Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.
Posttraumatic Stress Disorder Symptom Clusters in Surrogate Decision Makers of Patients Experiencing Chronic Critical Illness.
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DOI：
10.1097/cce.0000000000000647
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发表时间：
2022-03
影响因子：
--
通讯作者：
Carson SS
中科院分区：
文献类型：
--
作者：
Wendlandt B;Ceppe A;Gaynes BN;Cox CE;Hanson LC;Nelson JE;Carson SS
创伤后应激障碍（PTSD）的症状在慢性危重症（CCI）患者的代理决策者中很常见。创伤后应激障碍症状可分为侵入性、回避性和过度唤醒性，每一种症状都有不同的结果和治疗反应。我们的目的是确定在CCI患者的代用物中哪个症状群占主导地位。沟通干预临床试验数据的二次分析。最初的试验是在三家三级护理中心和一家社区医院的重症监护室进行的。CCI患者（机械通气≥7天，预计在随后的72小时内不会死亡或脱离呼吸机）及其替代物。没有。在患者CCI发作90天后，使用事件影响量表（IES-R）测量替代PTSD症状。IES-R包括总分（范围0-88分，分数越高表明症状越严重）以及三个评估入侵、回避和过度觉醒的子量表（入侵和回避得分范围0-32分，过度觉醒得分范围0-24分）。入侵症状最严重（平均评分，10.3;95% CI, 9.3-11.2），其次是逃避（平均评分，8.0;95% CI, 7.2-8.8）。高觉醒症状最低（平均评分5.1;95% CI, 4.5-5.7）。在多变量线性回归模型中，我们发现，即使在调整了焦虑和抑郁的基线症状后，死亡患者的代理人比存活患者的代理人有更高的侵入（β, 5.52; p < 0.0001）和逃避（β, 3.29; p = 0.001）症状的几率。患者死亡与高觉醒症状无关。侵入性思维是经历CCI患者的代理人中最严重的PTSD症状，在死亡患者的代理人中症状加剧。这些结果有可能为减少这一人群的PTSD症状提供量身定制的治疗策略。
Symptoms of posttraumatic stress disorder (PTSD) are common among surrogate decision makers of patients with chronic critical illness (CCI). PTSD symptoms can be categorized into clusters including intrusion, avoidance, and hyperarousal, each of which has been associated with distinct outcomes and treatment responses. Our objective was to determine which symptom cluster was predominant among surrogates of patients with CCI. Secondary analysis of data from a clinical trial of a communication intervention. The original trial was conducted in medical intensive care units at three tertiary-care centers and one community hospital. Patients with CCI (≥7 d of mechanical ventilation and not expected to die or to be weaned from the ventilator in the subsequent 72 hr) and their surrogates. None. Surrogate PTSD symptoms were measured 90 days after onset of patient CCI using the Impact of Events Scale-Revised (IES-R). The IES-R includes a total score (range, 0–88, higher scores indicate severe symptoms) as well as three subscales that assess intrusion, avoidance, and hyperarousal (range of intrusion and avoidance scores 0–32 and range of hyperarousal score 0–24). Intrusion symptoms were most severe (mean score, 10.3; 95% CI, 9.3–11.2), followed by avoidance (mean score, 8.0; 95% CI, 7.2–8.8). Hyperarousal symptoms were lowest (mean score, 5.1; 95% CI, 4.5–5.7). In a multivariable linear regression model, we found that surrogates of patients who died had higher odds of intrusion (β, 5.52; p < 0.0001) and avoidance (β, 3.29; p = 0.001) symptoms than surrogates of patients who lived, even after adjusting for baseline symptoms of anxiety and depression. Patient death was not associated with hyperarousal symptoms. Intrusive thoughts are the most severe PTSD symptom in surrogates of patients experiencing CCI, with intensified symptoms among surrogates of patients who died. These results have the potential to inform tailored treatment strategies to reduce PTSD symptoms in this population.
影响因子：
10.3
作者：
Beck JG;Clapp JD;Unger W;Wattenberg M;Sloan DM
通讯作者：
Sloan DM