Post-intensive Care Syndrome In Mechanically Ventilated Survivors And Their Family Members In Guangzhou

The rapid development of intensive care medicine has improved short-term outcomes and survival rates for critical patients,and the number of mechanically ventilated survivors has increased year by year.Survivors have encountered with cognitive,physical,or psychological dysfunction caused by critical illness and treatment experience in the intensive care unit,which seriously affected quality of life.Meanwhile,family members have also suffered from both physical and psychological stress.In our country,the primary goal of treatment in the intensive care unit was to save lives,while the research on long-term outcomes for mechanically ventilated survivors and their family members has been neglected in the past decades.Objective1.To describe the long-term outcomes of mechanically ventilated survivors,and investigate the views of survivors on the ICU rehabilitation clinic.2.To analyze the occurrence,the change trend with time and the influencing factors of post-intensive care syndrome(PICS)in mechanically ventilated survivors.3.To analyze the occurrence,the change trend with time and the influencing factors of post-intensive care syndrome family(PICS-F)in family members of mechanically ventilated survivors.Methods1.A single-center cross-sectional descriptive study was designed.Mechanically ventilated survivors admitted to the First Affiliated Hospital of Guangzhou University from January to December 2016 were recruited for the research.The follow-up study was conducted from August 2017 to March 2018.The Activity of Dailying Living Scale(ADL),the Impact of Event Scale-Revised(IES-R),and the Medical Outcomes Study36-Item Short Form Health Survey(SF-36)were used to evaluate the activities of daily living,the post-traumatic stress disorder(PTSD),and the quality of life(QOL)respectively.The statistical analyses were done with SPSS,version 25.0.2.A multicenter longitudinal descriptive study was conducted.Mechanically ventilated survivors admitted to ICU of three university affiliated hospitals in Guangzhou from May2018 to January 2019 were selected as research objects.Demographic features,previous health status data and disease treatment data were collected within 48 hours after discharged from the ICU.The activities of daily living,sleep quality,PTSD Symptoms,depressive symptoms,and the QOL were evaluated through the ADL,the Pittsburg Sleep Quality Index(PSQI),the IES-R,and the Beck Depression Inventory(BDI-Ⅱ),and the SF-36 respectively.SPSS 25.0 statistical software was used for data analysis.The general linear mixed effect model was adopted to analyze the changing trend and influencing factors of PICS in different periods.3.A multicenter longitudinal descriptive study was conducted.The family members of mechanically ventilated survivors of three university affiliated hospitals in Guangzhou from May 2018 to January 2019 were recruited for the research.Demographic features were collected in the first week after discharge from the ICU.Using Perceived social support scale(PSSS)、Zarit Caregiver Burden Interview(ZBI),PQSI,IES-R,Center for Epidemiological Survey,Depression Scale(CES-D),and the SF-36 to evaluate the family members’social support,care burden,sleep quality,PTSD symptoms,depressive symptoms,and quality of life.Assessment of these items was obtained by telephone follow-up one month and three months after ICU discharge.The statistical analyses were done with SPSS,version 25.0.The general linear mixed effect model was adopted to analyze the changing trend and influencing factors of PICS-F for family members in different periods.Results1.Investigation of the long-term outcomes in mechanically ventilated survivors.(1)A total of 248 ICU survivors were included in the study,130 of them were successfully followed up.Up to the follow-up date,only 45.1%of the employees had returned to work.(2)Our investigation indicated that,29.2%of the survivors had obvious dysfunction in activities of daily living,and 17.7%of the survivors had symptoms consistent with PTSD.The score of SF-36-Physical Component Summary(PCS)(61.12±17.09)was lower than Mental Component Summary(MCS)(65.97±21.85).(3)Multiple linear regression analysis results showed that,the diagnosis,APACHEⅡscore,age,PTSD symptoms were associated with activities of daily living(F=10.346,P<0.01,adjusted R~2=0.372),the length of stay in the ICU and ADL were the influencing factors of PTSD(F=9.654,P<0.01,adjusted R~2=0.118),the ADL and PTSD were the influence factors of QOL(PCS:F=21.507,P<0.01,adjusted R~2=0.527;MCS:F=18.171,P<0.01,adjusted R~2=0.482).(4)68.5%of the subjects considered it very helpful or helpful to set up an ICU clinic.2.Longitudinal study of post-intensive care syndrome in mechanically ventilated survivors in different periods.(1)73 ICU survivors were included,63 of them completed all the follow-ups,with 13.7%lost to follow-up.(2)Between 7 days to 3 months after ICU discharge,the total scores of ADL decreased over time.At 3 months after ICU,52.4%of the survivors had obvious dysfunction in activities of daily living.The incidence of sleep disorders was 73.9%at 1 month after ICU discharge and 66.7%at 3 months.The total scores of IES-R and BDI-Ⅱdecreased significantly over time.The PTSD positive rate were 29.0%(1 month)and 7.9%(3months),respectively.The positive rates of depression were 49.3%(7 days),31.9%(1 month)and 25.4%(3 months),respectively.The PCS score and MCS score of the SF-36 increased significantly over time.(3)General linear mixed effects model results showed that,under the control of other factors,length of mechanical ventilation,length of hospital stay and ICU admission diagnosis were impact factors of ADL;educational level,special treatment during ICU admission,social support(?=-0.16,P<0.001)were impact factors of sleep quality;educational level,length of mechanical ventilation,dose of corticosteroids and social support(?=-0.45,P<0.01)were impact factors of PTSD symptoms;special treatment during ICU admission,length of hospital stay,social support(?=-0.51,P<0.01)were impact factors of depression;length of hospital stay,the use of vasoactive drugs were associated with quality of life;the worse the activities of daily living,the worse the quality of life(PCS:?=-0.94,P<0.01;MCS:?=-0.43,P<0.01);the poorer the quality of sleep,the worse the PCS(?=-0.90,P<0.01);the more the depression symptoms,the worse the quality of life(PCS:?=-0.79,P<0.001;MCS:?=-1.82,P<0.001);higher levels of social support were associated with better MCS(?=0.76,P<0.01).3.Longitudinal study of post-intensive care syndrome in family members in different periods.(1)75 family members were included,64 of them completed all the follow-ups,with 13.3%lost to follow-up.(2)The incidence of sleep disorders was 25.3%at 7 days after ICU discharge.The total score of PSQI decreased significantly over time.The scores of IES-R decreased significantly over time.The PTSD positive rate were 32.9%(1 month)and 18.8%(3months),respectively.The positive rates of depression(total score of CES-D≥16)were 53.5%(7 days),30.0%(1 month)and 23.4%(3 months),respectively.PCS score of SF-36 was remained stable over time,while MCS score was increased significantly over time.(3)General linear mixed effects model results showed that,under the control of other factors,age,social support(?=-0.08,P<0.01),caregiver burden(?=0.09,P<0.01)were associated with sleep quality;survivors’length of hospital stay,social support(?=-0.64,P<0.01),caregiver burden(?=0.35,P<0.01)were associated with PTSD;social support(?=-0.61,P<0.01),caregiver burden(?=0.38,P<0.01)were associated with depression;survivors’age,family members’sex,depression symptoms(?=-0.54,P<0.05)were associated with PCS,while caregiver burden(?=-0.34,P<0.01),sleep quality(?=-1.21,P<0.01),PTSD symptoms(?=-0.20,P<0.01),depression symptoms(?=-1.34,P<0.01)were assocaited with MCS.Conclusions1.The long-term outcomes of mechanically ventilated survivors was not optimistic.The incidence of ADL dysfunction was 29.2%,and the positive rate of PTSD symptoms was17.7%.Older age,higher APACHEⅡscore and a AECOPD diagnosis were fators associated with impaired activities of daily living;the longer the length of ICU stay,the higer the PTSD symptoms;the physcial health and mental health affected each other.Most of the survivors thought that the establishment of ICU clinics was beneficial.2.Survivors had different levels of physical health and mental health from the 7 days to3months.More attention should be paid to those with prolonged mechanical ventilation,longer length of hospital stay,a diagnosis of AECOPD,special treatment and use of vasoactive drugs.Meanwhile,medical staff should strive to improve survivors’social support in order to improve their outcomes.3.Mechanically ventilated survivors were not the only group affected by ICU experience.From 7 days to 3 months after ICU discharge,the incidence of sleep quality,PTSD symptoms,and depressive symptoms varied among the family members at different stages.More attention should be paid to family members of survivors aged more than 60ys and prolonged hospital stay,as well as to female and elderly family members.What’s more,we should help family members make full use of social resources and reduce the stress of care,thus improving their health status.