Background: Family members of Intensive Care Unit (ICU) patients are subject to a higher risk of depression, anxiety, and stress-related disorders. This psychological distress inevitably affects their perception of th...Background: Family members of Intensive Care Unit (ICU) patients are subject to a higher risk of depression, anxiety, and stress-related disorders. This psychological distress inevitably affects their perception of the quality of care that their relative receives. The aim of this study is to enlighten the effect of psychopathology, resilience, and self-compassion on the satisfaction of family members of ICU patients and examine the role of self-compassion and resilience as explaining variables of the psychopathology and satisfaction relation. Methods: One hundred and seventy-six family members participated in the study. Each participant completed the Symptom Check List 90 (SCL-90-R), the Family Satisfaction in the Intensive Care Unit (FS-ICU) questionnaire, the Connor-Davidson Mental Endurance Scale (CD-RISC), and the Self-Compassion scale (SCS). Analysis of variance and path analysis was applied in order to test the research hypotheses. Results: The patient’s age, patient’s gender, type of relation, and age of the family member did not have a statistically significant direct or interaction effect on the satisfaction of the family members. The psychopathology had a significant negative correlation with the total satisfaction of the family members. The self-compassion was found to have a significant direct effect on psychopathology and a significant indirect effect on satisfaction via resilience, while both resilience and self-compassion had significant direct or indirect effects on satisfaction. Self-compassion was found to eliminate the mediation role of resilience on psychopathology and the resilience and psychopathology effect on satisfaction. Conclusions: Self-compassion emerged as the most important personality characteristic concerning the satisfaction of family members of ICU patients. Our study indicates that interventions aiming to enhance self-compassion will help patients’ relatives cope with the particularly stressful experience of the intensive care unit.展开更多
Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mor...Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.展开更多
Pulmonary hypertension(PH) is a condition characterized by the elevation of the mean pulmonary artery pressure above 25 mm Hg and the pulmonary vascular resistance above 3 wood units. Pulmonary arterial hypertension(P...Pulmonary hypertension(PH) is a condition characterized by the elevation of the mean pulmonary artery pressure above 25 mm Hg and the pulmonary vascular resistance above 3 wood units. Pulmonary arterial hypertension(PAH) is an uncommon conditionwith severe morbidity and mortality, needing early recognition and appropriate and specific treatment. PH is frequently associated with hypoxemia, mainly chronic obstructive pulmonary disease and DPLD and/or left heart diseases(LHD), mainly heart failure with reduced or preserved ejection fraction. Although in the majority of patients with PH the cause is not PAH, a significant number of published studies are still in regard to group Ⅰ PH, leading to a logical assumption that PH due to other causes is not such an important issue. So, is there a reason to discuss PH other than PAH? Chronic lung diseases, mainly chronic obstructive lung disease and DPLD, are associated with a high incidence of PH which is linked to exercise limitations and a worse prognosis. Although pathophysiological studies suggest that specific PAH therapy may benefit such patients, the results presented from small studies in regard to the safety and effectiveness of the specific PAH therapy are discouraging. PH is a common complication of left heart disease and is related to disease severity, especially in patients with reduced ejection fraction. There are two types of PH related to LHD based on diastolic pressure difference(DPD, defined as diastolic pulmonary artery pressure- mean PAWP): Isolated post-capillary PH, defined as PAWP > 15 mm Hg and DPD < 7 mm Hg, and combined post-capillary PH and pre-capillary PH, defined as PAWP > 15 mm Hg and DPD ≥ 7 mm Hg. The potential use of PAH therapies in patients with PH related to left heart disease is based on a logical pathobiological rationale. In patients with heart failure, endothelial dysfunction has been proposed as a cause of PH and hence as a target for treatment, supported by the presence of increased endothelin-1 activity and impaired nitric oxide-dependent vasodilation. Unfortunately, so far, there is no evidence supporting the use of specific PAH therapies in patients with PH related to left heart disease. In conclusion, the presence of PH in patients with conditions other than PAH contributes to the severity of the disease, affecting the outcome and quality of life. The disappointing results regarding the effectiveness of specific PAH therapies in patients withchronic lung diseases and LHD underline the need for seeking new underlying mechanisms and thus novel therapies targeting PH due to left heart disease and/or lung diseases.展开更多
文摘Background: Family members of Intensive Care Unit (ICU) patients are subject to a higher risk of depression, anxiety, and stress-related disorders. This psychological distress inevitably affects their perception of the quality of care that their relative receives. The aim of this study is to enlighten the effect of psychopathology, resilience, and self-compassion on the satisfaction of family members of ICU patients and examine the role of self-compassion and resilience as explaining variables of the psychopathology and satisfaction relation. Methods: One hundred and seventy-six family members participated in the study. Each participant completed the Symptom Check List 90 (SCL-90-R), the Family Satisfaction in the Intensive Care Unit (FS-ICU) questionnaire, the Connor-Davidson Mental Endurance Scale (CD-RISC), and the Self-Compassion scale (SCS). Analysis of variance and path analysis was applied in order to test the research hypotheses. Results: The patient’s age, patient’s gender, type of relation, and age of the family member did not have a statistically significant direct or interaction effect on the satisfaction of the family members. The psychopathology had a significant negative correlation with the total satisfaction of the family members. The self-compassion was found to have a significant direct effect on psychopathology and a significant indirect effect on satisfaction via resilience, while both resilience and self-compassion had significant direct or indirect effects on satisfaction. Self-compassion was found to eliminate the mediation role of resilience on psychopathology and the resilience and psychopathology effect on satisfaction. Conclusions: Self-compassion emerged as the most important personality characteristic concerning the satisfaction of family members of ICU patients. Our study indicates that interventions aiming to enhance self-compassion will help patients’ relatives cope with the particularly stressful experience of the intensive care unit.
文摘Acute respiratory distress syndrome(ARDS) is a syndrome with heterogeneous underlying pathological processes. It represents a common clinical problem in intensive care unit patients and it is characterized by high mortality. The mainstay of treatment for ARDS is lung protective ventilation with low tidal volumes and positive end-expiratory pressure sufficient for alveolar recruitment. Prone positioning is a supplementary strategy available in managing patients with ARDS. It was first described 40 years ago and it proves to be in alignment with two major ARDS pathophysiological lung models; the "sponge lung"- and the "shape matching"-model. Current evidence strongly supports that prone positioning has beneficial effects on gas exchange, respiratory mechanics, lung protection and hemodynamics as it redistributes transpulmonary pressure, stress and strain throughout the lung and unloads the right ventricle. The factors that individually influence the time course of alveolar recruitment and the improvement in oxygenation during prone positioning have not been well characterized. Although patients' response to prone positioning is quite variable and hard to predict, large randomized trials and recent meta-analyses show that prone position in conjunction with a lung-protective strategy, when performed early and in sufficient duration, may improve survival in patients with ARDS. This pathophysiology-based review and recent clinical evidence strongly support the use of prone positioning in the early management of severe ARDS systematically and not as a rescue maneuver or a last-ditch effort.
文摘Pulmonary hypertension(PH) is a condition characterized by the elevation of the mean pulmonary artery pressure above 25 mm Hg and the pulmonary vascular resistance above 3 wood units. Pulmonary arterial hypertension(PAH) is an uncommon conditionwith severe morbidity and mortality, needing early recognition and appropriate and specific treatment. PH is frequently associated with hypoxemia, mainly chronic obstructive pulmonary disease and DPLD and/or left heart diseases(LHD), mainly heart failure with reduced or preserved ejection fraction. Although in the majority of patients with PH the cause is not PAH, a significant number of published studies are still in regard to group Ⅰ PH, leading to a logical assumption that PH due to other causes is not such an important issue. So, is there a reason to discuss PH other than PAH? Chronic lung diseases, mainly chronic obstructive lung disease and DPLD, are associated with a high incidence of PH which is linked to exercise limitations and a worse prognosis. Although pathophysiological studies suggest that specific PAH therapy may benefit such patients, the results presented from small studies in regard to the safety and effectiveness of the specific PAH therapy are discouraging. PH is a common complication of left heart disease and is related to disease severity, especially in patients with reduced ejection fraction. There are two types of PH related to LHD based on diastolic pressure difference(DPD, defined as diastolic pulmonary artery pressure- mean PAWP): Isolated post-capillary PH, defined as PAWP > 15 mm Hg and DPD < 7 mm Hg, and combined post-capillary PH and pre-capillary PH, defined as PAWP > 15 mm Hg and DPD ≥ 7 mm Hg. The potential use of PAH therapies in patients with PH related to left heart disease is based on a logical pathobiological rationale. In patients with heart failure, endothelial dysfunction has been proposed as a cause of PH and hence as a target for treatment, supported by the presence of increased endothelin-1 activity and impaired nitric oxide-dependent vasodilation. Unfortunately, so far, there is no evidence supporting the use of specific PAH therapies in patients with PH related to left heart disease. In conclusion, the presence of PH in patients with conditions other than PAH contributes to the severity of the disease, affecting the outcome and quality of life. The disappointing results regarding the effectiveness of specific PAH therapies in patients withchronic lung diseases and LHD underline the need for seeking new underlying mechanisms and thus novel therapies targeting PH due to left heart disease and/or lung diseases.
