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 - Funding Information:
Supported, in part, by a grant from the Manitoba Medical Service Foundation (grant number 8-2014-07) to Dr. Blouw. Supported, in part, by Canadian Institutes of Health Research Foundation grant number 333252 (to Dr. Sareen). Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Funding Information:
Ms. Kredentser has received doctoral research awards from the Canadian Institutes of Health Research and the University of Manitoba Centre on Aging and Wu Scholarship. Dr. Blouw, Ms. Kredentser, and Drs. Sareen, Bienvenu, Ryu, Logsetty, and Olafson received funding from Manitoba Medical Services Foundation. Drs. Blouw, Sareen, Graff, Logsetty, and Olafson received support for article research from the Canadian Institutes of Health Research. Dr. Sareen disclosed that he was a consultant for UpTo-Date and has previously held Johnson and Johnson stock. Ms. Beatie has received doctoral research awards from the Social Sciences and Humanities Research Council of Canada and the University of Manitoba Centre on Aging. Drs. Ryu, Sweatman, and Debroni received a research stipend from the University of Manitoba for completing the Med II Summer Research Program while working on this article. Dr. Arora has received an unrestricted educational grant from Pfizer Canada Inc and honoraria from Mallickrodt Pharmaceuticals for work unrelated to this article. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: umkreden@myumanitoba.ca
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
UR - http://www.scopus.com/inward/record.url?scp=85056568130&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056568130&partnerID=8YFLogxK
U2 - 10.1097/CCM.0000000000003367
DO - 10.1097/CCM.0000000000003367
M3 - Article
C2 - 30119073
AN - SCOPUS:85056568130
VL - 46
SP - 1914
EP - 1922
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 12
ER -