Mobile Critical Care Recovery Program for Survivors of Acute Respiratory Failure: A Randomized Clinical Trial.
Mobile Critical Care Recovery Program for Survivors of Acute Respiratory Failure: A Randomized Clinical Trial.
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急性呼吸衰竭幸存者的移动的重症监护恢复计划：一项随机临床试验。
DOI：
10.1001/jamanetworkopen.2023.53158
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发表时间：
2024-01-02
影响因子：
13.8
通讯作者：
Boustani MA
中科院分区：
文献类型：
--
作者：
Khan BA;Perkins AJ;Khan SH;Unverzagt FW;Lasiter S;Gao S;Wang S;Zarzaur BL;Rahman O;Eltarras A;Qureshi H;Boustani MA
重症监护室（ICU）康复计划包括护士护理协调员和跨学科团队的支持，是否能改善急性呼吸衰竭（ARF）幸存者的生活质量？在466名ARF幸存者的随机临床试验中，通过护士护理协调员提供的12个月协作护理ICU恢复干预，并由临床医生（重症监护医生，老年病学家，护理和神经心理学家）的跨学科团队提供支持，并没有显着改善ARF幸存者的生活质量。这些结果表明，需要进一步的研究，以确定特定的患者群体，他们可以从更密集的家庭干预中受益，以改善危重病幸存者的恢复。超过50%的急性呼吸衰竭（ARF）幸存者经历认知，身体和心理障碍，对他们的生活质量（QOL）产生负面影响。评价重症监护病房（ICU）后项目，即由护士护理协调员和跨学科团队支持的移动的重症监护恢复项目（m-CCRP）在改善ARF幸存者生活质量方面的有效性。这项在ARF幸存者中进行的隐藏结局评估的随机临床试验于2017年3月1日至2022年4月30日进行，随访12个月。患者被收治到印第安纳州4家附属医院（1家社区医院、1家县医院、2家学术医院）的ICU服务，这些医院隶属于印第安纳州医学院。一个12个月的护士领导的协作护理干预（m-CCRP）的支持下，一个跨学科的临床医生（2重症监护医师，1老年病学家，1 ICU护士，1神经心理学家）进行了比较，以电话为基础的控制。干预包括纵向症状监测，再加上护士提供的护理协议，针对认知，身体功能，个人护理，移动性，睡眠障碍，疼痛，抑郁，焦虑，激动或攻击，妄想或幻觉，压力和身体健康，法律的和财务需求，以及药物依从性。主要结局为QOL，通过36项医学结局研究简表健康调查（SF-36）身体健康总评（PCS）和心理健康总评（MCS）进行测量，每个组成部分的评分范围为0-100，评分越高表示健康状况越好。在466名ARF幸存者的意向治疗分析中，（平均[SD]年龄，56.1 [14.4]岁; 250例[53.6%]女性;每组233例），与对照组相比，m-CCRP干预12个月未显著改善QOL（m-CCRP和对照组之间较基线变化的估计差异：SF-36 PCS为1.61 [95% CI，−1.06至4.29]; SF-36 MCS为−2.50 [95% CI，−5.29至0.30]。与对照组相比，m-CCRP组的住院率较高（117 [50.2%] vs 95 [40.8%]; P = 0.04），而12个月死亡率无统计学显著性降低（24 [10.3%] vs 38 [16.3%]; P = 0.05）。这项随机临床试验的结果表明，护士主导的12个月综合性跨学科护理干预并没有显著改善ICU住院后ARF幸存者的生活质量。这些结果表明，需要进一步的研究，以确定特定的患者群体谁可以受益于定制后ICU干预。ClinicalTrials.gov 标识符：NCT 03053245这项随机临床试验评估了一个由护士护理协调员组成的项目，由一个跨学科团队提供支持，是否能改善急性呼吸衰竭幸存者从重症监护室出院后的生活质量。
Does an intensive care unit (ICU) recovery program comprising a nurse care coordinator supported by an interdisciplinary team improve quality of life among acute respiratory failure (ARF) survivors? In this randomized clinical trial of 466 ARF survivors, a 12-month collaborative care ICU recovery intervention delivered through a nurse care coordinator and supported by an interdisciplinary team of clinicians (intensivists, geriatrician, nursing, and neuropsychologist) did not significantly improve the quality of life of ARF survivors. These results suggest that further research is needed to identify specific patient groups who could derive benefit from more intensive in-home interventions to allow for improved recovery in survivors of critical illness. Over 50% of Acute Respiratory Failure (ARF) survivors experience cognitive, physical, and psychological impairments that negatively impact their quality of life (QOL). To evaluate the efficacy of a post–intensive care unit (ICU) program, the Mobile Critical Care Recovery Program (m-CCRP) consisting of a nurse care coordinator supported by an interdisciplinary team, in improving the QOL of ARF survivors. This randomized clinical trial with concealed outcome assessments among ARF survivors was conducted from March 1, 2017, to April 30, 2022, with a 12-month follow-up. Patients were admitted to the ICU services of 4 Indiana hospitals (1 community, 1 county, 2 academic), affiliated with the Indiana University School of Medicine. A 12-month nurse-led collaborative care intervention (m-CCRP) supported by an interdisciplinary group of clinicians (2 intensivists, 1 geriatrician, 1 ICU nurse, and 1 neuropsychologist) was compared with a telephone-based control. The intervention comprised longitudinal symptom monitoring coupled with nurse-delivered care protocols targeting cognition, physical function, personal care, mobility, sleep disturbances, pain, depression, anxiety, agitation or aggression, delusions or hallucinations, stress and physical health, legal and financial needs, and medication adherence. The primary outcome was QOL as measured by the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), with scores on each component ranging from 0-100, and higher scores indicating better health status. In an intention-to-treat analysis among 466 ARF survivors (mean [SD] age, 56.1 [14.4] years; 250 [53.6%] female; 233 assigned to each group), the m-CCRP intervention for 12 months did not significantly improve the QOL compared with the control group (estimated difference in change from baseline between m-CCRP and control group: 1.61 [95% CI, −1.06 to 4.29] for SF-36 PCS; −2.50 [95% CI, −5.29 to 0.30] for SF-36 MCS. Compared with the control group, the rates of hospitalization were higher in the m-CCRP group (117 [50.2%] vs 95 [40.8%]; P = .04), whereas the 12-month mortality rates were not statistically significantly lower (24 [10.3%] vs 38 [16.3%]; P = .05). Findings from this randomized clinical trial indicated that a nurse-led 12-month comprehensive interdisciplinary care intervention did not significantly improve the QOL of ARF survivors after ICU hospitalization. These results suggest that further research is needed to identify specific patient groups who could benefit from tailored post-ICU interventions. ClinicalTrials.gov Identifier: NCT03053245 This randomized clinical trial assesses whether a program comprising a nurse care coordinator supported by an interdisciplinary team improves the quality of life after discharge from the intensive care unit among survivors of acute respiratory failure.
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影响因子：
38.9
作者：
Jensen, Janet F.;Egerod, Ingrid;Overgaard, Dorthe
通讯作者：
Overgaard, Dorthe
影响因子：
2.7
作者：
Khan, Babar A.;Lasiter, Sue;Boustani, Malaz A.
通讯作者：
Boustani, Malaz A.
DOI：
10.1186/cc8848
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Cuthbertson BH;Roughton S;Jenkinson D;Maclennan G;Vale L
通讯作者：
Vale L
影响因子：
5.7
作者：
Krebs, Erin E.;Lorenz, Karl A.;Bair, Matthew J.;Damush, Teresa M.;Wu, Jingwei;Sutherland, Jason M.;Asch, Steven M.;Kroenke, Kurt
通讯作者：
Kroenke, Kurt
影响因子：
158.5
作者：
Herridge, MS;Cheung, AM;Slutsky, AS
通讯作者：
Slutsky, AS