Glasgow Royal Infirmary, ICU, NHS Greater Glasgow and Clyde, Glasgow, G31 2ER, UK
| | - T Quasim
- Glasgow Royal Infirmary, ICU, NHS Greater Glasgow and Clyde, Glasgow, G31 2ER, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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16
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Dziadzko V, Dziadzko MA, Johnson MM, Gajic O, Karnatovskaia LV. Acute psychological trauma in the critically ill: Patient and family perspectives. Gen Hosp Psychiatry 2017; 47:68-74. [PMID: 28807140 DOI: 10.1016/j.genhosppsych.2017.04.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/24/2017] [Accepted: 04/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Post-intensive care syndrome (PICS), which encompasses profound psychological morbidity, affects many survivors of critical illness. We hypothesize that acute psychological stress during the intensive care unit (ICU) confinement likely contributes to PICS. In order to develop strategies that mitigate PICS associated psychological morbidity, it is paramount to first characterize acute ICU psychological stress and begin to understand its causative and protective factors. METHODS A structured interview study was administered to adult critical illness survivors who received ≥48h of mechanical ventilation in medical and surgical ICUs of a tertiary care center, and their families. RESULTS Fifty patients and 44 family members were interviewed following ICU discharge. Patients reported a high level of psychological distress. The families' perception of patient's stress level correlated with the patient's self-estimated stress level both in daily life (rho=0.59; p<0.0001) and in ICU (rho=0.45; p=0.002). 70% of patients experienced fear of death, 38% had additional other fears, 48% had hallucinations. Concerns included inability to communicate (34%), environmental factors (30%), procedures and restraints (24%), and being intubated (12%). Emotional support of family/friend/staff/clergy (86%), and physical therapy/walking (14%) were perceived to be important mitigating factors. Clinicians' actions that were perceived to be very constructive included reassurance (54%), explanations (32%) and physical touch (8%). CONCLUSIONS Fear, hallucinations, and the inability to communicate, are identified as central contributors to psychological stress during an ICU stay; the presence of family, and physician's attention are categorized as important mitigating factors. Patients and families identified several practical recommendations which may help assuage the psychological burden of the ICU stay.
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