Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year
Pierre Kalfon
(1, 2)
,
Marine Alessandrini
(2)
,
Mohamed Boucekine
(2)
,
Stéphanie Renoult
(3)
,
Marie-Agnès Geantot
(4)
,
Stéphanie Deparis-Dusautois
(5)
,
Audrey Berric
(6)
,
Olivier Collange
(7)
,
Bernard Floccard
(8)
,
Olivier Mimoz
(9, 10, 11)
,
Amour Julien
(12)
,
René Robert
(9)
,
Juliette Audibert
(1)
,
Anne Renault
(13)
,
Arnaud Follin
(14)
,
Didier Thevenin
(15)
,
Nathalie Revel
(16)
,
Marion Venot
(17)
,
René-Gilles Patrigeon
(18)
,
Thomas Signouret
(19)
,
Mélanie Fromentin
(20)
,
Tarek Sharshar
(21)
,
Coralie Vigne
(22)
,
Julien Pottecher
(23)
,
Quentin Levrat
(24)
,
Achille Sossou
(25)
,
Maïté Garrouste-Orgeas
(26)
,
Jean-Pierre Quenot
(27)
,
Claire Boulle
(28)
,
Élie Azoulay
(17)
,
Karine Baumstarck
(2)
,
Pascal Auquier
(2)
1
Hôpital Louis Pasteur [Chartres]
2 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
3 Hôpital Ambroise Paré [AP-HP]
4 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
5 Centre hospitalier de Troyes
6 Centre Hospitalier Intercommunal Toulon la Seyne sur mer
7 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
8 Hôpital Edouard Herriot [CHU - HCL]
9 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
10 PHAR [Poitiers] - Pharmacologie des anti-infectieux
11 UFR Santé [Poitiers] - Université de Poitiers – UFR Santé [Faculté de Médecine et de Pharmacie]
12 CHU Pitié-Salpêtrière [AP-HP]
13 CHU - BREST - Réa Med - CHRU Brest - Service de Réanimation Médicale
14 Service d'Anesthésie-Réanimation [CHU HEGP]
15 Centre Hospitalier de Lens
16 CHU - Hôpital Pasteur [Nice]
17 AP-HP - Hopital Saint-Louis [AP-HP]
18 CHA - Centre hospitalier d'Auxerre
19 HEM - Hôpital Européen de Marseille
20 Hôpital Cochin [AP-HP]
21 Service médical des soins intensifs [CHU Raymond Poincaré]
22 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
23 Hôpital de Hautepierre [Strasbourg]
24 Hopital Saint-Louis [La Rochelle]
25 Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay
26 Centre hospitalier Saint-Joseph [Paris]
27 Service de Réanimation Médicale (CHU de Dijon)
28 Centre Hospitalier [Douai, Nord]
2 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
3 Hôpital Ambroise Paré [AP-HP]
4 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
5 Centre hospitalier de Troyes
6 Centre Hospitalier Intercommunal Toulon la Seyne sur mer
7 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
8 Hôpital Edouard Herriot [CHU - HCL]
9 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
10 PHAR [Poitiers] - Pharmacologie des anti-infectieux
11 UFR Santé [Poitiers] - Université de Poitiers – UFR Santé [Faculté de Médecine et de Pharmacie]
12 CHU Pitié-Salpêtrière [AP-HP]
13 CHU - BREST - Réa Med - CHRU Brest - Service de Réanimation Médicale
14 Service d'Anesthésie-Réanimation [CHU HEGP]
15 Centre Hospitalier de Lens
16 CHU - Hôpital Pasteur [Nice]
17 AP-HP - Hopital Saint-Louis [AP-HP]
18 CHA - Centre hospitalier d'Auxerre
19 HEM - Hôpital Européen de Marseille
20 Hôpital Cochin [AP-HP]
21 Service médical des soins intensifs [CHU Raymond Poincaré]
22 Service Anesthésie et Réanimation [Hôpital Nord - APHM]
23 Hôpital de Hautepierre [Strasbourg]
24 Hopital Saint-Louis [La Rochelle]
25 Department of Anesthesiology and Critical Care Medicine, Emile-Roux general hospital, Le Puy-en-Velay
26 Centre hospitalier Saint-Joseph [Paris]
27 Service de Réanimation Médicale (CHU de Dijon)
28 Centre Hospitalier [Douai, Nord]
Olivier Mimoz
- Fonction : Auteur
- PersonId : 1162006
- ORCID : 0000-0003-1737-7915
- IdRef : 058753613
René Robert
- Fonction : Auteur
- PersonId : 920024
Julien Pottecher
- Fonction : Auteur
- PersonId : 769514
- ORCID : 0000-0001-6073-4354
- IdRef : 094477191
Jean-Pierre Quenot
- Fonction : Auteur
- PersonId : 998462
- ORCID : 0000-0003-2351-682X
- IdRef : 079287654
Élie Azoulay
- Fonction : Auteur
- PersonId : 1189025
- ORCID : 0000-0002-8162-1508
- IdRef : 066920515
Pascal Auquier
- Fonction : Auteur
- PersonId : 860193
Résumé
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.