MONITOR-IC study, a mixed methods prospective multicentre controlled cohort study assessing 5-year outcomes of ICU survivors and related healthcare costs: a study protocol

IntroductionDue to advances in critical care medicine, more patients survive their critical illness. However, intensive care unit (ICU) survivors often experience long-term physical, cognitive and mental problems, summarised as post-intensive care syndrome (PICS), impacting their health-related quality of life (HRQoL). In what frequency PICS occurs, and to what extent this influences ICU survivors’ HRQoL, is mostly unknown. The aims of this study are therefore to study the: (1) 5-year patient outcomes, (2) predictors for PICS, (3) ratio between HRQoL of ICU survivors and healthcare-related costs, and (4) care and support needs.MethodsThe MONITOR-IC study is a multicentre prospective controlled cohort study, carried out in ICUs in four Dutch hospitals. Patients will be included between July 2016 and July 2021 and followed for 5 years. We estimated to include 12000 ICU patients. Outcomes are the HRQoL, physical, cognitive and mental symptoms, ICU survivors’ care and support needs, healthcare use and related costs. A control cohort of otherwise seriously ill patients will be assembled to compare long-term patient-reported outcomes. We will use a mixed methods design, including questionnaires, medical data from patient records, cost data from health insurance companies and interviews with patients and family members.Ethics and disseminationInsights from this study will be used to inform ICU patients and their family members about long-term consequences of ICU care, and to develop prediction and screening instruments to detect patients at risk for PICS. Subsequently, tailored interventions can be developed and implemented to prevent and mitigate long-term consequences. Additionally, insights into the ratio between HRQoL of ICU patients and related healthcare costs during 5 years after ICU admission can be used to discuss the added value of ICU care from a community perspective. The study has been approved by the research ethics committee of the Radboud University Medical Center (2016-2724).Clinical trial registrationNCT03246334

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Long-Term Outcomes in COVID-19 ICU Patients: A Prospective Cohort Study

10.21203/rs.3.rs-395294/v1 ◽

2021 ◽

Author(s):

Nadine Van Veenendaal ◽

Ingeborg Van der Meulen ◽

Marisa Onrust ◽

Wolter Paans ◽

Willem Dieperink ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Psychological Functioning ◽

Employment Status ◽

Family Members ◽

Well Being ◽

Long Term Outcomes ◽

Icu Discharge

Abstract BACKGROUNDThe COVID-19 pandemic causes high rates of intensive care unit (ICU) admissions. After ICU-discharge patients and family members can suffer from persisting impairments known as ‘Post Intensive Care Syndrome’ (PICS) and PICS-family. Since COVID-19 is relatively new, there is barely any knowledge on the long-term outcomes of COVID-19 ICU-survivors and their family members.OBJECTIVESThis study aims to gain insight in the long-term physical, social and psychological functioning of COVID-19 ICU-survivors and their family members at three- and six-months following ICU discharge.METHODSA single-center, prospective cohort study was conducted in COVID-19 ICU-survivors and their family members. Enrolled participants received questionnaires at three and six months after ICU discharge. The MOS Short-Form General Health Survey, Clinical Frailty Scale, spirometry tests, McMaster Family Assessment Device (FAD-GF6+), the Hospital Anxiety and Depression Scale and return to work were used to evaluate physical, social and psychological functioning.RESULTSSixty COVID-19 ICU-survivors and 78 family members participated. Physical functioning was impaired in ICU-survivors as reflected by a score of 33.3 (IQR 16.7-66.7) and 50 (IQR 16.7-83.3) on the physical functioning subscale at 3- and 6-months follow-up respectively. Diffusion lung capacity was reduced in 69% of patients. Ninety percent of the ICU-survivors reported persistent symptoms after 6 months. Social functioning was impaired as 90% of the COVID-19 ICU-survivors did not reach their pre-ICU employment level, 6 months after ICU-discharge. Psychological functioning in ICU-survivors was normal. Family members experienced worse employment status in 35% and 34% including a decrease in employment rate of 18.3% and 7.4% at 3- and 6-months post ICU-discharge, respectively. Psychologically, 63% of the family members reported ongoing impaired well-being due to the COVID-19 related mandatory physical distance to their relatives.CONCLUSIONWe have shown that COVID-19 ICU-survivors suffer from a prolonged burden of disease, prominent in physical- and social functioning, worse employment status and persisting symptoms in 90%. In addition, family members also report long term effects expressed by a reduction in return to work and impaired well-being. Further research needs to extend the follow up and to study the effects of standardized rehabilitation in COVID-19 patients and their family members.

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Long-term follow-up for Psychological stRess in Intensive CarE (PRICE) survivors: study protocol for a multicentre, prospective observational cohort study in Australian intensive care units

BMJ Open ◽

10.1136/bmjopen-2018-023310 ◽

2019 ◽

Vol 9 (1) ◽

pp. e023310

Author(s):

Sumeet Rai ◽

Rhonda Brown ◽

Frank van Haren ◽

Teresa Neeman ◽

Arvind Rajamani ◽

...

Keyword(s):

Cohort Study ◽

Intensive Care ◽

Family Members ◽

Psychological Outcomes ◽

Observational Cohort Study ◽

Screening Tools ◽

Prospective Observational Cohort Study ◽

Observational Cohort

IntroductionThere are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims of this study are to describe and compare the long-term psychological outcomes of intubated and non-intubated ICU survivors and their family members in an Australian ICU setting.Methods and analysisThis will be a prospective observational cohort study across four ICUs in Australia. The study aims to recruit 150 (75 intubated and 75 non-intubated) adult ICU survivors and 150 family members of the survivors from 2015 to 2018. Long-term psychological outcomes and effects on health-related quality of life (HRQoL) will be evaluated at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective symptoms in intubated and non-intubated survivors of intensive care and their families and its effects on HRQoL. The secondary objective is to explore dyadic relations of psychological outcomes in patients and their family members.Ethics and disseminationThe study has been approved by the relevant human research ethics committees (HREC) of Australian Capital Territory (ACT) Health (ETH.11.14.315), New South Wales (HREC/16/HNE/64), South Australia (HREC/15/RAH/346). The results of this study will be published in a peer-reviewed medical journal and presented to the local intensive care community and other stakeholders.Trial registration numberACTRN12615000880549; Pre-results.

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Living with long‐term consequences: Experience of follow‐up care and support needs among Asian long‐term colorectal cancer survivors

Psycho-Oncology ◽

10.1002/pon.5452 ◽

2020 ◽

Vol 29 (10) ◽

pp. 1557-1563 ◽

Cited By ~ 1

Author(s):

Sungwon Yoon ◽

Teck Beng Chua ◽

Iain Beehuat Tan ◽

David Matchar ◽

Marcus Eng Hock Ong ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Survivors ◽

Support Needs ◽

Colorectal Cancer Survivors ◽

Care And Support ◽

Follow Up Care ◽

Long Term Consequences

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Impact of Opioid Administration in the Intensive Care Unit and Subsequent Use in Opioid-Naïve Patients

Annals of Pharmacotherapy ◽

10.1177/10600280211016856 ◽

2021 ◽

pp. 106002802110168

Author(s):

Niki M. Krancevich ◽

Julie J. Belfer ◽

Heather M. Draper ◽

Kyle J. Schmidt

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Opioid Use ◽

Opioid Prescription ◽

Icu Patients ◽

Confounding Variables ◽

Opioid Administration ◽

Long Term Consequences ◽

The Relationship

Background Opioids are a mainstay of therapy for patients in the intensive care unit (ICU) as part of the analgesia-first approach to sedation. Despite knowledge of acute consequences of opioid based analgosedation, less is known about the potential long-term consequences, including the effect of opioid administration in the ICU on subsequent opioid use in opioid-naïve patients. Objective To evaluate the relationship between ICU opioid administration to opioid-naïve patients and subsequent opioid use following discharge. Methods A query of the electronic medical record was performed to identify opioid-naïve adult patients admitted directly to an ICU. Patients who received continuous intravenous infusion of fentanyl, hydromorphone, or morphine were screened for inclusion into the analysis. Results Of the 342 patients included for analysis, 164 (47.1%) received an opioid at hospital discharge. In total, 17 of the 342 patients (5.0%) became long-term users, noted to be more common in patients who received an opioid prescription at discharge (8.7% vs 1.6%; P = 0.006). Neither total ICU morphine milligram equivalent (MME) nor average daily ICU MME administration were found to correlate with daily MME prescription quantity at discharge ( R2 = 0.008 and R2 = 0.03, respectively). Following control for potentially confounding variables, total ICU MME administration remained an insignificant predictor of subsequent receipt of an opioid prescription at discharge and long-term opioid use. Conclusion and Relevance This study failed to find a significant relationship between ICU opioid use in opioid-naïve patients and subsequent opioid use. These findings highlight the need to focus on transitions points between the ICU and discharge as potential opportunities to reduce inappropriate opioid continuation.

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Olmstead Update--November 2002: Serving People with Long-Term Care and Support Needs in Communities

PsycEXTRA Dataset ◽

10.1037/e615042007-001 ◽

2013 ◽

Keyword(s):

Long Term Care ◽

Support Needs ◽

Term Care ◽

Care And Support

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Delivering Cognitive Behavioral Therapy for Post–Intensive Care Syndrome–Family via a Mobile Health App

American Journal of Critical Care ◽

10.4037/ajcc2021962 ◽

2021 ◽

Vol 30 (6) ◽

pp. 451-458

Author(s):

Amy Petrinec ◽

Cindy Wilk ◽

Joel W. Hughes ◽

Melissa D. Zullo ◽

Yea-Jyh Chen ◽

...

Keyword(s):

Intensive Care ◽

Cognitive Behavioral Therapy ◽

Mobile Health ◽

Behavioral Therapy ◽

Family Members ◽

Intervention Group ◽

Cognitive Behavioral ◽

Control Group ◽

Icu Patients ◽

Post Intensive Care Syndrome

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

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Anxiety and depression symptoms in family members of icu patients

Avances en Enfermería ◽

10.15446/av.enferm.v33n1.48670 ◽

2015 ◽

Vol 33 (1) ◽

pp. 47-54 ◽

Cited By ~ 5

Author(s):

Maria Kourti ◽

Efstathia Christofilou ◽

George Kallergis

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Demographic Data ◽

Family Members ◽

Depression Scale ◽

Self Report ◽

Anxiety And Depression ◽

Depression Symptoms ◽

Hospital Anxiety ◽

Icu Patients

Objective: This study investigated symptoms of anxiety and depression in relatives of patients admitted in the Intensive Care Unit and determined whether these symptoms were associated to the seriousness of the patients’ condition.Metodology: A total of 102 patients’ relatives were surveyed during the study. They were given a self-report questionnaire in order to assess demographic data, anxiety and depression symptoms. The symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (hads). Patient’s condition was evaluated with a.p.a.ch.e ii Score.Results: More than 60% of patients’ relatives presented severe symptoms of anxiety and depression. No relation was found between symptoms of anxiety and depression of the relatives of patients and patients’ condition of health. On the contrary, these feelings used to exist regardless of the seriousness of patient’s condition.Conclusions: The assessment of these patients is recommended in order serious problems of anxiety and depression to be prevented.

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Admission of the very elderly to the intensive care unit: Family members’ perspectives on clinical decision-making from a multicenter cohort study

Palliative Medicine ◽

10.1177/0269216314566060 ◽

2015 ◽

Vol 29 (4) ◽

pp. 324-335 ◽

Cited By ~ 34

Author(s):

Daren K Heyland ◽

Peter Dodek ◽

Sangeeta Mehta ◽

Deborah Cook ◽

Allan Garland ◽

...

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Cohort Study ◽

Intensive Care ◽

Elderly Patients ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Decision Making ◽

Family Members ◽

Very Elderly

Background: Little is known about the perspectives and experiences of family members of very elderly patients who are admitted to the intensive care unit. Aim: To describe family members’ perspectives about care provided to very elderly critically ill patients. Design: Multicenter, prospective, cohort study. Participants and setting: In total, 535 family members of patients aged 80 years or older admitted to 22 intensive care units for more than 24 h. Results: Family members reported that the “patient be comfortable and suffer as little as possible” was their most important value and “the belief that life should be preserved at all costs” was their least important value considered in making treatment decisions. Most family members (57.9%) preferred that life support be used for their family member, whereas 24.1% preferred comfort measures only, and 14.4% were unsure of their treatment preferences. Only 57.3% reported that a doctor had talked to them about treatment options for the patient. Overall, 29.7% of patients received life-sustaining treatments for more than 7 days and 50.3% of these died in hospital. Families were most satisfied with the skill and competency of nurses and least satisfied with being included and supported in the decision-making process and with their sense of control over the patient’s care. Conclusion: There is incongruity between family values and preferences for end-of-life care and actual care received for very elderly patients who are admitted to the intensive care unit. Deficiencies in communication and decision-making may be associated with prolonged use of life-sustaining treatments in very elderly critically ill patients, many of whom ultimately die.

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