Determinants of self-reported unacceptable outcome of intensive care treatment 1 year after discharge

Kerckhoffs, Monika C.; Kosasi, Felicia F. L.; Soliman, Ivo W.; Delden, Johannes J. M. van; Cremer, Olaf L.; Lange, Dylan W. de; Slooter, Arjen J. C.; Kesecioğlu, Jozef; Dijk, Diederik van

doi:10.1007/s00134-019-05583-4

Cited by 50 publications

(79 citation statements)

References 38 publications

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“…A recent study by Heydon et al demonstrated that patients with psychological PICS related impairments identify these complaints as the most important area where they want support in [35]. Additionally, psychological PICS is referred to as the most important component of patient-reported unacceptable outcome by a recent study by Kerckhoffs et al [7]. We confirm these findings by demonstrating that PTSD and depression are both associated with a considerable decrease in quality of life and that patients with psychological PICS have a worse quality of life compared to the general Dutch population in contrast with patients without psychological PICS.…”

Section: Discussionmentioning

confidence: 99%

“…Depression and posttraumatic stress disorder (PTSD) related symptoms are the main components of psychological PICS. Psychological PICS is considered the most important component associated with patient-reported unacceptable outcome and decreased HRQoL [3,7]. Because these psychological sequelae can persist up to 5 years after ICU discharge, treatment of psychological PICS sequelae is becoming an important target to improve quality of life [8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Patients suffering from psychological impairments following critical illness are in need of information

et al. 2020

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Background: Because critical illness survivors frequently experience several long-term psychological impairments altering quality of life after ICU, there is a trend towards increasing follow-up care, mainly via ICU follow-up clinics. Despite these and other initiatives, understanding of patient's post-ICU needs to help them cope with their problems and subsequently improve quality of life is largely lacking. Our aim was therefore to assess the needs, expectations and wishes in ICU survivors to receive information with the purpose to help them better grasp ICU treatment. In addition, we assessed the perceived burden of psychological trauma after ICU treatment and the health-related quality of life (HRQoL) up to 2.5 years after ICU discharge. Methods: In a multicentre, retrospective cross-sectional cohort study, the needs and preferred intervention methods were assessed using a self-composed inventory in adult mechanically ventilated ICU survivors (n = 43). Additionally, the Impact of Event Scale Revised, the Beck Depression Inventory, the EuroQol-5D-5L, and the Short-Form 12 were used to assess psychological burden and HRQoL. Results: A substantial proportion of all ICU survivors (59%, 95% CI 44% to 74%) suffered from psychological impairments after ICU treatment. Seventy-five percent of these patients expressed a wish to receive information, but only 36% desired to receive this information using a commonly used information brochure. In contrast, 71% of these patients had a wish to receive information using a video film/VR. Furthermore, only 33% of these patients was satisfied with the information provided by their treating hospital. Patients with psychological PICS reported a worse HRQoL as compared to a normative Dutch sample (P < 0.001) and as compared to patients without psychological PICS (P < 0.01). Conclusions: In a Dutch cohort of critical illness survivors, a substantial part of ICU survivors suffer from psychological impairments, such as PTSD and depression, which was associated with a worse HRQoL. These patients are in need of information, have no desire using an information brochure, but are willing to receive information using a video film/virtual reality module. These results support the exploration of such an intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patients suffering from psychological impairments following critical illness are in need of information

et al. 2020

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“…This can also be an effect of the research conducted in this field by these countries alongside other cultural and organisational factors. However, qualitative studies regarding the experience of patients can address decisions in daily care and can be the basis of the development of tools capable of measuring the quality of such experiences within the so‐called PROMs perspectives (patient‐reported outcome measures; Kerckhoffs et al, 2019), thus all aimed at improving the quality of care. Therefore, all countries are encouraged to consider this field as deserving investigation including international‐based research projects.…”

Section: Discussionmentioning

confidence: 99%

Understanding patients’ experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta‐synthesis and meta‐summary

Danielis

Povoli

Mattiussi

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To synthesise the evidence reported in qualitative studies concerning the lived experiences of adult patients receiving mechanical ventilation in Intensive Care Unit (ICU). Background Critically ill patients receiving mechanical ventilation in the ICU have been reported to suffer from severe physical and emotional responses such as hopelessness, anxiety, high levels of frustration and stress. Recent improvements in the field of mechanical ventilation and sedative medications as experienced by patients that can inform nursing care have not been summarised to date. Design A systematic review of qualitative studies followed by a meta‐synthesis and a meta‐summary was performed. Methods Four electronic databases were searched by two authors in June 2019. A total of nine studies were included and evaluated based on their methodological quality using the Critical Appraisal Skills Programme checklist. Results A total of 24 codes emerged from the abstraction process, which were categorised into 11 categories and four themes: (a) “The effect of the intense stress on the body's systems,” (b) “The induced negative emotional situations,” (c) “The feeling of being cared for in a hospital setting” and (d) “The perceived support from the family and loved ones.” Furthermore, the most frequent codes across studies were “Being afraid,” “Feeling supervised,” “Feeling comforted,” “Failing to communicate,” and “Experiencing difficulties in breathing,” with an intensity of 66.6%. Conclusion Patients receiving mechanical ventilation have expressed a general sense of vulnerability, of which critical care nurses need to be aware. Relevance to clinical practice Findings suggest the need for improvements at the nursing, unit, educational and policy levels; furthermore, more research is also required at the international levels given the current trends towards no sedation protocols for the management of ICU patients: listening to their experiences becomes imperative, in order to ensure an awake, comfortable and ventilator‐tolerant patient.

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“…We also evaluated the subjective signi cance of SF-36 score among ICU patients. A previous study showed that the mental status of PICS patients was signi cantly associated with self-reported unacceptable outcomes [50], and the underlying reason was considered to be the small sample size of the study. As indicated by the improvement in SF-36 MCS score at 6 months among all patients, there were only 18 patients with mental impairment.…”

Section: Comparison To Other Studiesmentioning

confidence: 99%

Prevalence of Post Intensive Care Syndrome Among Japanese Intensive Care Unit Patients: A Prospective, Multicenter, Observational J-PICS Study

Kawakami

Fujitani

Morimoto

et al. 2020

Preprint

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BackgroundMany studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls, instead of baseline quality of life. Furthermore, many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2 but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, the clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 health survey questionnaire subscales and interpreted the patients’ subjective significance of impairment.MethodsA prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 Japanese hospitals. Adult ICU patients expected to receive mechanical ventilation for > 48 hours were enrolled and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, change in SF-36 physical component score (PCS) ≥ 10 points; mental status, change in SF-36 mental component score ≥ 10 points; cognitive function, Short-Memory Questionnaire (SMQ) score worsened and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients’ subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating.ResultsAmong 192 patients, 48 (29.6%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 19 (19.9%) patients. Physical, mental, and cognitive impairments occurred in 33.3%, 14.6%, and 37.5% patients, respectively. Low education level was associated with PICS occurrence (Odds ratio: 3.8, 95% confidence interval: 1.1–17.9, P=0.036). Based on the patients’ subjective assessment, a 10-point change in PCS indicated moderate negative change.ConclusionsAmong the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS occurrence was associated with low educational level. Future studies elucidating the minimal clinically important difference of SF-36 scores among the ICU patients and standardizing the PICS definition are required.Trial registrationUMIN000034072

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Determinants of self-reported unacceptable outcome of intensive care treatment 1 year after discharge

Cited by 50 publications

References 38 publications

Patients suffering from psychological impairments following critical illness are in need of information

Patients suffering from psychological impairments following critical illness are in need of information

Understanding patients’ experiences of being mechanically ventilated in the Intensive Care Unit: Findings from a meta‐synthesis and meta‐summary

Prevalence of Post Intensive Care Syndrome Among Japanese Intensive Care Unit Patients: A Prospective, Multicenter, Observational J-PICS Study

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