Addressing the Psychological Symptoms of Critical Illness

Kross, Erin K.; Pollak, Kathryn I.; Curtis, J. Randall

doi:10.1001/jama.2019.0072

Cited by 4 publications

(1 citation statement)

References 14 publications

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“…In addition, preliminary studies suggest a positive effect of medical cannabis on PTSD-related symptoms such as nightmares [8]. PTSD is a common long-term consequence of critical illness as part of a syndrome referred to as post-intensive care syndrome (PICS) that can affect up to 30% to 50% of ICU survivors [9]. These potential benefits of medical cannabis, along with its recent legalization and lower risk profile compared to opioids [10], make it a candidate therapy for investigation in critically ill patients at high risk of opioid tolerance and PICS.…”

Section: Competing Interestsmentioning

confidence: 99%

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

2021

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Objectives To determine acceptability of medical cannabis research in critically ill patients. Design Q-methodology survey. Setting Convenience sample of healthcare providers and the general public were recruited at an acute care community hospital in Ontario, Canada. Participants In the first phase, 63 respondents provided 197 unique viewpoints in response to a topic statement about medical cannabis use in critically ill patients. Twenty-five viewpoints were selected for the q-sample. In the second phase, 99 respondents ranked these viewpoints according to an a priori quasi normal distribution ranging from +4 (most agree) to -4 (least agree). Factor analysis was combined with comments provided by survey respondents to label and describe the extracted factors. Results The factor labels were hoping and caring (factor 1), pragmatic progress (factor 2), and cautious/conservative and protectionist (factor 3). Factor 1 describes a viewpoint of unequivocal support for medical cannabis research in this population with few caveats. Factor 2 describes a viewpoint of cautious support with a need to monitor for unintended adverse effects. Factor 3 describes a viewpoint of ensuring that current analgosedation techniques are optimized before exposing patients to another potentially harmful drug. Conclusions Using a q-methodology design, we were able to sample and describe the viewpoints that exist about medical cannabis research in critically ill patients. Three factors emerged that seemed to adequately describe the relative ranking of q-statements by the majority of respondents. Combining the distinguishing statements along with respondent comments allowed us to determine that the majority support medical cannabis research in critically ill patients.

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Section: Competing Interestsmentioning

confidence: 99%

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

2021

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Learning from aftercare to improve acute care

Walsh

Endacott

2019

Intensive Care Med

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Pre‐existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta‐analysis of prevalence

Pilowsky

Elliott

Roche

2021

Journal of Advanced Nursing

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Aims To determine the reported prevalence rate of pre‐existing mental health disorders in patients admitted to adult ICUs and identify the most commonly occurring types of these disorders. Design Systematic review and meta‐analysis. Data sources Five electronic databases were searched from 1 January 2000 ‐15 April 2020. Google Scholar was used to perform forwards citation searching. Methods This review was conducted in line with the PRISMA guidelines and protocol registered with PROSPERO CRD42020181818. Meta‐analyses were performed using the quality effects model to calculate weighted pooled prevalence estimates and heterogeneity was tested using the I2 statistic. Results Seven articles were included in the final review and meta‐analysis (143,179 participants). Identified prevalence rates varied considerably, ranging from 6.2–28.0%, reflecting variation in each study's clinical context, as well as different patient selection and identification methodologies. The pooled prevalence rate of all pre‐existing mental health disorders was 19.4% (95% CI 8.9–32.6%). Depression was the most common subtype, accounting for an estimated 60.5% (95% CI 54.4–66.5%) of identified mental health disorders. All analyses showed significant heterogeneity with I2 > 95%. Conclusion Approximately 19% of adult ICU patients have a history of a mental health disorder, most commonly depression. Further research is needed to improve the accuracy of this estimate as well as determine the best identification method. Impact This study has demonstrated that patients with pre‐existing mental health disorders, particularly depression, constitute a significant subgroup in ICU. Given that the presence of a pre‐existing mental health disorder appears to confer an increased mortality risk following ICU discharge, clinicians need to be made aware of this group of patients to provide additional support. Further research is needed to more accurately quantify this vulnerable group and establish methods to enable clinicians to readily identify and refer these patients for appropriate follow‐up treatment.

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Addressing the Psychological Symptoms of Critical Illness

Cited by 4 publications

References 14 publications

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

Elicitation of stakeholder viewpoints about medical cannabis research for pain management in critically ill ventilated patients: A Q-methodology study

Learning from aftercare to improve acute care

Pre‐existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta‐analysis of prevalence

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