Konrad Fr Schmidt1, Daniel Schwarzkopf2, Laura-Mae Baldwin3, Frank M Brunkhorst4, Antje Freytag5, Christoph Heintze6, Konrad Reinhart7, Nico Schneider8, Michael von Korff9, Susanne Worrack2, Michel Wensing10, Jochen Gensichen11. 1. Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany. Electronic address: Konrad.Schmidt@charite.de. 2. Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany. 3. Department of Family Medicine, University of Washington School of Medicine, Seattle. 4. Center of Clinical Studies, Jena University Hospital, Germany. 5. Institute of General Practice and Family Medicine, Jena University Hospital, Germany. 6. Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany. 7. Center of Sepsis Control and Care, Jena University Hospital, Germany; Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Germany. 8. Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Germany. 9. Kaiser Permanente Washington Health Research Institute, Seattle. 10. Institute of Family Medicine and Health Services Research, Heidelberg University Hospital, Germany. 11. Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University, Munich, Germany.
Abstract
BACKGROUND:Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare. METHODS: This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews. RESULTS:One hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups. CONCLUSIONS: Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
RCT Entities:
BACKGROUND:Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare. METHODS: This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews. RESULTS: One hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups. CONCLUSIONS: Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
Authors: Konrad F R Schmidt; Katharina Huelle; Thomas Reinhold; Hallie C Prescott; Rebekka Gehringer; Michael Hartmann; Thomas Lehmann; Friederike Mueller; Konrad Reinhart; Nico Schneider; Maya J Schroevers; Robert P Kosilek; Horst C Vollmar; Christoph Heintze; Jochen S Gensichen Journal: J Clin Med Date: 2022-02-21 Impact factor: 4.241
Authors: A Bautista Hernández; E de Vega-Ríos; J Serrano Ballesteros; D Useros Braña; L Cardeñoso Domingo; A Figuerola Tejerina; D Jiménez Jiménez; I de Los Santos Gil; C Sáez Béjar Journal: Rev Esp Quimioter Date: 2022-01-31 Impact factor: 1.553
Authors: Zudin A Puthucheary; Jochen S Gensichen; Aylin S Cakiroglu; Richard Cashmore; Lara Edbrooke; Christoph Heintze; Konrad Neumann; Tobias Wollersheim; Linda Denehy; Konrad F R Schmidt Journal: Crit Care Date: 2020-09-25 Impact factor: 9.097