Stress Disorders Following Prolonged Critical Illness in Survivors of Severe Sepsis

Wintermann, Gloria‐Beatrice; Brunkhorst, Frank M.; Petrowski, Katja; Strauß, Bernhard; Oehmichen, Frank; Pohl, Marcus; Rosendahl, Jenny

doi:10.1097/ccm.0000000000000936

Cited by 86 publications

(73 citation statements)

References 33 publications

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“…Jones et al [6] did not find any association between the family members' posttraumatic stress and demographic characteristics related to the patient's ICU stay which confirms our findings. Above, sepsis has not been consistently elucidated as significant risk factor for post-ICU psychological morbidity in patients and their family members [17,[49][50][51]. The present findings confirm lower HRQL in women and participants of older age.…”

Section: Discussionsupporting

confidence: 79%

“…Patients and the patients' family members were enrolled and interviewed (up to 6 months following transfer to postacute rehabilitation) if both gave oral informed consent on the telephone. For the present study, a subsample of the already published sample of chronically critically ill patients with data available of their close family members was used [17].…”

Section: Participants and Sample Sizementioning

confidence: 99%

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Predictors of Posttraumatic Stress and Quality of Life in Family Members of Chronically Critically ill Patients After Intensive Care

Wintermann

Weidner

Strauß

et al. 2016

Journal of Psychosomatic Research

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Background: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient-and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients. Methods:In a cross-sectional design nested within a prospective longitudinal cohort study, posttraumatic stress symptoms and quality of life were assessed in family members of CCI patients (n = 83, aged between 18 and 72 years) up to 6 months after transfer from ICU at acute care hospital to post-acute rehabilitation. Patients admitted a large rehabilitation hospital for ventilator weaning. The Posttraumatic Stress Scale-10 and the Euro-Quality of life-5D-3L were applied in both patients and their family members via telephone interview.Results: A significant proportion of CCI patients and their family members (14.5 and 15.7 %, respectively) showed clinically relevant scores of posttraumatic stress. Both CCI patients and family members reported poorer HRQL than a normative sample. Factors independently associated with posttraumatic stress in family members were the time following ICU discharge (β = .256, 95 % confidence interval .053-.470) and the patients' diagnosis of PTSD (β = .264, 95 % confidence interval .045-.453). Perceived satisfaction with the relationship turned out to be a protective factor for posttraumatic stress in family members of CCI patients (β = −.231, 95 % confidence interval −.423 to −.015). Regarding HRQL in family members, patients' acute posttraumatic stress at ICU (β = −.290, 95 % confidence interval −.360 to −.088) and their own posttraumatic stress 3 to 6 months post-transfer (β = −.622, 95 % confidence interval −.640 to −.358) turned out to be significant predictors. Conclusions:Posttraumatic stress and HRQL should be routinely assessed in family members of CCI patients at regular intervals starting early at ICU. Preventive family-centered interventions are needed to improve posttraumatic stress and HRQL in both patients and their family members.

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Section: Discussionsupporting

confidence: 79%

Section: Participants and Sample Sizementioning

confidence: 99%

Predictors of Posttraumatic Stress and Quality of Life in Family Members of Chronically Critically ill Patients After Intensive Care

Wintermann

Weidner

Strauß

et al. 2016

Journal of Psychosomatic Research

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“…There are conflicting data on emotional impairment with some studies suggesting increased rates of psychiatric diagnoses [149] and others suggesting little change in rates of self-reported depressive symptoms [150] albeit with elevated pre-sepsis symptom burden. Multiple cohorts describe a clear high burden of psychological problems among survivors, including anxiety and post-traumatic stress disorder, regardless of whether it is pre-existing, unmasked, or truly caused by the sepsis or other critical illness [151][152][153][154]. These data are indirect, however, as they come from non-septic critically ill patients or exclusively elderly septic patients.…”

Section: Post-icumentioning

confidence: 87%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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“…Around 50% of patients who had ARDS have not returned to work 1 year after discharge (9). Less than 10% of patients on mechanical ventilation for over 4 days are alive and independent 1 year later (1)(2)(3)(4)(5).…”

Section: Increasing Awareness Of Picsmentioning

confidence: 98%

“…Psychologic consequences include symptoms of depression, anxiety, and sleep disturbances, which can last from months to years (1,3). A total of 10-50% of patients have symptoms of posttraumatic stress disorder (PTSD), which can persist for 8 years (1,4,6).…”

Section: Increasing Awareness Of Picsmentioning

confidence: 99%

Postintensive Care Syndrome

Harvey

Davidson

2016

Critical Care Medicine

190

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Stress Disorders Following Prolonged Critical Illness in Survivors of Severe Sepsis

Abstract: A regular screening of post-ICU patients after discharge from hospital should be an integral part of aftercare management. The underlying mechanisms of severe sepsis in the development of posttraumatic stress disorder need further examination.

Cited by 86 publications

References 33 publications

Predictors of Posttraumatic Stress and Quality of Life in Family Members of Chronically Critically ill Patients After Intensive Care

Predictors of Posttraumatic Stress and Quality of Life in Family Members of Chronically Critically ill Patients After Intensive Care

Surviving sepsis campaign: research priorities for sepsis and septic shock

Postintensive Care Syndrome

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