Post-intensive Care Syndrome-family Research Articles

ICU Bridge Program: Working with staff towards no family members feeling like "the elephant in the room"

The intensive care unit (ICU) provides specialized care to critically ill patients. Given the traumatic nature of critical illness and its treatments, up to 75% of family members of ICU decedents and survivors experience long-term psychological consequences, termed post-intensive care syndrome family (PICS-F). Anxiety, PTSD, and depression are common manifestations that significantly impact families’ quality of life and the recovery of those dependent on their caregiving. Although PICS-F can be mitigated by engagement with ICU staff, critical care workers are at risk of burnout and requesting closer liaisons with families is unfeasible. Bridging visitors and the ICU health care team would ensure that family members never feel like “the elephant in the room”.The ICU Bridge Program (ICUBP) is a unique volunteering and shadowing initiative designed and run by university students. Bridge Program volunteers are assigned to hospital ICUs in Montreal to be the first point of contact for visitors. This program addresses PICS-F by humanizing the ICU experience through compassionate human contact, continuous support, and an open line of communication. The diverse applicants are carefully selected and trained to maximize soft skills, such as emotional intelligence and active listening, which ensures that families feel welcome and understood in this tense environment. Furthermore, the ICUBP’s self-sufficient structure off-loads administrative responsibilities from resource-constrained hospitals and makes its implementation feasible and cost-efficient. By continuously monitoring its effect on patients, families, and staff, the ICUBP aims to improve and expand its contribution to whole-person care in the ICU.

Postintensive care syndrome family: A comprehensive review.

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS-F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS-F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post-traumatic syndrome is 20-40%, and that of non-physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS-F was frequently conducted at 3- or 6-month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS-F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow-up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS-F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS-F to facilitate acute care physicians' understanding of PICS-F.

Being devastated by critical illness journey in the family: A grounded theory approach of post-intensive care syndrome-family

ObjectivesThis study aimed to explore the meaning and structure of postintensive care syndrome experienced by families of critically ill patients. MethodsThis qualitative study applied the constructivist grounded theory approach and conducted one or two interviews with eight participants with postintensive care syndrome-family for a total of 12 interviews. The contents of the interviews were analysed through line-by-line coding, focused coding, and categorisation. Data collection and analysis were iterative, to enable continuous comparative analysis. FindingsThe core category of postintensive care syndrome experienced by families was ‘being devastated by the critical illness journey in the family’ and comprised the interactions of four categories: ‘overwhelming intensive care experience’, ‘taking responsibility for the recovery trajectory of critical illness’, ‘life devastated by the trauma of intensive care and family caregiving’, and ‘balancing and compromising’. ConclusionBased on this grounded theory approach, postintensive care syndrome experienced by families is a complex and ongoing phenomenon that arises from the recovery trajectory of a critical illness. It involves mental, physical, social and familial aspects, particularly the impact on the patient’s family. Implications for Clinical PracticeThe findings can guide critical care nurses to understand postintensive care syndrome experienced by families in providing patient or family-centred care. To improve the long-term outcomes and quality of life for families, it is necessary to assess their unique needs within the continuum of post-intensive care syndrome experienced by the family and to propose interventions to satisfy those needs.

The Caregiver Pathway, a Model for the Systematic and Individualized Follow-up of Family Caregivers at Intensive Care Units: Development Study.

Family caregivers of patients who are critically ill have a high prevalence of short- and long-term symptoms, such as fatigue, anxiety, depression, symptoms of posttraumatic stress, and complicated grief. These adverse consequences following a loved one's admission to an intensive care unit (ICU) are also known as post-intensive care syndrome-family. Approaches such as family-centered care provide recommendations for improving the care of patients and families, but models for family caregiver follow-up are often lacking. This study aims to develop a model for structuring and individualizing the follow-up of family caregivers of patients who are critically ill, starting from the patients' ICU admission to after their discharge or death. The model was developed through a participatory co-design approach using a 2-phased iterative process. First, the preparation phase included a meeting with stakeholders (n=4) for organizational anchoring and planning, a literature search, and interviews with former family caregivers (n=8). In the subsequent development phase, the model was iteratively created through workshops with stakeholders (n=10) and user testing with former family caregivers (n=4) and experienced ICU nurses (n=11). The interviews revealed how being present with the patient and receiving adequate information and emotional care were highly important for family caregivers at an ICU. The literature search underlined the overwhelming and uncertain situation for the family caregivers and identified recommendations for follow-up. On the basis of these recommendations and findings from the interviews, workshops, and user testing, The Caregiver Pathway model was developed, encompassing 4 steps: within the first few days of the patient's ICU stay, the family caregivers will be offered to complete a digital assessment tool mapping their needs and challenges, followed by a conversation with an ICU nurse; when the patient leaves the ICU, a card containing information and support will be handed out to the family caregivers; shortly after the ICU stay, family caregivers will be offered a discharge conversation by phone, focusing on how they are doing and whether they have any questions or concerns; and within 3 months after the ICU stay, an individual follow-up conversation will be offered. Family caregivers will be invited to talk about memories from the ICU and reflect upon the ICU stay, and they will also be able to talk about their current situation and receive information about relevant support. This study illustrates how existing evidence and stakeholder input can be combined to create a model for family caregiver follow-up at an ICU. The Caregiver Pathway can help ICU nurses improve family caregiver follow-up and aid in promoting family-centered care, potentially also being transferrable to other types of family caregiver follow-up.

Neurocritical Care Recovery Clinics: An Idea Whose Time Has Come.

Purposes were to identify evidence for post-intensive care syndrome (PICS) and post-intensive care syndrome-family (PICS-F), defined as the psychological impact on families from exposure to critical care, in the neurologically injured population and to characterize existing models for neurorecovery clinics and the evidence to support their use. There has been an explosion of post-ICU clinics among the general critical care population, with their use largely justified based on the management of PICS and PICS-F, terminology which excludes brain injured patients. In contrast, neurocritical care recovery clinics are not common and not well-described. There is however evidence in the neuro-ICU population supporting the provision of "dyadic" care, whereby the patient and caregiver are treated as one unit. Brain injured populations likely experience many of the same PICS phenomena as medically ill patients but are not represented in this body of literature. These patients deserve the same level of follow-up as other patients who have experienced critical illness. We propose a neuro-ICU transitional care clinic that addresses PICS-like symptoms and is modeled after transitional care provided to other brain injured populations. Future investigations should be targeted toward understanding the sequalae of a neuro-ICU admission, mechanisms for providing dyadic care, and the impact of neurorecovery clinics on long-term outcomes.

Efficiency of a psychiatric support for PTSD on a cohort of relatives of patients hospitalized in intensive care unit during the French lockdown – the OLAF (Opération Liaison et Aide aux Familles in French) dispositive

IntroductionHaving a family member admitted in Intensive Care Unit (ICU) can cause a severe psychological stress, and various psychological disorders gathered into the notion of Post intensive care syndrome-family (PICS-F). In this way, Family-centered care in ICU represents the aim of international accepted recommendations focusing on a partnership approach to health care decision-making between the family and health care provider to prevent PICS-F. During the first SARS-CoV-2 linked lockdown, social restrictions impaired the right application of these recommendations, increasing risk of PICS-F, particularly Post-Traumatic Stress Disorder (PTSD).ObjectivesThe main objective was to compare the PTSD prevalence at 6 months in a group of relatives including during OLAF implementation with a control group in a cohort of ICU-patient relatives.MethodsConsidering this, the psychiatric team and the ICU team of the Toulouse University, France, proposed the creation of a temporary device called OLAF (Opération de Liaison et d’Aide aux Familles in French), aiming to bring a psychological phone support to ICU-patient relatives. Besides this operational approach we designed a research approach that aimed to investigate the impact of OLAF device on PICS-F.ResultsWe noted that 12 participants (11.5 %) presented a PTSD at 6 months without statistically significant differences between the groups (p=0.8). Considering that OLAF group presented higher PDI (Peritraumatric Distress Inventory) score at screening we also considered a mediation model suggesting that OLAF could have played a role to diminish the PCL-5 score as a covariable. In the multinomial logistic regression analysis, we found that the only factor associated with the PTSD diagnosis was the level of Anxiety and Depression Signs measured with HADS (Hospital Anxiety and Depression Scale) at screening (OR= 1.2, p<0.001).ConclusionsWe found no difference in PTSD prevalence according to OLAF intervention. Nevertheless, our result suggested that the intervention could have play a role in reducing PTSD by acting on anxiety and peri traumatic distress in a mediated model. We found that anxiety score could serve as a risk marker to predict PTSD and should probably be precociously screened and treated in this population.Disclosure of InterestNone Declared

Beyond the ICU Rotation: The Importance of Trainee Involvement in Post-Intensive Care Unit Clinics.

Medical learners are vital to the care of critically ill patients in the intensive care unit (ICU). Although these learners are exposed to the challenges and stresses of acute ICU management, they do not typically experience the benefits of following ICU patients and families longitudinally after their ICU rotation. Post-ICU clinics and recovery programs may fill this crucial gap in trainee education. These clinics have emerged as an appealing approach to potentially support patient recovery, enhance provider satisfaction, and provide feedback on vital lessons learned in long-term follow-up to improve the quality of ICU care. Notably, the effect of such a program on trainee education has not been explored. In this article, we propose a framework for medical learner participation in post-ICU follow-up based on the Accreditation Council for Graduate Medical Education milestones and discuss the potential benefits, including: education about post-ICU recovery, including post–intensive care syndrome and post–intensive care syndrome–family; experience in quality improvement to enhance ICU care by understanding long-term outcomes; engagement in reflection; and mitigation of compassion fatigue and burnout.

The impact of an intensive care unit admission on the health status of relatives of intensive care survivors: A prospective cohort study in primary care

Background Relatives of intensive care unit (ICU) survivors may suffer from various symptoms after ICU admittance of their relative, known as post-intensive care syndrome-family (PICS-F). Studies regarding PICS-F have been performed but its impact in primary care is unknown. Objectives To explore health problems of relatives of ICU survivors in primary care. Methods This is an exploratory prospective cohort study in which we combined data from two hospitals and a primary care research network in the Netherlands. ICU survivors who had been admitted between January 2005 and July 2017 were identified and matched by sex and age with up to four chronically ill (e.g. COPD, cardiovascular disease) patients. In both groups, relatives living in the same household were identified and included in this study. Primary outcome was the number of new episodes of care (International Classification of Primary Care-2) for up to five years. Hazard ratios (HRs) for the total number of new episodes were calculated. Results Relatives of ICU survivors (n = 267, mean age 38.1 years, 41.0% male) had significantly more new care episodes compared to the reference group (n = 705, mean age 36.3 years, 41.1% male) 1–2 years (median 0.11 vs. 0.08, HR 1.26; 95% confidence interval (CI) 1.03–1.54) and 2–5 years (median 0.18 vs. 0.13, HR 1.28; 95%CI 1.06–1.56) after ICU discharge. No differences were found in the period before ICU admission. Conclusion Relatives of ICU survivors present more morbidity in primary care than relatives of chronically ill patients up to five years after ICU discharge.

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review.

Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization”. A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.

Discussion Guide for the Petrinec Article

Each year, almost 6 million Americans are admitted to an intensive care unit (ICU) for management of a life-threatening, critical illness. The trauma of witnessing a loved one endure critical illness predisposes patients’ family members to post–intensive care syndrome–family (PICS-F), a cluster of negative psychological symptoms such as anxiety, depression, posttraumatic stress, and complicated grief. PICS-F can reduce family members’ quality of life and subsequently impede patients’ recovery. Cognitive behavioral therapy (CBT) is a first-line nonpharmacological treatment for a number of psychological conditions, including the symptoms encompassed by PICS-F. As smartphone technology continues to expand, mobile health apps have emerged as a promising modality to enhance users’ confidence in their ability to manage their mental health. However, the effectiveness of such apps has not been examined among family members of critically ill patients. Therefore, the authors examined the feasibility of using a CBT mobile health app for family members during and after a patient’s ICU stay.The investigators used a prospective, longitudinal cohort design with a consecutive sample of patients and family members from 2 mixed adult ICUs at a tertiary care hospital. Adult family members were eligible if they identified as the family decision-maker for an adult patient who had been in the ICU for more than 3 days, was receiving mechanical ventilation, and lacked decision-making capacity. Family members completed a sociodemographic questionnaire and self-report instruments that measured anxiety, depression, posttraumatic stress, health-related quality of life, mental health self-efficacy, app use, and app satisfaction. Family participants in the interventional study phase were provided with a smartphone containing a free and commercially available mobile health app called Sanvello, completed 1 identical lesson, and were then instructed to use any of the remaining app contents as they desired. Baseline data were collected at enrollment; follow-up data were collected 30 (T2) and 60 (T3) days after study enrollment.In total, 49 family members participated (25 in the intervention group). The participants were predominantly White women; almost three-quarters were married, and approximately half were unemployed. For patients, the mean ICU stay was 13 days, with 10% of patients dying while in the hospital. Eighty-percent of app recipients provided follow-up data at T2 and T3. App group participants logged into the app a mean of 18 times, with a third logging in 12 times or more. Mean use time per login was 5.5 minutes, and overall, participants endorsed satisfaction with the app, with the most common criticism relating to the burden of carrying around an additional device. Psychological outcomes improved at each time point. Notably, participants in the app group reported statistically significant improvements in symptoms of anxiety and depression at T2 and T3, whereas participants in the control group reported statistically significant improvements only at T3. Also, mental health self-efficacy increased within the app group but not in the control group. The authors conclude that using an app to support family members of critically ill patients is feasible and acceptable.Amy Petrinec, PhD, RN, the corresponding author for this article, provides additional information about this study. In her work as a clinical nurse, she noticed how many family members regularly used smart-phones while visiting the patient. She also recognizes that “healthcare providers may not have extra time beyond the care they are already providing to [their patients].” Therefore, she “began to think about how to leverage smartphone technology” in an acceptable and meaningful way to provide support to family members in the ICU. She turned to the scientific literature and found that CBT delivery via mobile health apps was effective in mitigating comparable psychological symptoms in other populations. As a result, Dr Petrinec “thought this might be a good way to support family members by providing on-demand help [by] using their phones” without imposing additional effort on clinicians.Dr Petrinec acknowledges the obstacles that she encountered in conducting this work. For example, as the new and sole faculty member researching ICU family members, she needed “to organize the right infrastructure.” Professional networking was a crucial part of this process: “I met with several department chairs to identify individuals with research interests that aligned with my own. I reached out to several investigators and met with them to discuss my research ideas and plans and eventually found a very experienced researcher with whom to collaborate,” who then helped her solicit their statistician. Finally, Dr Petrinec “networked further at the clinical research site, where [she] developed relationships with several clinical personnel interested in [her] area of research.” Dr Petrinec advises, “Persistence, perseverance, and a willingness to incorporate ideas from experienced colleagues are essential to building an effective team.”Dr Petrinec encountered additional obstacles during the study. For example, “family members who did not own their own smartphone struggled with the learning curve of using [one].” Even those family members who owned their own smartphone found it “cumbersome” to carry around a second device and “would admit to sometimes forgetting the phone at home.” Dr Petrinec chose to remain optimistic: Dr Petrinec recognizes the potential of her team’s work: “The current project offers a potential treatment option that may address [family members’] psychological symptoms directly without adding significant cost or requiring significant resources to implement.” She adds, “the app can be provided in addition to the standard of care … and can be used … throughout the critical illness trajectory regardless of patient outcomes.” While she acknowledges that “there are several unresolved issues in my area of research … [such as the need] to develop an effective screening tool for family members at risk for PICS-F,” her team’s research is moving critical care science closer to providing “individualized care for family members” without placing substantial workforce or economic demands on the health care system.This feature briefly describes the personal journey and background story of the EBR article’s investigators, discussing the circumstances that led them to undertake the line of inquiry represented in the research article featured in this issue.Amy Petrinec, PhD, RN, started her career more than 30 years ago at a level I burn and trauma critical care facility. After completing a master’s degree, she began teaching critical care concepts to nursing students. While teaching, she “began thinking that supporting family members was an important part of the caring process, and we could do better.” She eventually completed a PhD in nursing science and received postdoctoral training in symptom science as part of a National Institutes of Health institutional training grant. She concludes, “I didn’t set out when I was 18 years old to be an ICU nurse or to earn my PhD and do research. My nursing career just snowballed and evolved over time.”

Delivering Cognitive Behavioral Therapy for Post-Intensive Care Syndrome-Family via a Mobile Health App.

Family members of intensive care unit (ICU) patients are at risk for post-intensive care syndrome- family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

Association between intensive care unit admission of a patient and mental disorders in the spouse: a retrospective matched-pair cohort study

BackgroundPrevious prospective studies have suggested that spouses of patients who are admitted to the intensive care unit (ICU) have a high prevalence of mental disorders, termed post-intensive care syndrome-family (PICS-F). However, it remains unclear whether the patient’s ICU admission is associated with the occurrence of mental disorders in the spouse outside of the prospective study setting. We therefore investigated the proportion of ICU patients’ spouses who visited medical facilities for mental disorders and the association between ICU admission of a patient and mental disorders in the spouse using real-world data.MethodsThis was a retrospective matched-pair cohort study using commercially available, routinely collected administrative claims data. As the study population, we identified all married couples (both wife and husband) who were registered in the database from 1 April 2012 to 31 August 2018 using family identification codes. We identified spouses of patients who were admitted to the ICU for more than 2 days as the exposure group and defined the date of admission to the ICU as the index date. We randomly matched four individuals in the non-exposure group with one individual in the exposure group. The primary outcome was any PICS-F–related mental disorder in the spouses within 6 months from the index date. As a sensitivity analysis, we also investigated the proportion and association of individuals (excluding spouses) with a history of mental disorders.ResultsAmong 1,082,208 married couples, we identified 8490 spouses of ICU patients, and they were matched with 33,946 individuals. The proportion of any PICS-F–related mental disorder within 6 months from the index date was 12.8% in ICU patients’ spouses and 11.3% in the matched individuals (adjusted odds ratio, 1.29; 95% confidence interval, 1.03–1.42). The sensitivity analysis showed significant associations between ICU admission and spouses’ mental disorders.ConclusionsSpouses of patients who were admitted to the ICU had a slightly higher risk of mental disorders within 6 months than spouses of patients who were not admitted to the ICU.

Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study.

Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes. A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL. Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (±standard deviation) 52 (11) and 41 (13) respectively (p=0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (rs -0.74, p<0.001). Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.

Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study.

BackgroundFamily members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy.ObjectiveThe purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients.MethodsFor our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura’s social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study.ResultsRecruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022.ConclusionsThe proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial.Trial RegistrationClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767International Registered Report Identifier (IRRID)DERR1-10.2196/30813

A Whirlpool of Stress in Families of Intensive Care Unit Patients: A Qualitative Multicenter Study.

Family members of patients admitted to the intensive care unit must tolerate high levels of stress, making them emotionally and physically vulnerable. However, little is known about the kinds of stress family members may experience. To explore perceived stress in the families of patients admitted to the intensive care unit. This qualitative content analysis study involved 23 family members of patients admitted to intensive care units. Participants were drawn from family members of patients hospitalized in intensive care units of 3 public and 2 private hospitals. Data were collected through semistructured interviews. Three themes emerged from the data: "distrust," "repeated stress exposure," and "a whirlpool of persistent negative emotional-physical state." The first theme had 2 categories: "fearful mindset" and "negative beliefs about professional caregivers." The second theme also had 2 categories: "fear of the future" and "sustained accumulation of tensions." The third theme had 3 categories: "impaired mental health," "impaired physical health," and "impaired family function." The findings of this study may help critical care nurses better understand the nature and sources of family stresses during a patient's intensive care unit stay. Supervisory nurses should alert their staff to these issues so that family care programs can address them, thereby reducing family members' risk of posttraumatic stress disorder and post-intensive care syndrome-family.

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

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.

[Research progress of post-intensive care syndrome-family].

随着重症患者救治理念和救治技术的提升，越来越多的重症患者在ICU的治疗中获益，同时重症患者及其家属的整体身心健康亦越来越受到关注。家属ICU后综合征的发生率在ICU患者转出后6个月为6%~69%，严重影响家属的生活质量。家属ICU后综合征的发生是多因素综合作用的结果，很难采取单一措施进行干预，家属作为ICU转出患者预后康复的主要照顾者，其生活质量间接影响患者的长期预后。本文拟对家属ICU后综合征的临床表现、发病原因、评估工具及干预措施进行综述，以期提高临床医护人员对ICU后综合征的全面理解与关注。.

Post-intensive care syndrome following cardiothoracic critical care: Feasibility of a complex intervention.

ObjectivesTo describe the long-term outcomes of cardiac intensive care unit patients and their primary caregivers, and to explore the feasibility of implementing a complex intervention, designed to support problems associated with post-intensive care syndrome and post-intensive care syndrome– family, in the year following discharge from the cardiac intensive care unit.DesignA complex multidisciplinary rehabilitation programme, delivered as a quality improvement initiative, in a single centre in the West of Scotland. Outcomes were measured using surveys of health related quality of life, self efficacy, anxiety, depression, pain, caregiver strain, and insomnia.ParticipantsPatients and their caregivers were invited to participate 12 weeks after hospital discharge. Twenty-seven patients and 23 caregivers attended the programme.ResultsOver 90% of patients had problems in at least one quality of life domain at baseline, 41% of patients had symptoms of anxiety and 22% had symptoms of depression. During the baseline visit, caregiver strain was present in 20% of caregivers, 57% had symptoms of anxiety, and 35% had symptoms of depression. Improvements in outcomes were seen in both patients and caregivers at 1-year follow-up. The programme was implemented, and iterative learning obtained about the content and the operationalization of the service, in order to understand feasibility.ConclusionThis small-scale quality improvement project has demonstrated that this complex multidisciplinary rehabilitation programme is feasible and has positive implications for patients following discharge from the cardiac intensive care unit, and their caregivers.LAY ABSTRACTPatients, and relatives (or caregivers) of patients, treated in specialist intensive care units often only have access to limited recovery programmes focussing on a single disease. For patients treated in general intensive care units a recovery programme called InS:PIRE has been developed. The programme runs over multiple weeks, combining healthcare teams with social and financial help, and involves community organizations. It also brings groups of patients and relatives together so that they can help each other (known as peer support). This study describes the process of adapting the InS:PIRE programme for those treated in a specialist heart and lung centre. The problems these patients and relatives experience in the year after their illness is described, demonstrating that these issues are similar to those experienced after general intensive care. The results show that this model of recovery is possible in this setting and appears to be valued by the participating patients and relatives.

Stress, anxiety, depression and basic hope in family members of patients hospitalised in intensive care units - preliminary report.

The family response to intensive care unit (ICU) hospitalisation includes development of adverse psychological outcomes such as stress, anxiety or depression. These complications from exposure to critical care are termed post-intensive care syndrome-family (PICS-f). Psychological repercussions of critical illness affect the family member's ability to perform care functions after hospitalisation. Atotal of 37 family members of patients hospitalised in an ICU were included. To evaluate the level stress, anxiety, depression and basic hope the standardized questionnaires the Perceived Stress Scale (PSS-10), the Hospital Anxiety and Depression Scale (HADS) and the Basic Hope Inventory (BHI-12) respectively were used. In 33 respondents (89.19%) ahigh level of stress was identified, and 14 (37.84%) and 12 (32.43%) respondents had severe anxiety and depression, respectively. Higher levels of stress, anxiety and depression were found in spouses and family members living with the patient. Female subjects had ahigher level of basic hope (P = 0.026). It was found that perceived stress correlated with anxiety (r = 0.456, P = 0.005) and depression (r = 0.481, P = 0.003). Most relatives of the patients reported stress, anxiety, depression and low basic hope. Preventive family-centred interventions are needed to minimize the risk of adverse psychological repercussions, including post-intensive care syndrome family.

Interventions in Post-Intensive Care Syndrome-Family: A Systematic Literature Review.

Data show that family members of ICU patients may have high levels of anxiety, depression, posttraumatic stress disorders, and/or complicated grief. This was previously referred to as post-intensive care syndrome-family. We systematically review randomized controlled trials for post-intensive care syndrome-family. Systematic research in databases (Pubmed, EMBASE, PsycINFO, CINHAL for articles published between January 2000 and October 2019). Interventions in randomized controlled trials for post-intensive care syndrome-family in relatives of adult ICU patients. Review, quality assessment, and risk assessment for bias of eligible publications were performed along recommended guidelines for each investigation. Quality assessment graded studies into "strong" (n = 5), "moderate" (n = 4), and "weak" (n = 2). Out of 2,399 publications, 11 investigations were found eligible (3,183 relatives of ICU patients). Studies addressed interventions during ICU stay (n = 6), during the post-ICU period (n = 4), or both (n = 1). Two studies included relatives of dying/deceased patients. One study implemented end-of-life conferences and showed reduced prevalence of posttraumatic stress disorder (45% vs 69%; p = 0.01), anxiety (45% vs 67%; p = 0.02), and depression (29% vs 56%; p = 0.003). Family conferences with a physician and proactive participation of a nurse reduced anxiety-scores (p = 0.01) without reducing anxiety prevalence (33.3% vs 52.3%; p = 0.08). Other studies failed to improve symptoms or reduce prevalence of post-intensive care syndrome-family. Interestingly, condolence letters may even increase prevalence of posttraumatic stress disorder (52.4% vs 37.1%; p = 0.03). Meetings without the presence of ICU physicians were shown to increase Impact of Event Scale-Revised scores (25.9 vs 21.3; p = 0.0495). Only few data are available on interventions for post-intensive care syndrome-family. It appears that proactive communication and provision of information seems pivotal for post-intensive care syndrome-family treatment. Interestingly, some interventions may even worsen post-intensive care syndrome-family. In the light of the relevance of post-intensive care syndrome-family in daily ICU care, more high-quality data seems urgently needed.