Pierre Kalfon1,2, Marine Alessandrini3, Mohamed Boucekine3, Stéphanie Renoult4, Marie-Agnès Geantot5, Stéphanie Deparis-Dusautois6, Audrey Berric7, Olivier Collange8, Bernard Floccard9, Olivier Mimoz10, Amour Julien11, René Robert12, Juliette Audibert13, Anne Renault14, Arnaud Follin15, Didier Thevenin16, Nathalie Revel17, Marion Venot18, René-Gilles Patrigeon19, Thomas Signouret20, Mélanie Fromentin21, Tarek Sharshar22, Coralie Vigne23, Julien Pottecher24, Quentin Levrat25, Achille Sossou26, Maïté Garrouste-Orgeas27, Jean-Pierre Quenot28, Claire Boulle29, Elie Azoulay18, Karine Baumstarck3, Pascal Auquier3. 1. Réanimation Polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, 28018, Le Coudray, France. pkalfon@ch-chartres.fr. 2. Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France. pkalfon@ch-chartres.fr. 3. Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France. 4. Réanimation, Clinique Ambroise Paré, Neuilly/Seine, France. 5. Département d'Anesthésie Réanimation, CHU Dijon Bourgogne, Dijon, France. 6. Réanimation, CH Troyes, Troyes, France. 7. Réanimation polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne sur mer, Toulon, France. 8. Réanimation chirurgicale polyvalente, Hôpital Civil, CHU Strasbourg, Strasbourg, France. 9. Réanimation polyvalente, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 10. Réanimation chirurgicale, CHU La Milétrie, Poitiers, France. 11. Réanimation de chirurgie cardiaque, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 12. Réanimation médicale, CHU La Milétrie, Poitiers, France. 13. Réanimation Polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, 28018, Le Coudray, France. 14. Réanimation médicale, CHU Brest, Brest, France. 15. Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, AP-HP, Paris, France. 16. Réanimation, CH Lens, Lens, France. 17. Réanimation Médico-Chirurgicale, Hôpital Pasteur, CHU Nice, Nice, France. 18. Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France. 19. Réanimation, CH Auxerre, Auxerre, France. 20. Réanimation, Hôpital Européen de Marseille, Marseille, France. 21. Réanimation chirurgicale, CHU Cochin, AP-HP, Paris, France. 22. Réanimation médicale adulte, CHU Raymond Poincaré, AP-HP, Paris, France. 23. Réanimation chirurgicale, CHU Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Marseille, France. 24. Réanimation chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France. 25. Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France. 26. Réanimation, CH Émile Roux, Le Puy-En-Velay, France. 27. Médecine intensive et réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France. 28. Réanimation médicale, CHU Dijon Bourgogne, Dijon, France. 29. Réanimation, CH Douai, Douai, France.
Abstract
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. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02762409.
RCT Entities:
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 illpatients. 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. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02762409.
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