Journal
CRITICAL CARE MEDICINE
Volume 46, Issue 12, Pages 1914-1922Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/CCM.0000000000003367
Keywords
anxiety; depression; intensive care; intensive care unit diaries; postintensive care syndrome; posttraumatic stress disorder
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Funding
- Manitoba Medical Service Foundation [8-2014-07]
- Canadian Institutes of Health Research Foundation [333252]
- Canadian Institutes of Health Research
- University of Manitoba Centre on Aging and Wu Scholarship
- Manitoba Medical Services Foundation
- Social Sciences and Humanities Research Council of Canada
- University of Manitoba Centre on Aging
- University of Manitoba
- Pfizer Canada Inc
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Objectives: Critical illness can have a significant psychological impact on patients and their families. To inform the design of a larger trial, we assessed feasibility of ICU diaries and psychoeducation to prevent posttraumatic stress disorder, depression, and anxiety following ICU stays. Design: Four-arm pilot randomized controlled trial. Setting: A 10-bed tertiary ICU in Winnipeg, MB, Canada. Patients: Critically ill patients greater than 17 years old with predicted ICU stays greater than 72 hours and mechanical ventilation duration greater than 24 hours. Interventions: Patients were randomized to usual care, ICU diary, psychoeducation, or both ICU diary and psychoeducation. Measurements and Main Results: Our primary objective was to determine feasibility measured by enrollment/mo. Secondary outcomes included acceptability of the ICU diary intervention and psychological distress, including patients' memories 1 week post ICU using the ICU Memory Tool, posttraumatic stress disorder (Impact of Events Scale-Revised), depression, and anxiety symptoms (Hospital Anxiety and Depression Scale) 30 and 90 days post ICU. Over 3.5 years, we enrolled 58 patients, an average of 1.9 participants/mo. Families and healthcare providers wrote a mean of 3.2 diary entries/d (sd, 2.9) and indicated positive attitudes and low perceived burden toward ICU diary participation. A majority of patients reported distressing memories of their ICU stay. Those who received the diary intervention had significantly lower median Hospital Anxiety and Depression Scale anxiety (3.0 [interquartile range, 2-6.25] vs 8.0 [interquartile range, 7-10]; p = 0.01) and depression (3.0 [interquartile range, 1.75-5.25] vs 5.0 [interquartile range, 4-9]; p = 0.04) symptom scores at 90 days than patients who did not receive a diary. Conclusions: ICU diaries are a feasible intervention in a tertiary Canadian ICU context. Preliminary evidence supports the efficacy of ICU diaries to reduce psychological morbidity following discharge.
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