Abstract
Background Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients.MethodsIn a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview.ResultsA significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053–.470) and the patients’ diagnosis of PTSD (β = .264, 95 % confidence interval .045–.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = −.231, 95 % confidence interval −.423 to −.015). Regarding HRQL in family members, patients’ acute posttraumatic stress at ICU (β = −.290, 95 % confidence interval −.360 to −.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = −.622, 95 % confidence interval −.640 to −.358) turned out to be significant predictors.ConclusionsPosttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0174-0) contains supplementary material, which is available to authorized users.
Highlights
Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical ill‐ ness (CCI)
Members of critical illness (CCI) patients experience a cluster of mental complications [e.g., major depression, complicated grief, acute and posttraumatic stress disorder (ASD/PTSD)] which have been referred to as post-intensive care syndrome family (PICS-F) [3]
There is a considerable rate of clinically relevant posttraumatic stress symptoms and significantly diminished health-related quality of life (HRQL) in close family members of CCI patients following intensive care unit (ICU) stay
Summary
Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical ill‐ ness (CCI). Elective placement of tracheotomy and prolonged mechanical ventilation for at least 21 consecutive days put these patients at risk for the development of chronic critical illness (CCI). The traumatic event of acute critical illness leading to ICU treatment, the heightened 1-year mortality and associated severe physical complications lead to increased caregiving demands and psychological stress in the whole family system of CCI patients [2]. Members of CCI patients experience a cluster of mental complications [e.g., major depression, complicated grief, acute and posttraumatic stress disorder (ASD/PTSD)] which have been referred to as post-intensive care syndrome family (PICS-F) [3]. Few studies exist assessing the occurrence and severity of posttraumatic stress in family members of CCI patients
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