Zusammenfassung
Hintergrund
Intensivtagebücher werden für Intensivpatienten geschrieben, um das Risiko für psychische Folgen wie posttraumatische Belastungsstörungen (PTBS), Angst und Depressionen zu senken. Die Autoren eines Cochrane-Reviews zu dieser Frage aus dem Jahr 2015 kamen zu dem Schluss, dass es zurzeit nur unzureichende Evidenz für den Einsatz von Intensivtagebüchern zur Senkung des Risikos von psychischen Folgen gibt.
Methode
Die Methodik des Cochrane-Reviews wurde mit der gleichen Suchstrategie wiederholt, aber unter Einschluss von Studien, die die psychischen Folgen des Intensivaufenthaltes auch mit anderen validierten Methoden untersucht haben. Primärer Outcomeparameter war eine PTBS bei Patienten oder Angehörigen mit Intensivtagebuch. Sekundäre Outcomeparameter waren Symptome einer Angst- bzw. depressiven Störung. Die Studienqualität wurde mit dem Cochrane Risk of Bias Assessment beurteilt.
Ergebnisse
Die erneute Suche führte zu 3179 Treffern, von denen 6 Studien mit 605 Patienten und 145 Angehörigen in die Metaanalysen eingeschlossen wurden. Die Evidenz der Studien ist gering bis gut. Die Metaanalysen zur PTBS ergaben a) bei Intensivpatienten (4 Studien, n = 569 Patienten) eine nichtsignifikante Reduktion (Odds-Ratio [OR] 0,58; 95 %-Konfidenzintervall [95 %-KI]: 0,24–1,42; p = 0,23), b) bei Angehörigen (2 Studien, n = 145 Angehörige) eine signifikante Reduktion (OR 0,17; 95 %-KI: 0,08–0,38; p < 0,0001). Für die Symptome von Angst und Depression bei Intensivpatienten (jeweils 2 Studien, n = 88 Patienten) lag eine signifikante Reduktion vor (OR 0,23, 95 %-KI: 0,07–0,77; p = 0,02, bzw. OR 0,27; 95 %-KI: 0,09–0,77, p = 0,01). Die Heterogenität lag zwischen 0 und 54 %.
Schlussfolgerungen
Intensivtagebücher können die Risiken für psychische Folgen nach einem Intensivaufenthalt bei Patienten und Angehörigen senken.
Abstract
Background
Diaries are written for patients on intensive care units (ICU) by clinicians and relatives to reduce the risk of psychological complications such as posttraumatic stress disorder (PTSD), anxiety, and depression. The authors of a Cochrane Review on this topic published in 2015, included studies with PTSD diagnoses based on interviews carried out by qualified personnel, and concluded that there is inadequate evidence to support the thesis that ICU diaries reduce the risk of psychological complications.
Methods
The present study replicated the design of the Cochrane Review with identical search algorithms, but included additional outcomes data from validated methods of diagnosing psychological complications that were not considered in the original Cochrane Review. The primary outcome was PTSD in patients or relatives with ICU diaries. Secondary outcomes were anxiety and/or depression symptoms. Study quality was evaluated using the Cochrane risk of bias assessment.
Results
The replicated search produced 3179 citations, of which there were 6 eligible studies from which 605 patients and 145 relatives could be included in the meta-analysis. Studies ratings ranged from low to good. The meta-analyses of the PTSD outcome demonstrated the following: (a) for ICU patients (4 studies, n = 569 patients) a non-significant reduction (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.24–1.42, p = 0.23), and (b) for relatives’ PTSD (2 studies, n = 145 relatives) a significant reduction (OR 0.17, 95%CI: 0.08–0.38, p < 0.0001). The symptoms anxiety and depression in ICU patients (2 studies each, n = 88 patients) were significantly reduced (OR 0.23, 95%CI: 0.07–0.77, p = 0.02; OR 0.27, 95%CI: 0.09–0.77, p = 0.01, respectively). Heterogeneity was between 0 and 54%.
Conclusion
ICU diaries may reduce the risk of psychological complications in patients and relatives after ICU stays.
Notes
Es sind stets Personen aller Geschlechter gemeint. Zur besseren Lesbarkeit wurde die männliche Form gewählt.
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Danksagung
Für die Hilfe bei der Literaturrecherche und weiteren Informationen bedanken sich die Autorinnen und Autoren bei L. Aitken, M. Benazzour, M.R. Blouw, M. Garrouste-Orgeas, C. Glimelius-Peterson, A. Højager Nielsen, C. Jones, F.S. Kundt, Dale M. Needham und K. Sundararajan.
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P. Nydahl, M. Fischill, T. Deffner, V. Neudeck und P. Heindl geben an, dass kein Interessenkonflikt besteht.
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Nydahl, P., Fischill, M., Deffner, T. et al. Intensivtagebücher senken Risiko für psychische Folgestörungen. Med Klin Intensivmed Notfmed 114, 68–76 (2019). https://doi.org/10.1007/s00063-018-0456-4
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DOI: https://doi.org/10.1007/s00063-018-0456-4