Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year
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.
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).
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).
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.
ClinicalTrials.gov identifier NCT02762409.
KeywordsCritical care Post-traumatic stress disorder Discomfort Tailored program Patient-reported outcome ICU
This research was financially supported by a grant from the Programme de Recherche sur la Performance du Système de Soins, 2015, PREPS-15-000183, funded by the French Ministry of Health. We thank all of the nursing staff members and doctors whose enthusiasm and work have made this clinical trial possible. We particularly thank Anderson Loundou (Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France) for participating in the statistical analysis; Bénédicte Mauchien (CH de Chartres) for her major and invaluable role in providing technical and educational support to all the investigators under the supervision of the lead investigator; and Claude Martin and Marc Leone (CHU Hôpital Nord, AP-HM) for participating in the steering committee. Members of the IPREA-AQVAR study group: Co-investigators and collaborators (alphabetically by institution, all in France) from Centre Hospitalier (CH) d’Auxerre: Karine Vie; Centre Hospitalier (CHU) de Brest: Gwenaëlle Lannuzel; CHU Dijon Bourgogne: Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, and Alicia Richard; CH de Douai: Benjamin Kowalski, and Elisa Klusek; CHU Raymond Poincaré, AP-HP: Andrea Polito, Caroline Duvallet, and Sonia Krim; Groupe Hospitalier de La Rochelle-Ré-Aunis: Nicolas Girard; CH de Chartres: Cécile Jourdain, and Stéphane Techer; CH Emile Roux, Le Puy-en-Velay: Corinne Chauvel, and Corinne Bruchet; CH de Lens: Johanna Temime, Stéphanie Beaussart, and Fabienne Jarosz; CHU Edouard Herriot, Hospices Civils de Lyon: Julien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, and Valérie Cerro; Hôpital Européen de Marseille: Déborah Levy; CHU Hôpital Nord, Assistance Publique Hôpitaux de Marseille: Sébastien Andre; Clinique Ambroise Paré, Neuilly/Seine: Philippe Estagnasie, Delphine Biet, and Steve Novak; CHU Nice: Jean-Christophe Orban, Aminata Diop, and Carole Ichai; CHU Cochin, AP-HP: Antoine Tesniere, Jean-Pascal Goupil, and Frédérique Laville; CHU Hôpital Européen Georges Pompidou, AP-HP: Nadège Rutter; Groupe Hospitalier Paris Saint-Joseph: Sandie Brochon, and Kelly Tiercelet; CHU Pitié-Salpêtrière, AP-HP: Nora Ait-Hamou, and Marjorie Leger; CHU Saint-Louis, AP-HP: Virginie Souppart; CHU La Milétrie, Poitiers: Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, and Sabrina Seguin; CHU Strasbourg: Caroline Wuiot, Karine Sanches, and Stéphane Hecketsweiler; Centre Hospitalier Intercommunal Toulon/La Seyne sur mer: Catherine Sylvestre-Marconville and Vincent Gardan; and CH de Troyes: Georges Simon and Yana Chaban.
Compliance with ethical standards
Conflicts of interest
Dr. Kalfon has received consulting fees from Philips Healthcare and General Electric Healthcare. On behalf of all remaining authors, the corresponding author states that the remaining authors have no conflict of interest.
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