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Garrouste-Orgeas M, Flahault C, Vinatier I, Rigaud JP, Thieulot-Rolin N, Mercier E, Rouget A, Grand H, Lesieur O, Tamion F, Hamidfar R, Renault A, Parmentier-Decrucq E, Monseau Y, Argaud L, Bretonnière C, Lautrette A, Badié J, Boulet E, Floccard B, Forceville X, Kipnis E, Soufir L, Valade S, Bige N, Gaffinel A, Hamzaoui O, Simon G, Thirion M, Bouadma L, Large A, Mira JP, Amdjar-Badidi N, Jourdain M, Jost PH, Maxime V, Santoli F, Ruckly S, Vioulac C, Leborgne MA, Bellalou L, Fasse L, Misset B, Bailly S, Timsit JF. Effect of an ICU Diary on Posttraumatic Stress Disorder Symptoms Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. JAMA 2019; 322:229-239. [PMID: 31310299 PMCID: PMC6635906 DOI: 10.1001/jama.2019.9058] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Keeping a diary for patients while they are in the intensive care unit (ICU) might reduce their posttraumatic stress disorder (PTSD) symptoms. OBJECTIVES To assess the effect of an ICU diary on the psychological consequences of an ICU hospitalization. DESIGN, SETTING, AND PARTICIPANTS Assessor-blinded, multicenter, randomized clinical trial in 35 French ICUs from October 2015 to January 2017, with follow-up until July 2017. Among 2631 approached patients, 709 adult patients (with 1 family member each) who received mechanical ventilation within 48 hours after ICU admission for at least 2 days were eligible, 657 were randomized, and 339 were assessed 3 months after ICU discharge. INTERVENTIONS Patients in the intervention group (n = 355) had an ICU diary filled in by clinicians and family members. Patients in the control group (n = 354) had usual ICU care without an ICU diary. MAIN OUTCOMES AND MEASURES The primary outcome was significant PTSD symptoms, defined as an Impact Event Scale-Revised (IES-R) score greater than 22 (range, 0-88; a higher score indicates more severe symptoms), measured in patients 3 months after ICU discharge. Secondary outcomes, also measured at 3 months and compared between groups, included significant PTSD symptoms in family members; significant anxiety and depression symptoms in patients and family members, based on a Hospital Anxiety and Depression Scale score greater than 8 for each subscale (range, 0-42; higher scores indicate more severe symptoms; minimal clinically important difference, 2.5); and patient memories of the ICU stay, reported with the ICU memory tool. RESULTS Among 657 patients who were randomized (median [interquartile range] age, 62 [51-70] years; 126 women [37.2%]), 339 (51.6%) completed the trial. At 3 months, significant PTSD symptoms were reported by 49 of 164 patients (29.9%) in the intervention group vs 60 of 175 (34.3%) in the control group (risk difference, -4% [95% CI, -15% to 6%]; P = .39). The median (interquartile range) IES-R score was 12 (5-25) in the intervention group vs 13 (6-27) in the control group (difference, -1.47 [95% CI, -1.93 to 4.87]; P = .38). There were no significant differences in any of the 6 prespecified comparative secondary outcomes. CONCLUSIONS AND RELEVANCE Among patients who received mechanical ventilation in the ICU, the use of an ICU diary filled in by clinicians and family members did not significantly reduce the number of patients who reported significant PTSD symptoms at 3 months. These findings do not support the use of ICU diaries for preventing PTSD symptoms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02519725.
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Affiliation(s)
- Maité Garrouste-Orgeas
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical unit, French British Hospital, Levallois-Perret, France
| | - Cécile Flahault
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Isabelle Vinatier
- Medical ICU, Les Oudaries Hospital, La Roche-sur-Yon, Vendée, France
| | | | | | - Emmanuelle Mercier
- CRICS-TRIGGERSEP group, Medical-Surgical ICU, Tours University Hospital, Tours, France
| | - Antoine Rouget
- Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France
| | - Hubert Grand
- Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France
| | | | - Fabienne Tamion
- Medical ICU, University Medical Center, Rouen, France
- INSERM U-1096, University of Rouen, Rouen, France
| | - Rebecca Hamidfar
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Anne Renault
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | | | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Cédric Bretonnière
- Medical ICU, Nantes University Hospital, Nantes, France
- EA3826, Laboratory of Clinical and Experimental Therapeutics of Infections, University of Nantes, Nantes, France
| | - Alexandre Lautrette
- Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France
- LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, France
| | - Julio Badié
- Medical-Surgical ICU, General Hospital Belfort-Montbéliard, Belfort, France
| | - Eric Boulet
- Medical ICU, Beaumont General Hospital, Beaumont, France
| | - Bernard Floccard
- Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Xavier Forceville
- Medical-Surgical ICU, Great Hospital of East Francilien, Meaux, France
| | - Eric Kipnis
- Surgical ICU, Lille University Hospital, Lille, France
| | - Lilia Soufir
- Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France
| | | | - Naike Bige
- Medical ICU, Saint Antoine University Hospital, Paris, France
| | - Alain Gaffinel
- Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France
| | - Olfa Hamzaoui
- Medical Surgical ICU, University Hospital Paris -Sud, Beclère University Hospital, Clamart, France
| | - Georges Simon
- Medical-Surgical ICU, General Hospital, Troyes, France
| | - Marina Thirion
- Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France
| | - Lila Bouadma
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
| | - Audrey Large
- Medical ICU, François Mitterrand University Hospital, Dijon, France
| | - Jean-Paul Mira
- Medical ICU, Cochin University Hospital, Paris Centre Hospital Group, AP-HP, Paris, France
| | | | - Mercé Jourdain
- Group of medical ICUs, Lille University Hospital, Lille, France
- Lille University, Inserm U1190, Lille, France
| | - Paul-Henri Jost
- Surgical ICU, Henri Mondor University Hospital, Créteil, France
| | - Virginie Maxime
- Medical ICU, Raymond Poincaré University Hospital, Garches, France
| | - François Santoli
- Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France
| | | | - Christel Vioulac
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Marie Annick Leborgne
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Lucie Bellalou
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Léonor Fasse
- LPPS-EA4057, Laboratory of Psychopathology and Health Process, Paris Descartes University, Paris, France
| | - Benoit Misset
- Medical ICU, University Medical Center, Rouen, France
| | - Sébastien Bailly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Grenoble Alpes University, INSERM, University hospital Grenoble Alpes, HP2, Grenoble, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
- Department of Biostatistics, Outcomerea, Paris, France
- Medical ICU, Bichat University Hospital, Paris, France
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Garrouste-Orgeas M, Flahault C, Fasse L, Ruckly S, Amdjar-Badidi N, Argaud L, Badie J, Bazire A, Bige N, Boulet E, Bouadma L, Bretonnière C, Floccard B, Gaffinel A, de Forceville X, Grand H, Halidfar R, Hamzaoui O, Jourdain M, Jost PH, Kipnis E, Large A, Lautrette A, Lesieur O, Maxime V, Mercier E, Mira JP, Monseau Y, Parmentier-Decrucq E, Rigaud JP, Rouget A, Santoli F, Simon G, Tamion F, Thieulot-Rolin N, Thirion M, Valade S, Vinatier I, Vioulac C, Bailly S, Timsit JF. The ICU-Diary study: prospective, multicenter comparative study of the impact of an ICU diary on the wellbeing of patients and families in French ICUs. Trials 2017; 18:542. [PMID: 29141694 PMCID: PMC5688734 DOI: 10.1186/s13063-017-2283-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 05/12/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Post-intensive care syndrome includes the multiple consequences of an intensive care unit (ICU) stay for patients and families. It has become a new challenge for intensivists. Prevention programs have been disappointing, except for ICU diaries, which report the patient's story in the ICU. However, the effectiveness of ICU diaries for patients and families is still controversial, as the interpretation of the results of previous studies was open to criticism hampering an expanded use of the diary. The primary objective of the study is to evaluate the post-traumatic stress syndrome in patients. The secondary objectives are to evaluate the post-traumatic stress syndrome in families, anxiety and depression symptoms in patients and families, and the recollected memories of patients. Endpoints will be evaluated 3 months after ICU discharge or death. METHODS A prospective, multicenter, randomized, assessor-blind comparative study of the effect of an ICU diary on patients and families. We will compare two groups: one group with an ICU diary written by staff and family and given to the patient at ICU discharge or to the family in case of death, and a control group without any ICU diary. Each of the 35 participating centers will include 20 patients having at least one family member who will likely visit the patient during their ICU stay. Patients must be ventilated within 48 h after ICU admission and not have any previous chronic neurologic or acute condition responsible for cognitive impairments that would hamper their participation in a phone interview. Three months after ICU discharge or death of the patient, a psychologist will contact the patient and family by phone. Post-traumatic stress syndrome will be evaluated using the Impact of Events Scale-Revised questionnaire, anxiety and depression symptoms using the Hospital Anxiety and Depression Scale questionnaire, both in patients and families, and memory recollection using the ICU Memory Tool Questionnaire in patients. The content of a randomized sample of diaries of each center will be analyzed using a grid. An interview of the patients in the intervention arm will be conducted 6 months after ICU discharge to analyze in depth how they use the diary. DISCUSSION This study will provide new insights on the impact of ICU diaries on post-traumatic stress disorders in patients and families after an ICU stay. TRIAL REGISTRATION ClinicalTrial.gov, ID: NCT02519725 . Registered on 13 July 2015.
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Affiliation(s)
- Maïté Garrouste-Orgeas
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France. .,Department of Biostatistics, Outcomerea, Paris, France. .,Medical unit, French British Hospital Institute, Levallois-Perret, France.
| | - Cécile Flahault
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Léonor Fasse
- Laboratoire Psy-DREPI EA-7458, Bourgogne Franche Comté University, Dijon, France
| | - Stéphane Ruckly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.,Department of Biostatistics, Outcomerea, Paris, France
| | | | - Laurent Argaud
- Medical ICU, Edouard Herriot University Hospital, Lyon, France
| | - Julio Badie
- Medical-Surgical ICU, General Hospital Belfort-Montbeliard, Belfort, France
| | - Amélie Bazire
- Medical ICU, La Cavale Blanche University Hospital, Brest, France
| | - Naike Bige
- Medical ICU, Saint Antoine University Hospital, Paris, France
| | - Eric Boulet
- Medical ICU, Beaumont General Hospital, Beaumont, France
| | - Lila Bouadma
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.,Medical ICU, Bichat University Hospital, Paris, France
| | - Cédric Bretonnière
- Medical ICU, Nantes University Hospital, Nantes, France.,EA3826, Laboratory of clinical and experimental therapeutics of infections, University of Nantes, Nantes, France
| | - Bernard Floccard
- Medical ICU, Hospices Civils de Lyon, Edouard Herriot University Hospital, Lyon, France
| | - Alain Gaffinel
- Medical-Surgical ICU, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Hubert Grand
- Medical-Surgical ICU, Hospital Robert Boulin, Libourne, France
| | - Rebecca Halidfar
- Medical ICU, Albert Michallon University Hospital, Grenoble, France
| | - Olfa Hamzaoui
- Medical ICU, University Hospital Paris-Sud, Beclère University Hospital, Clamart, France
| | - Mercé Jourdain
- Lille University, Inserm U1190, Lille, France.,Group of medical ICUs, Lille University Hospital, Lille, France
| | - Paul-Henri Jost
- Surgical ICU, Henri Mondor University Hospital, Créteil, France
| | - Eric Kipnis
- Surgical ICU, Lille University Hospital, Lille, France
| | - Audrey Large
- Medical ICU, François Mitterrand University Hospital, Dijon, France
| | - Alexandre Lautrette
- Medical ICU, Gabriel-Montpied University Hospital, Clermont Ferrand, France.,LMGE UMR CNRS 6023, University of Clermont-Ferrand, Clermont Ferrand, France
| | - Olivier Lesieur
- Medical-Surgical ICU, General Hospital, La Rochelle, France.,EA 4569, University Paris Descartes, Paris, France
| | - Virginie Maxime
- Medical ICU, Raymond Poincaré University Hospital, Garches, France
| | - Emmanuelle Mercier
- CRICS group, Medical-Surgical ICU, Tours University Hospital, Tours, France
| | | | | | | | | | - Antoine Rouget
- Medical-Surgical ICU, Rangueil University Hospital, Toulouse, France
| | - François Santoli
- Medical ICU, General Hospital Robert Ballanger, Aulnay-Sous-Bois, France
| | - Georges Simon
- Medical-Surgical ICU, General Hospital, Troyes, France
| | - Fabienne Tamion
- Medical ICU, University medical center, Rouen, France.,INSERM U-1096, University of Rouen, Rouen, France
| | | | - Marina Thirion
- Medical-Surgical ICU, General Hospital Victor Dupouy, Argenteuil, France
| | | | | | - Christel Vioulac
- Psychology laboratory and work process, Paris Descartes University, Paris, France
| | - Sebastien Bailly
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France
| | - Jean-François Timsit
- Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM and Paris Diderot University, Department of Biostatistics - HUPNVS - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.,Department of Biostatistics, Outcomerea, Paris, France.,Medical ICU, Bichat University Hospital, Paris, France
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