Blair Wendlandt1, Casey Olm-Shipman2, Agathe Ceppe3, Catherine L Hough4, Douglas B White5, Christopher E Cox6, Shannon S Carson3. 1. Division of Pulmonary Diseases and Critical Care Medicine (B.W., A.C., S.S.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. Electronic address: blair.wendlandt@unchealth.unc.edu. 2. Division of Neurocritical Care (C.O.-S.), Departments of Neurology and Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 3. Division of Pulmonary Diseases and Critical Care Medicine (B.W., A.C., S.S.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. 4. Department of Critical Care Medicine (D.B.W.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 5. Division of Pulmonary, Allergy, and Critical Care Medicine (C.E.C.), Department of Medicine, Duke University, Durham, North Carolina, USA. 6. Division of Pulmonary and Critical Care (C.L.H.), Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Abstract
CONTEXT: Severe Acute Brain Injury (SABI) is neurologically devastating, and surrogates for these patients may struggle with particularly complex decisions due to substantial prognostic uncertainty. OBJECTIVES: To compare anxiety and depression symptoms over time between SABI surrogates and non-SABI surrogates for patients requiring prolonged mechanical ventilation (PMV). METHODS: We conducted a secondary analysis of the data from a multicenter randomized trial of a decision aid intervention for surrogates of adults experiencing PMV. Eligible patients were enrolled from medical, surgical, trauma, cardiac, and neurologic intensive care units (ICUs). ICU admitting diagnoses were used to identify patients experiencing SABI. We compared anxiety and depression symptoms as measured by the Hospital Anxiety and Depression Scale score 6 months after trial enrollment between surrogates of patients with SABI and surrogates of patients experiencing PMV for other reasons. RESULTS: Our analysis included 206 patients, 60 (29%) with SABI and 146 (71%) without SABI, and their primary surrogate decision makers. After adjusting for potential confounders including surrogate demographics, surrogate financial distress, patient severity of illness baseline GCS, and patient health status at 6 months, we found that surrogates of patients experiencing SABI had higher symptoms of anxiety and depression than surrogates of non-SABI patients (adjusted mean difference 3.6, 95% CI 1.2-6.0). CONCLUSION: Surrogates of PMV patients with SABI experience persistently elevated anxiety and depression symptoms over 6 months compared to surrogates of PMV patients without SABI. Further work is needed to understand contributors to prolonged distress in this higher risk population.
CONTEXT: Severe Acute Brain Injury (SABI) is neurologically devastating, and surrogates for these patients may struggle with particularly complex decisions due to substantial prognostic uncertainty. OBJECTIVES: To compare anxiety and depression symptoms over time between SABI surrogates and non-SABI surrogates for patients requiring prolonged mechanical ventilation (PMV). METHODS: We conducted a secondary analysis of the data from a multicenter randomized trial of a decision aid intervention for surrogates of adults experiencing PMV. Eligible patients were enrolled from medical, surgical, trauma, cardiac, and neurologic intensive care units (ICUs). ICU admitting diagnoses were used to identify patients experiencing SABI. We compared anxiety and depression symptoms as measured by the Hospital Anxiety and Depression Scale score 6 months after trial enrollment between surrogates of patients with SABI and surrogates of patients experiencing PMV for other reasons. RESULTS: Our analysis included 206 patients, 60 (29%) with SABI and 146 (71%) without SABI, and their primary surrogate decision makers. After adjusting for potential confounders including surrogate demographics, surrogate financial distress, patient severity of illness baseline GCS, and patient health status at 6 months, we found that surrogates of patients experiencing SABI had higher symptoms of anxiety and depression than surrogates of non-SABI patients (adjusted mean difference 3.6, 95% CI 1.2-6.0). CONCLUSION: Surrogates of PMV patients with SABI experience persistently elevated anxiety and depression symptoms over 6 months compared to surrogates of PMV patients without SABI. Further work is needed to understand contributors to prolonged distress in this higher risk population.
Authors: Johannes Textor; Benito van der Zander; Mark S Gilthorpe; Maciej Liskiewicz; George Th Ellison Journal: Int J Epidemiol Date: 2016-12-01 Impact factor: 7.196
Authors: Kitty S Chan; Lisa Aronson Friedman; O Joseph Bienvenu; Victor D Dinglas; Brian H Cuthbertson; Richard Porter; Christina Jones; Ramona O Hopkins; Dale M Needham Journal: Gen Hosp Psychiatry Date: 2016-07-12 Impact factor: 3.238
Authors: Jill I Cameron; Leslie M Chu; Andrea Matte; George Tomlinson; Linda Chan; Claire Thomas; Jan O Friedrich; Sangeeta Mehta; Francois Lamontagne; Melanie Levasseur; Niall D Ferguson; Neill K J Adhikari; Jill C Rudkowski; Hilary Meggison; Yoanna Skrobik; John Flannery; Mark Bayley; Jane Batt; Claudia dos Santos; Susan E Abbey; Adrienne Tan; Vincent Lo; Sunita Mathur; Matteo Parotto; Denise Morris; Linda Flockhart; Eddy Fan; Christie M Lee; M Elizabeth Wilcox; Najib Ayas; Karen Choong; Robert Fowler; Damon C Scales; Tasnim Sinuff; Brian H Cuthbertson; Louise Rose; Priscila Robles; Stacey Burns; Marcelo Cypel; Lianne Singer; Cecilia Chaparro; Chung-Wai Chow; Shaf Keshavjee; Laurent Brochard; Paul Hébert; Arthur S Slutsky; John C Marshall; Deborah Cook; Margaret S Herridge Journal: N Engl J Med Date: 2016-05-12 Impact factor: 91.245
Authors: Claire J Creutzfeldt; Marina G Hanna; C Sherry Cheever; Abhijit V Lele; Charles Spiekerman; Ruth A Engelberg; J Randall Curtis Journal: Neurocrit Care Date: 2017-10 Impact factor: 3.210