Objectives:This systematic review aimed to assess the properties and feasibility of existing risk prediction models for post-intensive care syndrome outcomes in adult survivors of critical illness.Methods:As of Novemb...Objectives:This systematic review aimed to assess the properties and feasibility of existing risk prediction models for post-intensive care syndrome outcomes in adult survivors of critical illness.Methods:As of November 1,2023,Cochrane Library,PubMed,Embase,CINAHL,Web of Science,PsycInfo,China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang database,and China Science and Technology Journal Database(VIP)were searched.Following the literature screening process,we extracted data encompassing participant sources,post-intensive care syndrome(PICS)outcomes,sample sizes,missing data,predictive factors,model development methodologies,and metrics for model performance and evaluation.We conducted a review and classification of the PICS domains and predictive factors identified in each study.The Prediction Model Risk of Bias Assessment Tool was employed to assess the quality and applicability of the studies.Results:This systematic review included a total of 16 studies,comprising two cognitive impairment studies,four psychological impairment studies,eight physiological impairment studies,and two studies on all three domains.The discriminative ability of prediction models measured by area under the receiver operating characteristic curve was 0.68e0.90.The predictive performance of most models was excellent,but most models were biased and overfitted.All predictive factors tend to encompass age,pre-ICU functional impairment,in-ICU experiences,and early-onset new symptoms.Conclusions:This review identified 16 prediction models and the predictive factors for PICS.Nonetheless,due to the numerous methodological and reporting shortcomings identified in the studies under review,clinicians should exercise caution when interpreting the predictions made by these models.To avert the development of PICS,it is imperative for clinicians to closely monitor prognostic factors,including the in-ICU experience and early-onset new symptoms.展开更多
BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharg...BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharge from the intensive care unit(ICU).These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family.Connect,Introduce,Communicate,Ask,Respond,Exit(CICARE)communication advocates that patients should be respected and accepted when receiving medical services.Clinicians should attach importance to the communication mode of feelings,including connection,introduction,communication,ask,response,and exit 6 steps.AIM To assess the impact of CICARE communication on the reduction of anxiety,depression,and post-traumatic stress disorder(PTSD)symptoms in patients transitioning from the ICU to other care settings.METHODS This prospective,randomized,controlled study was performed between October 2021 and March 2023.Intensive Care Unit Memory Tool was used to evaluate patients’ICU memory.The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms.Impact of Event Scale-Revised was utilized to assess the presence of PTSD.All data were processed and analyzed using R language software version 4.1.0.The measurement data were expressed as mean±SD,and the t test was used.The count data were analyzed by theχ2 test and expressed as[n(%)].RESULTS In total,248 subjects were included in this study.Among them,206 were successfully followed up for three months after transfer from the ICU,and 42 cases were lost to follow-up.There was no significant difference in the composition of ICU memory between the two groups.The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model,as well as the adoption of only the motivational psychological intervention nursing model,demonstrated favorable effects on PICS.Both groups of patients showed a reduction in anxiety scores,depression scores,and PTSD scores following the implementation of these two nursing models.However,it is noteworthy that the experimental group exhibited greater improvements compared to the control group.CONCLUSION Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.展开更多
In this editorial,I address the mental health status of patients who have been discharged from intensive care units(ICUs)after battling coronavirus disease 2019(COVID-19).An ICU admission is generally a stressful expe...In this editorial,I address the mental health status of patients who have been discharged from intensive care units(ICUs)after battling coronavirus disease 2019(COVID-19).An ICU admission is generally a stressful experience,and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences.These individuals may experience psychiatric distress,including symptoms such as insomnia,anxiety,depression,and even posttraumatic psychological issues.Research indicates that during the first 6 months to 1 year following an ICU stay,nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder.Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic,particularly for those who underwent an ICU stay.The ICU environment itself is inherently stressful,filled with the constant noise of various medical devices.Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.展开更多
AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.METHODS Retrospective study including data from a cohort of 198 hospitalized patien...AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.METHODS Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality(KATZ Index of Independence in Activities of Daily Living) and muscle strength(MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit(ICU), in the Ward(WARD) and the total time of hospital stay(TOT).RESULTS Considering the functional outcome(ΔKATZ), the variables that significantly contributed to the model(P < 0.05) were the KATZ and MRC on admission, age, sepsis(no), and total length of stay(TLS). Regarding the muscle strength outcome model(ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex(female). The variable age(AUC = 0.664) discriminated the ΔKATZICU. The variables age(AUC = 0.712), KATZ in ICU(AUC = 0.590) and on ward admission(AUC = 0.746), and MRC on ward admission(AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission(AUC = 0.621) and TLS(AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII(AUC = 0.661) and MRC on ICU admission(AUC = 0.653) were discriminative. MRC on ICU(AUC = 0.681) and ward admission(AUC = 0.553) were discriminative for ΔMRCWARD. TLS(AUC = 0.649) and MRC on ward admission(AUC = 0.696) discriminative for the ΔMRCTOT.CONCLUSION Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.展开更多
Background:There are insufficient data regarding the impact of acute respiratory distress syndrome related to coronavirus disease 2019(C-ARDS)–caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)–on...Background:There are insufficient data regarding the impact of acute respiratory distress syndrome related to coronavirus disease 2019(C-ARDS)–caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)–on health-related quality of life(HRQoL)and the occurrence of stress-related disorders in coronavirus disease 2019(COVID-19)intensive care unit(ICU)survivors.The aim of this study is to assess HRQoL and the occurrence of stress-related disorders(acute stress disorder[ASD]and post-traumatic stress disorder[PTSD])in C-ARDS ICU survivors at 1 and 6 months following hospital discharge.Methods:This prospective observational study included 90 patients treated for C-ARDS between March and May 2020 in the ICU and discharged alive from the hospital.All patients included in the study were contacted by telephone 1 month and 6 months post-hospital discharge to assess the presence of symptoms of stress-related disorders and HRQoL using the 8-item Treatment Outcome Post-traumatic Stress Disorder scale(TOP-8)and 36-item Short Form survey(SF-36).We performed univariate analyses to evaluate differences between patients who developed stress and those who did not.We also compared SF-36 scores in our sample with data from the general Spanish population and from cohorts of non–C-ARDS and severe acute respiratory syndrome coronavirus-1(SARS-CoV-1)survivors.Results:There are 24.1%of patients showed symptoms of ASD;in 13.5%of cases the symptoms persisted 6 months later.Risk factors for the development of symptoms of ASD and PTSD are younger age,female sex,obesity,a previously diagnosed psychiatric disease and disease severity at ICU admission(P<0.05).HRQoL was greatly affected by C-ARDS;however,there was improvement on all scales of the SF-36 at the 6-month follow-up(P<0.05).The mean SF-36 score of our sample was higher than those previously reported in non–C-ARDS survivors(P<0.05)for physical functioning(78.0 vs.52.0),role functioning/physical(51.0 vs.31.0),bodily pain(76.1 vs.57.0),vitality(58.6 vs.48.0),social function(72.6 vs.63.0)and role emotional(77.4 vs.55.0),except on the general health scale.C-ARDS survivors also scored better than SARS-CoV-1 survivors on all scales except for body pain(P<0.05).Conclusions:The impact of C-ARDS on HRQoL is substantial,with frequent occurrence of PTSD symptoms.Patients are heavily affected in all areas of health in the first month of post-hospital discharge but show a dramatic improvement within 6 months,especially in terms of physical health.展开更多
基金supported by the Scientific Research Project of Shanghai Municipal Health Commission(202140047)the Characteristic Research Project of Shanghai General Hospital(CCTR-2022N03)the Technology Standardization Management and Promotion Project of Shanghai Shenkang Hospital Development Center(SHDC22022219)and the funding organization has played no roles in the survey's design,implementation,and analysis.
文摘Objectives:This systematic review aimed to assess the properties and feasibility of existing risk prediction models for post-intensive care syndrome outcomes in adult survivors of critical illness.Methods:As of November 1,2023,Cochrane Library,PubMed,Embase,CINAHL,Web of Science,PsycInfo,China National Knowledge Infrastructure(CNKI),SinoMed,Wanfang database,and China Science and Technology Journal Database(VIP)were searched.Following the literature screening process,we extracted data encompassing participant sources,post-intensive care syndrome(PICS)outcomes,sample sizes,missing data,predictive factors,model development methodologies,and metrics for model performance and evaluation.We conducted a review and classification of the PICS domains and predictive factors identified in each study.The Prediction Model Risk of Bias Assessment Tool was employed to assess the quality and applicability of the studies.Results:This systematic review included a total of 16 studies,comprising two cognitive impairment studies,four psychological impairment studies,eight physiological impairment studies,and two studies on all three domains.The discriminative ability of prediction models measured by area under the receiver operating characteristic curve was 0.68e0.90.The predictive performance of most models was excellent,but most models were biased and overfitted.All predictive factors tend to encompass age,pre-ICU functional impairment,in-ICU experiences,and early-onset new symptoms.Conclusions:This review identified 16 prediction models and the predictive factors for PICS.Nonetheless,due to the numerous methodological and reporting shortcomings identified in the studies under review,clinicians should exercise caution when interpreting the predictions made by these models.To avert the development of PICS,it is imperative for clinicians to closely monitor prognostic factors,including the in-ICU experience and early-onset new symptoms.
文摘BACKGROUND Post-intensive care syndrome(PICS)is a term used to describe a constellation of new or worsened dysfunctions in the physical,cognitive,or mental health status of critically ill patients after their discharge from the intensive care unit(ICU).These dysfunctions persist beyond the acute phase of illness and have a significant impact on both the patient and their family.Connect,Introduce,Communicate,Ask,Respond,Exit(CICARE)communication advocates that patients should be respected and accepted when receiving medical services.Clinicians should attach importance to the communication mode of feelings,including connection,introduction,communication,ask,response,and exit 6 steps.AIM To assess the impact of CICARE communication on the reduction of anxiety,depression,and post-traumatic stress disorder(PTSD)symptoms in patients transitioning from the ICU to other care settings.METHODS This prospective,randomized,controlled study was performed between October 2021 and March 2023.Intensive Care Unit Memory Tool was used to evaluate patients’ICU memory.The Hospital Anxiety and Depression Scale was employed to determine the presence of anxiety or depression symptoms.Impact of Event Scale-Revised was utilized to assess the presence of PTSD.All data were processed and analyzed using R language software version 4.1.0.The measurement data were expressed as mean±SD,and the t test was used.The count data were analyzed by theχ2 test and expressed as[n(%)].RESULTS In total,248 subjects were included in this study.Among them,206 were successfully followed up for three months after transfer from the ICU,and 42 cases were lost to follow-up.There was no significant difference in the composition of ICU memory between the two groups.The application of the CICARE communication nursing model combined with the motivational psychological intervention nursing model,as well as the adoption of only the motivational psychological intervention nursing model,demonstrated favorable effects on PICS.Both groups of patients showed a reduction in anxiety scores,depression scores,and PTSD scores following the implementation of these two nursing models.However,it is noteworthy that the experimental group exhibited greater improvements compared to the control group.CONCLUSION Our findings suggest that CICARE communication nursing mode may have good influence on relieving PICS.
文摘In this editorial,I address the mental health status of patients who have been discharged from intensive care units(ICUs)after battling coronavirus disease 2019(COVID-19).An ICU admission is generally a stressful experience,and for severe COVID-19 survivors prolonged treatment in the ICU can lead to significant psychological consequences.These individuals may experience psychiatric distress,including symptoms such as insomnia,anxiety,depression,and even posttraumatic psychological issues.Research indicates that during the first 6 months to 1 year following an ICU stay,nearly one-third of survivors exhibit symptoms similar to those of depression and post-traumatic stress disorder.Several factors may have contributed to the development of depressive and anxious symptoms during the COVID-19 pandemic,particularly for those who underwent an ICU stay.The ICU environment itself is inherently stressful,filled with the constant noise of various medical devices.Studies have provided strong evidence that the prolonged need for ventilation support and the loss of freedom of movement are key factors in the development of psychological problems among COVID-19 patients who had been treated in the ICU.
文摘AIM To investigate the factors associated with the functional progress of hospitalized patients following an intensive care admission.METHODS Retrospective study including data from a cohort of 198 hospitalized patients following an intensive care admission and not requiring mechanical ventilation in a single tertiary referral hospital. A generalized linear model was used to identify the main effects of clinical and demographic variables on the outcomes of functionality(KATZ Index of Independence in Activities of Daily Living) and muscle strength(MRC Scale). The covariates identified as independent predictors were analysed using the receiver operating characteristic curves. The analysis differentiated the periods in the intensive care unit(ICU), in the Ward(WARD) and the total time of hospital stay(TOT).RESULTS Considering the functional outcome(ΔKATZ), the variables that significantly contributed to the model(P < 0.05) were the KATZ and MRC on admission, age, sepsis(no), and total length of stay(TLS). Regarding the muscle strength outcome model(ΔMRC), the predictors were MRC on admission, Simplified Acute Physiology Score III, previous stroke, TLS, and sex(female). The variable age(AUC = 0.664) discriminated the ΔKATZICU. The variables age(AUC = 0.712), KATZ in ICU(AUC = 0.590) and on ward admission(AUC = 0.746), and MRC on ward admission(AUC = 0.721) were discriminative for ΔKATZWARD. For ΔKATZTOT the variables KATZ on ICU admission(AUC = 0.621) and TLS(AUC = 0.617) were discriminative. For ΔMRCICU the variables SAPSIII(AUC = 0.661) and MRC on ICU admission(AUC = 0.653) were discriminative. MRC on ICU(AUC = 0.681) and ward admission(AUC = 0.553) were discriminative for ΔMRCWARD. TLS(AUC = 0.649) and MRC on ward admission(AUC = 0.696) discriminative for the ΔMRCTOT.CONCLUSION Specific functional, clinical and demographical variables at ICU admission are associated with the functional prognosis during the hospitalization period.
文摘Background:There are insufficient data regarding the impact of acute respiratory distress syndrome related to coronavirus disease 2019(C-ARDS)–caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)–on health-related quality of life(HRQoL)and the occurrence of stress-related disorders in coronavirus disease 2019(COVID-19)intensive care unit(ICU)survivors.The aim of this study is to assess HRQoL and the occurrence of stress-related disorders(acute stress disorder[ASD]and post-traumatic stress disorder[PTSD])in C-ARDS ICU survivors at 1 and 6 months following hospital discharge.Methods:This prospective observational study included 90 patients treated for C-ARDS between March and May 2020 in the ICU and discharged alive from the hospital.All patients included in the study were contacted by telephone 1 month and 6 months post-hospital discharge to assess the presence of symptoms of stress-related disorders and HRQoL using the 8-item Treatment Outcome Post-traumatic Stress Disorder scale(TOP-8)and 36-item Short Form survey(SF-36).We performed univariate analyses to evaluate differences between patients who developed stress and those who did not.We also compared SF-36 scores in our sample with data from the general Spanish population and from cohorts of non–C-ARDS and severe acute respiratory syndrome coronavirus-1(SARS-CoV-1)survivors.Results:There are 24.1%of patients showed symptoms of ASD;in 13.5%of cases the symptoms persisted 6 months later.Risk factors for the development of symptoms of ASD and PTSD are younger age,female sex,obesity,a previously diagnosed psychiatric disease and disease severity at ICU admission(P<0.05).HRQoL was greatly affected by C-ARDS;however,there was improvement on all scales of the SF-36 at the 6-month follow-up(P<0.05).The mean SF-36 score of our sample was higher than those previously reported in non–C-ARDS survivors(P<0.05)for physical functioning(78.0 vs.52.0),role functioning/physical(51.0 vs.31.0),bodily pain(76.1 vs.57.0),vitality(58.6 vs.48.0),social function(72.6 vs.63.0)and role emotional(77.4 vs.55.0),except on the general health scale.C-ARDS survivors also scored better than SARS-CoV-1 survivors on all scales except for body pain(P<0.05).Conclusions:The impact of C-ARDS on HRQoL is substantial,with frequent occurrence of PTSD symptoms.Patients are heavily affected in all areas of health in the first month of post-hospital discharge but show a dramatic improvement within 6 months,especially in terms of physical health.
