Psychological Outcomes in Family Members of Patients With Acute Respiratory Failure: Does Inter-ICU Transfer Play a Role?

Abstract

Family members of patients admitted to the ICU experience a constellation of sequelae described as postintensive care syndrome-family. The influence that an inter-ICU transfer has on psychological outcomes is unknown. Is inter-ICU transfer associated with poor psychological outcomes in families of patients with acute respiratory failure? Cross-sectional observational study of 82 families of patients admitted to adult ICUs (tertiary hospital). Data included demographics, admission source, and outcomes. Admission source was classified as inter-ICU transfer (n= 39) for patients admitted to the ICU from other hospitals and direct admit (n= 43) for patients admitted from the ED or the operating room of the same hospital. We used quantitative surveys to evaluate psychological distress (Hospital Anxiety and Depression Scale [HADS]) and posttraumatic stress (Post-Traumatic Stress Scale; PTSS) and examined clinical, family, and satisfaction factors associated with psychological outcomes. Families of transferred patients travelled longer distances (mean ± SD, 109 ± 106 miles) compared with those of patients directly admitted (mean ± SD, 65 ± 156 miles; P≤ .0001). Transferred patients predominantly were admitted to the neuro-ICU (64%), had a longer length of stay (direct admits: mean ± SD, 12.7 ± 9.3days; transferred patients: mean ± SD, 17.6 ± 9.3days; P< .01), and a higher number of ventilator days (direct admits: mean ± SD, 6.9 ± 8.6days; transferred: mean ± SD, 10.6 ± 9.0days; P< .01). Additionally, they were less likely to be discharged home (direct admits, 63%; transferred, 33%; P= .08). In a fully adjusted model of psychological distress and posttraumatic stress, family members of transferred patients were found to have a 1.74-point (95%CI, -1.08 to 5.29; P= .30) higher HADS score and a 5.19-point (95%CI, 0.35-10.03; P= .03) higher PTSS score than those of directly admitted family members. In this exploratory study, posttraumatic stress measured by the PTSS was higher in the transferred families, but these findings will need to be replicated to infer clinical significance.