Sortable Database of AICU Library Media

Care of ICU survivors in the community: a guide for GPs

Fiona Kiernan, MB BCh BAO, MSc (Health Econ), FCAI, EDIC, Consultant in Critical Care Medicine

Medical Journal

No

Specialists in intensive care medicine have long focused on the prevention of short-term mortality. As intensive care unit (ICU) mortality continues to improve, interest in outcome measures has expanded to include the morbidity and mortality of survivors. Over the last 10 years it has been increasingly recognised that critical illness is a medical condition itself, irrespective of the underlying cause for ICU admission, and patients experience physical, psychological, and cognitive dysfunction after hospital discharge (Figure 1). However, because relatively few patients ultimately require critical care, many GPs may have little contact with these patients. It may therefore be difficult to provide the additional support required by ICU survivors. This short paper highlights some of the physical and psychological difficulties that patients face after discharge from ICUs, and will hopefully help GPs to plan long-term management of their patients in the community.

Bedside Treatments for ABCDE Protocol

ICUdelirium.org

Chart

No

Bedside Treatments for ABCDE Protocol

Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma

Armstrong P A, McCarthy M C, Peoples J B

Medical Research

No

Reduced use of resources by early tracheostomy in ventilator-dependent patients with blunt trauma. Surgery 1998; 124(4): 763-766StatusThis is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn.CRD summaryIndexing statusSubject indexing assigned by NLMIndex termsAdult; Female; Health Resources /economics /utilization; Hospital Charges; Humans; Intensive Care Units /economics /utilization; Length of Stay; Male; Middle Aged; Respiration, Artificial /adverse effects /economics; Retrospective Studies; Time Factors; Tracheostomy /adverse effects /economics; Wounds, Nonpenetrating /therapy

Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: a randomised controlled trial

Sabrina Eggmann, MartinL. Verra , Gere Luder, Jukka Takala, Stephan M. Jakob

Medical Journal

No

INTRODUCTION: Neuromuscular weakness resulting in severe functional impairment is common in critical care survivors. This study aimed to evaluate effects of an early progressive rehabilitation intervention in mechanically ventilated adults at risk.METHODS: This was a parallel, two-arm, assessor-blinded, randomised controlled trial with 6-months follow-up that was conducted in a mixed ICU of an academic centre in Switzerland. Previously independent, mechanically ventilated, critically ill adults with expected critical care stay =72 hours (n = 115) were randomised to a control group receiving standard physiotherapy including early mobilisation or to an experimental group with early endurance and resistance training combined with mobilisation. Primary endpoints were functional capacity (6-Minute Walk Distance) and functional independence (Functional Independence Measure) at hospital discharge. Secondary endpoints including muscle strength were assessed at critical care discharge. Safety was monitored closely by standard monitoring and predefined adverse events.RESULTS: Physiotherapy started within 48 hours of critical care admission while 97% of participants were still ventilated and 68% on inotropes. Compared to the control group (n = 57), the experimental group (n = 58) received significantly more physiotherapy (sessions: 407 vs 377, p<0.001; time/session: 25min vs 18min, p<0.001) and had less days with sedation (p<0.001). Adverse events were rare (0.6%) and without consequences. There were no significant between-group differences in 6-Minute Walk Distance (experimental 123m (IQR 25-280) vs control 100m (IQR 0-300); p = 0.542) or functional independence (98 (IQR 66-119) vs 98 (IQR 18-115); p = 0.308). Likewise, no differences were found for the secondary outcomes, except a trend towards improved mental health in the experimental group after 6 months (84 (IQR 68-88) vs 70 (IQR 64-76); p = 0.023).CONCLUSIONS: Early endurance and resistance training in mechanically ventilated, intensive care patients does not improve functional capacity or independence at hospital discharge compared to early standard physiotherapy but may improve mental health 6-months after critical care discharge.TRIAL REGISTRATION: German Clinical Trials Register (DRKS): DRKS00004347, registered on 10 September 2012.

EFFECT OF A MULTIDISCIPLINARY INTERVENTION ON COMMUNICATION AND COLLABORATION AMONG PHYSICIANS AND NURSES

Sondra Vazirani, MD, MPH; Ron D. Hays, PhD; Martin F. Shapiro, MD, PhD; and Marie Cowan, RN, PhD.

Medical Journal

No

• BACKGROUND Improving communication and collaboration among doctors and nurses can improve satisfaction among participants and improve patients’ satisfaction and quality of care. • OBJECTIVE To determine the impact of a multidisciplinary intervention on communication and collaboration among doctors and nurses on an acute inpatient medical unit. • METHODS During a 2-year period, an intervention unit was created that differed from the control unit by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and collaboration were administered to personnel in both units. Physicians were surveyed at the completion of each rotation on the unit; nurses, biannually. • RESULTS Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123) were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration with nurses than did physicians in the control group (P< .001); the largest effect was among the residents. Physicians in the intervention group reported better collaboration with the nurse practitioners than with the staff nurses (P< .001). Physicians in the intervention group also reported better communication with fellow physicians than did physicians in the control group (P=.006). Nurses in both groups reported similar levels of communication (P= .59) and collaboration (P= .47) with physicians. Nurses in the intervention group reported better communication with nurse practitioners than with physicians (P<.001). • CONCLUSIONS The multidisciplinary intervention resulted in better communication and collaboration among the participants. (American Journal of Critical Care. 2005;14:71-77)

Predictors of Post-Intensive Care Syndrome in Family Members of Patients With Severe Sepsis.

Matt B, Schwarzkopf D, Fritzenwanger M, Witte O, Reinhart K, and Hartog C

Medical Journal

No

Introduction Relatives of patients with severe sepsis have high risk of adverse psychological outcomes. Better knowledge about risk factors is needed. Objectives To predict psychological outcomes in relatives of patients at 90 days after death or discharge. Methods Prospective study on 4 ICUs in one German University hospital (04/2014 - 01/2015). The main relative of consecutive patients with severe sepsis were interviewed by phone at 90 days after patient discharge or death. Post-traumatic stress symptoms (PTSS) were assessed by the Impact of Event Scale (IES), symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale(HADS). Predictors were chosen based on literature, including demographic data, satisfaction with ICU care and information and experience of end-of-life care in the ICU. All patients’ health status before severe sepsis and survivors’ health status at 90 days were assessed by the relative using the EQ-5D questionnaire. A new item was introduced: feeling over strained by the ICU experience with rating on a scale from 1 to 10. Linear regression analyses were used to identify predictors in the full sample and among relatives of deceased and surviving patients. Results 143 relatives (64% response rate) participated. Fifty (35%)patients died in the ICU, 78 (55%) were alive at the time of the interview. Among relatives, median [IQR] age was54 [47,63], 73% were female, 43% were spouses and 39%were children of the patient, 78% were legal proxies. After90 days, 66 relatives (47%) experienced symptoms of PTSS; 55 (39%) and 41 (29%) suffered from symptoms of anxiety and depression, respectively. IES, HADS anxiety or depression scores did not differ between relatives of deceased and surviving patients. By multivariate analyses, no item on satisfaction with the ICU experience or the experience of end-of-life care reached significance. Female gender and lower education of relatives were risk factors for some psychological symptoms in the full sample and among relatives of deceased patients. Tracheostomy was a predictor of IES in the full sample (p=.004), treatment on a surgical ICU was a predictor of IES among relatives of deceased patients (p=.004). The degree of feeling over-strained by the ICU experience was a predictor of IES, HADS anxiety and depression in the full sample as well as in the subsamples of relatives of deceased and surviving patients (p≤.021).ThedifferenceinEQ-5Dhealthstatuspredicted IES and HADS depression among surviving patients (p≤.049). Conclusions Feeling overs trained during the ICU stay might be the strongest predictor of relatives’ psychological symptoms after three months. Tracheostomy in the ICU might be a predictor for PTSS. Both should be investigated in prospective longitudinal or interventional studies to better assess and prevent relatives’ psychological burden after their ICU experience.

Cam ICU Pocket Cards

E. Wesley Ely, MD, MPH

Brochure

No

Cam ICU Pocket Cards help the medical practitioner to do "delirium assessment" and " Sedation Assessment".

Intensive care diaries reduce new onset post traumatic stress disorder following critical illness: a randomised, controlled trial

Christina Jones, Carl Bäckman, Maurizia Capuzzo, Ingrid Egerod, Hans Flaatten, Cristina Granja, Christian Rylander, Richard D Griffiths & the RACHEL group

Medical Research

No

Introduction Patients recovering from critical illness have been shown to be at risk of developing Post Traumatic Stress disorder (PTSD). This study was to evaluate whether a prospectively collected diary of a patient's intensive care unit (ICU) stay when used during convalescence following critical illness will reduce the development of new onset PTSD. Methods Intensive care patients with an ICU stay of more than 72 hours were recruited to a randomised controlled trial examining the effect of a diary outlining the details of the patients ICU stay on the development of acute PTSD. The intervention patients received their ICU diary at 1 month following critical care discharge and the final assessment of the development of acute PTSD was made at 3 months. Results 352 patients were randomised to the study at 1 month. The incidence of new cases of PTSD was reduced in the intervention group compared to the control patients (5% versus 13%, P = 0.02). Conclusions The provision of an ICU diary is effective in aiding psychological recovery and reducing the incidence of new PTSD.