Caregiving and Long-term Mechanical Ventilation

Abstract

We would like to thank Drs. Douglas and Daly for their commentary on our article,1Im K Belle SH Schulz R et al.Prevalence and outcomes of caregiving after prolonged (≥ 48 hours) mechanical ventilation in the ICU.Chest. 2004; 125: 597-606Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar which was submitted prior to their article.2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Although the two studies included slightly different caregiver populations due to different patient eligibility criteria and definition of long-term ventilation in the ICU, some of the results are very similar. The mean levels of caregivers’ depression (Center for Epidemiology depression scale [CES-D]) are remarkably similar, with similar variability, in these two studies: 13.9 (SD 12.8) and 13.2 (SD 11.0) for Douglas and Daly2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar and Im et al,1Im K Belle SH Schulz R et al.Prevalence and outcomes of caregiving after prolonged (≥ 48 hours) mechanical ventilation in the ICU.Chest. 2004; 125: 597-606Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar respectively. However, these results can not be compared directly because of the two distinctively different outcome time points, ie, 6 months after discharge from the hospital for the sample used by Douglas et al2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar and 2 months following ventilation for the sample used by Im et al.1Im K Belle SH Schulz R et al.Prevalence and outcomes of caregiving after prolonged (≥ 48 hours) mechanical ventilation in the ICU.Chest. 2004; 125: 597-606Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar We did collect CES-D data at 6 months and 12 months following intubation, but have not published these data yet. Despite the difference, both studies show similar proportions of caregivers at risk of clinical depression, defined as CES-D score ≥ 16, ie, 36.4% at 6 months after hospital discharge in the study of Douglas and Daly2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar and 33.9% at 2 months following intubation in our study. Douglas and Daly2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar showed that there was a significant relationship between patient location and caregiver's CES-D, indicating that caregivers of patients who resided in an institution reported more depressive symptoms than did caregivers of patients who resided at home. In our study, we found a similar relationship, though the p value associated with the parameter for location was 0.07. We did, however, indicate our opinion that it was important to consider strategies to assist caregivers whose care recipients were institutionalized precisely because they may be at greater risk of depression. The findings by Douglas and Daly2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar provide supporting evidence for our proposition. Most importantly, both studies conclude that caregivers of patients receiving mechanical ventilation do indeed suffer from, or are at risk of, serious clinical depression, something that is not well recognized in the field of caregiving research. We really need to work on developing intervention strategies to help this population. On this issue, we concur with Douglas and Daly.2Douglas SL Daly BJ Caregivers of long-term ventilator patients: physical and psychological outcomes.Chest. 2003; 123: 1073-1081Abstract Full Text Full Text PDF PubMed Scopus (96) Google Scholar Caregiving and Long-term Mechanical VentilationCHESTVol. 126Issue 4PreviewWe read with interest the recent research article by Im and colleagues,1 and were particularly interested to note that they reported that it was difficult to compare their results to other studies of critically ill patients surviving mechanical ventilatory support. While we agree that such studies are rare, the similarity between the work of Im and colleagues and ours2 is remarkable and warrants comparison. Full-Text PDF