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Intensivtagebücher senken Risiko für psychische Folgestörungen

Systematische Literaturrecherche und Metaanalyse

Diaries for intensive care unit patients reduce the risk for psychological sequelae

Systematic literature review and meta-analysis

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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.

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Notes

  1. 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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Authors and Affiliations

  1. Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    P. Nydahl MScN

  2. Salzburg, Österreich

    M. Fischill MScN

  3. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland

    T. Deffner Dr. rer. nat.

  4. Salzburg, Österreich

    V. Neudeck MScN

  5. Internistischer Intensivbehandlungsbereich, Notfallmedizin und Intensivbehandlung für Brandverletzte, Allgemeines Krankenhaus der Stadt Wien, Medizinischer Universitätscampus, Wien, Österreich

    P. Heindl Dr. phil.

  6. Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Brunswiker Str. 10, 24105, Kiel, Deutschland

    P. Nydahl MScN

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  1. P. Nydahl MScN
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  3. T. Deffner Dr. rer. nat.
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  4. V. Neudeck MScN
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  5. P. Heindl Dr. phil.
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Correspondence to P. Nydahl MScN.

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Interessenkonflikt

P. Nydahl, M. Fischill, T. Deffner, V. Neudeck und P. Heindl geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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C. Hermes, Siegburg/Bonn

A. Kaltwasser, Reutlingen

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Das Electronic Suppelementary Material beinhaltet weitere Analysen mit anderen statistischen Modellen, die verwendeten Daten sowie eine PRISMA Checkliste

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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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