Abstract
Background: Having a loved one admitted to the ICU is an extraordinarily stressful event, principally with poor prognosis and when death may occur. Aim: To evaluate the impact of poor prognosis patients admitted in the ICU on their family member’s emotional disorders. Design and setting: Prospective study conducted in a 22-bed mixed ICU in a tertiary hospital in Sao Paulo, Brazil. Family members completed the Hospital Anxiety and Depression Scale 48 hours post-admission. Family members answered the HADS, the Impact of Event Scale by phone at 30-days and 90-days after ICU discharge. Results: 95/575 patients admitted at the ICU were defined as poor prognostic patients. Poor prognostic patients required more mechanical ventilation (50.0% vs. 32.9%, p=0.002), tracheotomy (11.6% vs. 5.0%, p=0.014), vasopressors (54.7% vs. 36.8%, p=0.001), remained longer under mechanical ventilation (7 [3-15] vs. 3 [2-6] days, p=0.030) and stay longer at ICU (8 [5-18] vs. 4 [3-8], p<0.001) when compared with non-poor prognosis patients. They also had high mortality at ICU (32.6%), 30-days (60.0%) and 90-days (73.5%) and we also observed an intense emotional suffering among their respective family members during and after ICU discharge. Conclusion: Family members of poor prognosis patients admitted to the ICU were more likely to suffer with symptoms of anxiety, depression and post traumatic distress. Their loved ones needed more aggressive treatments during ICU and had higher mortality in a short time.
Highlights
Almost one out of five Americans die in an intensive care unit (ICU) or shortly after an ICU stay [1]
Family members of poor prognosis patients admitted to the ICU were more likely to suffer with symptoms of anxiety, depression and post traumatic distress
They were admitted to the ICU due the postoperative status (27.4%), acute respiratory failure and/or pulmonary diseases (24.2%), shock (20.0%), neurologic diseases (14.7%), cardiovascular diseases (6.3%), acute renal failure (2.1%) and others (5.3%)
Summary
Almost one out of five Americans die in an intensive care unit (ICU) or shortly after an ICU stay [1]. Despite the growing Palliative Care movement, most admissions of terminal patients still occur in ICUs. The Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatments (SUPPORT) [2] was one of the first studies to systematically investigate symptoms in seriously ill hospitalized patients. Patients at high risk of dying suffer more during ICU: they stay longer under mechanical ventilation, receive more opioids and sedatives, suffer with delirium, anxiety, they are confused, tired, with severe pain and other symptoms [3]. Patients with unlikely benefit whether admitted to the ICU because of high risk of death should be carefully treated in the ward. Having a loved one admitted to the ICU is an extraordinarily stressful event, principally with poor prognosis and when death may occur
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