Risk of Post-traumatic Stress Symptoms in Family Members of Intensive Care Unit Patients

Azoulay, Élie; Pochard, Frédéric; Kentish-Barnes, Nancy; Chevret, Sylvie; Aboab, Jérôme; Adrie, Christophe; Annane, D.; Bleichner, G; Bollaert, Pierre Edouard; Darmon, Michaël; Fassier, Thomas; Galliot, Richard; Garrouste-Orgeas, Maïté; Goulenok, Cyril; Goldgran-Tolédano, Dany; Hayon, Jan; Jourdain, M.; Kaidomar, Michel; Laplace, Christian; Larché, Jérôme; Liotier, Jérôme; Papazian, Laurent; Poisson, Catherine; Reignier, Jean; Saidi, F; Schlemmer, Benoı̂t

doi:10.1164/rccm.200409-1295oc

Cited by 1,151 publications

(1,015 citation statements)

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“…The burden of intensive care, a prospective study in caregivers of octogenarians in the ICU More than half of patients with ventilator support surviving critical care require caregiver assistance after ICU discharge [52]. Many caregivers report high levels of PTSD and depressive symptoms [53]. Variables significantly associated with worse mental health outcomes in caregivers are age and less social support.…”

Section: Severity Of Disease Models and The Elderlymentioning

confidence: 99%

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The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

218

196

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The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

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Section: Severity Of Disease Models and The Elderlymentioning

confidence: 99%

“…Many suffer from this insult in their own ways [52,53]. This might be particularly true in the family members of the elderly ICU survivors, but little is known about the post-ICU syndrome in these family members nor of its consequences in the long run.…”

Section: Burden Of Caregiversmentioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

218

196

View full text Add to dashboard Cite

show abstract

“…There is compelling evidence of anxiety, depression, and posttraumatic stress disorder among family members of critically ill patients [14][15][16][17]. Observed risk factors for these psychological symptoms include any one of the following: family involvement in decision making [15], family preference for less involvement in decision making [18], and a family role that is discordant with its members' preferences [19].…”

Section: Commentarymentioning

confidence: 99%

“…Observed risk factors for these psychological symptoms include any one of the following: family involvement in decision making [15], family preference for less involvement in decision making [18], and a family role that is discordant with its members' preferences [19].…”

Section: Commentarymentioning

confidence: 99%

The Use of Informed Assent in Withholding Cardiopulmonary Resuscitation in the ICU

Curtis

2012

AMA Journal of Ethics

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ETHICS CASEThe Use of Informed Assent in Withholding Cardiopulmonary Resuscitation in the ICU Commentary by J. Randall Curtis, MD, MPH Ms. Rose's family had gathered in the intensive care unit conference room. Her three sons and daughter all looked haggard; their mother's advancing lung cancer had led to a long stay in the intensive care unit (ICU). This was the second conference since their mother was intubated a week before. After that meeting, she'd done well with treatments, and the breathing tube had just been removed, although she was still drifting in and out of consciousness. However, the last few days had been increasingly difficult, and, although Ms. Rose's lung function was improved, she was no longer aware of what was going on around her. Her heart had weakened, and her blood pressure had slowly been dropping despite medications.

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confidence: 99%

Life after death in the ICU: detecting family-centered outcomes remains difficult

2017

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Family members of patients who die in the ICU experience significant and lasting psychological burdens, such as post-traumatic stress disorder (PTSD), anxiety, depression, and prolonged grief [1,2]. Among the many potential contributors to these adverse bereavement outcomes are the circumstances surrounding and processes of limiting life support. This hypothesis is supported by evidence that ICU deaths are commonly preceded by decisions to withdraw life support [3], and evidence that both ICU processes of care [4,5] and behaviors of ICU clinicians [1,6] near the end of life can influence family members' post-ICU psychological outcomes. Thus, uncertainty regarding which approaches to withdrawing mechanical ventilation are least distressing for patients and families [7,8] represents an important area for rigorous investigation.In this context, Reignier and colleagues performed a prospective observational cohort study to compare psychological symptoms in over 400 family members of patients who died after withdrawal of mechanical ventilation by immediate extubation vs. terminal weaning in 43 French ICUs [9]. Impressively, the authors were able to assess the primary endpoint of PTSD symptoms 3 months after death among over 95% of enrolled family members. Secondary endpoints included symptoms of anxiety, depression, and complicated grief among family members, symptom burdens of patients during the dying process, and strains on ICU staff.The authors found no differences between groups in any of the psychological outcomes reported by family members at 3 months. This was a durable finding when adjusted for patient characteristics and center effects, and at 6-and 12-month follow-up assessments. ICU staff experienced similar levels of job strain regardless of the withdrawal method chosen, with the exception of nursing assistants who reported less strain with immediate extubation. Patients in the immediate extubation group experienced more gasping and airway obstruction and received significantly lower doses, on average, of sedatives and analgesics compared to those undergoing terminal weaning. Given these results, the authors conclude that the choice between these two approaches to withdrawal of mechanical ventilation does not impact psychological symptoms among family members. They also suggest, and we agree, that standardized approaches to medication administration near the end of life may reduce patient suffering.This study is innovative in empirically evaluating the impact of how mechanical ventilation is withdrawn on family-centered outcomes. It is also strengthened by the diverse sample of ICUs, and the outstanding follow-up rate. However, the ability to draw conclusions is tempered by the non-randomized design. Although the authors appropriately note that randomly assigning ICUs to an unfamiliar withdrawal method might engender low adherence to the assigned interventions, the observational design amounts to a comparison of withdrawal methods on family members who chose (or whose clinicians chose for them) a particul...

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Risk of Post-traumatic Stress Symptoms in Family Members of Intensive Care Unit Patients

Abstract: Post-traumatic stress reaction consistent with a high risk of PTSD is common in family members of ICU patients and is the rule among those who share in end-of-life decisions. Research is needed to investigate PTSD rates and to devise preventive and early-detection strategies.

Cited by 1,151 publications

References 43 publications

The status of intensive care medicine research and a future agenda for very old patients in the ICU

The status of intensive care medicine research and a future agenda for very old patients in the ICU

The Use of Informed Assent in Withholding Cardiopulmonary Resuscitation in the ICU

Life after death in the ICU: detecting family-centered outcomes remains difficult

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