Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year

Purpose Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU s...

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Published in:	Intensive care medicine Vol. 45; no. 2; pp. 223 - 235
Main Authors:	Kalfon, Pierre, Alessandrini, Marine, Boucekine, Mohamed, Renoult, Stéphanie, Geantot, Marie-Agnès, Deparis-Dusautois, Stéphanie, Berric, Audrey, Collange, Olivier, Floccard, Bernard, Mimoz, Olivier, Julien, Amour, Robert, René, Audibert, Juliette, Renault, Anne, Follin, Arnaud, Thevenin, Didier, Revel, Nathalie, Venot, Marion, Patrigeon, René-Gilles, Signouret, Thomas, Fromentin, Mélanie, Sharshar, Tarek, Vigne, Coralie, Pottecher, Julien, Levrat, Quentin, Sossou, Achille, Garrouste-Orgeas, Maïté, Quenot, Jean-Pierre, Boulle, Claire, Azoulay, Elie, Baumstarck, Karine, Auquier, Pascal
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2019 Springer Springer Nature B.V Springer Verlag
Subjects:	Adult Aged Aged, 80 and over Anesthesiology Clustering Cohort Studies Comparative analysis Critical Care Medicine Critical Illness - psychology Critical Illness - therapy Discomfort Emergency Medicine Exposure Female Health care Hospitalization - statistics & numerical data Humans Intensive Intensive care Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Life Sciences Male Medical research Medicine Medicine & Public Health Medicine, Experimental Mental disorders Middle Aged Original Pain Medicine Patient Comfort - methods Patient Comfort - standards Patient-Centered Care - methods Patients Pediatrics Pharmaceutical sciences Pneumology/Respiratory System Post traumatic stress disorder Program Evaluation - methods Prospective Studies Quality of Life - psychology Reduction Signs and symptoms Simplified Acute Physiology Score Statistics, Nonparametric Stress Disorders, Post-Traumatic - epidemiology Stress Disorders, Post-Traumatic - prevention & control Stress Disorders, Post-Traumatic - psychology Surveys and Questionnaires Survivors - psychology Survivors - statistics & numerical data France Tailored program Critical care Patient-reported outcome ICU Discomfort Post-traumatic stress disorder
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Summary:	Purpose Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors. Methods This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1 year was assessed based on the Impact of Event Scale–Revised (IES-R). Results Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively ( p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1 year ( p = 0.015). Conclusions Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1 year. Trial registration ClinicalTrials.gov identifier NCT02762409.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0342-4642 1432-1238
DOI:	10.1007/s00134-018-05511-y