Choi JiYeon, Hoffman Leslie A, Schulz Richard, Tate Judith A, Donahoe Michael P, Ren Dianxu, Given Barbara A, Sherwood Paula R
Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.
Department of Acute & Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Pain Symptom Manage. 2014 Feb;47(2):257-70. doi: 10.1016/j.jpainsymman.2013.03.019. Epub 2013 Jul 12.
Survivors of critical illness must overcome persistent physical and psychological challenges. Few studies have longitudinally examined self-reported physical symptoms in intensive care unit (ICU) survivors.
To describe prevalence and severity of self-reported symptoms in 28 adult medical ICU survivors during the first four months post-ICU discharge and their associations with family caregiver responses.
Patients completed the Modified Given Symptom Assessment Scale. Caregivers completed the Shortened 10-item Center for Epidemiologic Studies Depression Scale, Brief Zarit Burden Score, Pittsburgh Sleep Quality Index, and the Caregiver Health Behavior form. Data at ICU discharge (two weeks or less), and two and four months post-ICU discharge were analyzed.
Across the time points, most patients reported one or more symptoms (88.5-97%), with sleep disturbance, fatigue, weakness, and pain the most prevalent. For these four symptoms with the highest prevalence, there were: 1) moderate correlations among symptom severity at two and four months post-ICU discharge; and 2) no difference in prevalence or severity by patients' disposition (home vs. institution), except worse fatigue in patients at home at two weeks or less post-ICU discharge. Patients' overall symptom burden showed significant correlation with caregivers' depressive symptoms two weeks or less post-ICU discharge. There were trends of moderate correlations between patients' overall symptom burden and caregivers' health risk behaviors and sleep quality at two and four months post-ICU discharge.
In our sample, sleep disturbance, fatigue, weakness, and pain were the four key symptoms during first four months post-ICU discharge. Future studies focusing on these four symptoms are necessary to promote quality in post-ICU symptom management.
危重症幸存者必须克服持续存在的身体和心理挑战。很少有研究对重症监护病房(ICU)幸存者自我报告的身体症状进行纵向研究。
描述28名成年医学ICU幸存者在ICU出院后的前四个月自我报告症状的患病率和严重程度,以及这些症状与家庭照顾者反应之间的关联。
患者完成改良的给定症状评估量表。照顾者完成简版10项流行病学研究中心抑郁量表、简短的扎里特负担量表、匹兹堡睡眠质量指数和照顾者健康行为表格。分析了ICU出院时(两周或更短时间)、ICU出院后两个月和四个月的数据。
在各个时间点,大多数患者报告了一种或多种症状(88.5 - 97%),其中睡眠障碍、疲劳、虚弱和疼痛最为普遍。对于这四种患病率最高的症状,有:1)ICU出院后两个月和四个月时症状严重程度之间存在中度相关性;2)患者的安置情况(回家与住院机构)在患病率或严重程度上没有差异,只是在ICU出院后两周或更短时间回家的患者疲劳情况更严重。患者的总体症状负担在ICU出院后两周或更短时间与照顾者的抑郁症状显著相关。在ICU出院后两个月和四个月时,患者的总体症状负担与照顾者的健康风险行为和睡眠质量之间存在中度相关的趋势。
在我们的样本中,睡眠障碍、疲劳、虚弱和疼痛是ICU出院后前四个月的四个关键症状。未来有必要针对这四种症状进行研究,以提高ICU后症状管理的质量。