Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1year
Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1year
复制标题
DOI：
10.1007/s00134-018-05511-y
复制
发表时间：
2019-02-01
影响因子：
38.9
通讯作者：
Auquier, Pascal
中科院分区：
文献类型：
--
作者：
Kalfon, Pierre;Alessandrini, Marine;Auquier, Pascal
目的减少重症监护室（ICU）的不适感对长期预后有积极影响。本研究评估了一个量身定制的多组分减轻不适计划是否能有效减轻一般ICU幸存者1年后的创伤后应激障碍（PTSD）症状。方法本研究是一项前瞻性观察性比较疗效队列研究，涉及30个ICU。这是IPREA 3研究的延伸，IPREA 3是一项随机分组对照试验，旨在评估定制的多组分方案减少重症患者不适的有效性。该计划包括评估ICU相关的自我感觉不适，立即和每月向医疗保健团队反馈，以及针对特定地点的定制干预措施。暴露的是这个计划的实施。合格患者暴露于与未暴露的一般成人ICU幸存者。大量的PTSD症状在1年的患病率进行了评估的基础上的影响事件量表修订版（IES-R）。ResultsOf的1537 ICU幸存者包括在研究中，475未暴露的患者和344暴露的患者在1年的随访数据：57（12.0%）和21（6.1%）与PTSD在1年，分别（P=0.004）。考虑到聚类，并在调整年龄，性别，McCabe分类和ICU相关的自我感知总体不适评分后，暴露的患者在1年时出现PTSD症状的可能性显著低于未暴露的患者（p=0.015）.结论在ICU实施一个量身定制的多组分计划，已被证明是有效的，以减少自我-在一般成人ICU幸存者中感觉到的不适感也降低了1年时大量PTSD症状的患病率registrationClinicalTrials.gov。
PurposeReducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors. MethodsThis study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1year was assessed based on the Impact of Event Scale-Revised (IES-R).ResultsOf the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p=0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1year (p=0.015).ConclusionsImplementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1year.Trial registrationClinicalTrials.gov identifier NCT02762409.