TY - JOUR
T1 - Preventing posttraumatic stress in ICU survivors
T2 - A single-center pilot randomized controlled trial of ICU diaries and psychoeducation
AU - Kredentser, Maia S.
AU - Blouw, Marcus
AU - Marten, Nicole
AU - Sareen, Jitender
AU - Joseph Bienvenu, O.
AU - Ryu, Jennifer
AU - Beatie, Brooke E.
AU - Logsetty, Sarvesh
AU - Graff, Lesley A.
AU - Eggertson, Shauna
AU - Sweatman, Sophia
AU - Debroni, Braeden
AU - Cianflone, Nina
AU - Arora, Rakesh C.
AU - Zarychanski, Ryan
AU - Olafson, Kendiss
N1 - Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2018
Y1 - 2018
N2 - Objectives: Critical illness can have a significant psychological impact on patients and their families. To inform the design of a larger trial, we assessed feasibility of ICU diaries and psychoeducation to prevent posttraumatic stress disorder, depression, and anxiety following ICU stays. Design: Four-arm pilot randomized controlled trial. Setting: A 10-bed tertiary ICU in Winnipeg, MB, Canada. Patients: Critically ill patients greater than 17 years old with predicted ICU stays greater than 72 hours and mechanical ventilation duration greater than 24 hours. Interventions: Patients were randomized to usual care, ICU diary, psychoeducation, or both ICU diary and psychoeducation. Measurements and Main Results: Our primary objective was to determine feasibility measured by enrollment/mo. Secondary outcomes included acceptability of the ICU diary intervention and psychological distress, including patients' memories 1 week post ICU using the ICU Memory Tool, posttraumatic stress disorder (Impact of Events Scale-Revised), depression, and anxiety symptoms (Hospital Anxiety and Depression Scale) 30 and 90 days post ICU. Over 3.5 years, we enrolled 58 patients, an average of 1.9 participants/mo. Families and healthcare providers wrote a mean of 3.2 diary entries/d (sd, 2.9) and indicated positive attitudes and low perceived burden toward ICU diary participation. A majority of patients reported distressing memories of their ICU stay. Those who received the diary intervention had significantly lower median Hospital Anxiety and Depression Scale anxiety (3.0 [interquartile range, 2-6.25] vs 8.0 [interquartile range, 7-10]; p = 0.01) and depression (3.0 [interquartile range, 1.75-5.25] vs 5.0 [interquartile range, 4-9]; p = 0.04) symptom scores at 90 days than patients who did not receive a diary. Conclusions: ICU diaries are a feasible intervention in a tertiary Canadian ICU context. Preliminary evidence supports the efficacy of ICU diaries to reduce psychological morbidity following discharge.
AB - Objectives: Critical illness can have a significant psychological impact on patients and their families. To inform the design of a larger trial, we assessed feasibility of ICU diaries and psychoeducation to prevent posttraumatic stress disorder, depression, and anxiety following ICU stays. Design: Four-arm pilot randomized controlled trial. Setting: A 10-bed tertiary ICU in Winnipeg, MB, Canada. Patients: Critically ill patients greater than 17 years old with predicted ICU stays greater than 72 hours and mechanical ventilation duration greater than 24 hours. Interventions: Patients were randomized to usual care, ICU diary, psychoeducation, or both ICU diary and psychoeducation. Measurements and Main Results: Our primary objective was to determine feasibility measured by enrollment/mo. Secondary outcomes included acceptability of the ICU diary intervention and psychological distress, including patients' memories 1 week post ICU using the ICU Memory Tool, posttraumatic stress disorder (Impact of Events Scale-Revised), depression, and anxiety symptoms (Hospital Anxiety and Depression Scale) 30 and 90 days post ICU. Over 3.5 years, we enrolled 58 patients, an average of 1.9 participants/mo. Families and healthcare providers wrote a mean of 3.2 diary entries/d (sd, 2.9) and indicated positive attitudes and low perceived burden toward ICU diary participation. A majority of patients reported distressing memories of their ICU stay. Those who received the diary intervention had significantly lower median Hospital Anxiety and Depression Scale anxiety (3.0 [interquartile range, 2-6.25] vs 8.0 [interquartile range, 7-10]; p = 0.01) and depression (3.0 [interquartile range, 1.75-5.25] vs 5.0 [interquartile range, 4-9]; p = 0.04) symptom scores at 90 days than patients who did not receive a diary. Conclusions: ICU diaries are a feasible intervention in a tertiary Canadian ICU context. Preliminary evidence supports the efficacy of ICU diaries to reduce psychological morbidity following discharge.
KW - Anxiety
KW - Depression
KW - Intensive care
KW - Intensive care unit diaries
KW - Postintensive care syndrome
KW - Posttraumatic stress disorder
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U2 - 10.1097/CCM.0000000000003367
DO - 10.1097/CCM.0000000000003367
M3 - Article
C2 - 30119073
AN - SCOPUS:85056568130
SN - 0090-3493
VL - 46
SP - 1914
EP - 1922
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -