Preventing Posttraumatic Stress in ICU Survivors: A Single-Center Pilot Randomized Controlled Trial of ICU Diaries and Psychoeducation.

Abstract

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.

• Authors: Maia S Kredentser, Marcus Blouw, Nicole Marten, Jitender Sareen, O Joseph Bienvenu, Jennifer Ryu, Brooke E Beatie, Sarvesh Logsetty, Lesley A Graff, Shauna Eggertson, Sophia Sweatman, Braeden Debroni, Nina Cianflone, Rakesh C Arora, Ryan Zarychanski, Kendiss Olafson
• Journal: Critical care medicine (Crit Care Med) Vol. 46 Issue 12 Pg. 1914-1922 (12 2018) ISSN: 1530-0293 [Electronic] United States
• PMID: 30119073 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Anxiety (prevention & control)
• Canada
• Critical Illness (psychology)
• Depression (prevention & control)
• Family (psychology)
• Female
• Humans
• Intensive Care Units (organization & administration)
• Male
• Mental Health
• Middle Aged
• Patient Education as Topic (methods)
• Pilot Projects
• Psychotherapy (methods)
• Respiration, Artificial (psychology)
• Self-Management (education)
• Stress Disorders, Post-Traumatic (prevention & control)
• Survivors (psychology)
• Time Factors