Tramm Ralph, Hodgson Carol, Ilic Dragan, Sheldrake Jayne, Pellegrino Vincent
Monash University, Department of Epidemiology and Preventive Medicine (DEPM), Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Australia.
Monash University, Department of Epidemiology and Preventive Medicine (DEPM), Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Australia; The Alfred Hospital, Department of Physiotherapy, Australia.
Aust Crit Care. 2015 Feb;28(1):31-6. doi: 10.1016/j.aucc.2014.04.005. Epub 2014 May 17.
Extracorporeal membrane oxygenation (ECMO) is one of the most invasive rescue therapies for acute heart and/or lung failure. Survivors have high rates of adverse mental health outcomes, such as post-traumatic stress symptoms (PTSS) and manifest post-traumatic stress disorder (PTSD). Yet no study to date has identified and explored PTSD risk factors in these patients.
The primary aim of this study was to determine and explore post-traumatic stress risk factors for patients treated with ECMO. It also aimed to provide a baseline profile for future hypothesis testing with respect to risk factor exposure, level of exposure and post-traumatic stress outcomes in these patients.
Retrospective cohort study.
The study was conducted at the Alfred Hospital Melbourne, Australia.
Patients were selected in 2012 from an Intensive Care Unit (ICU) registry that prospectively included all patients admitted to ICU and treated with ECMO.
Data were extracted from the ICU ECMO registry, ICU and ward charts, progress notes, referrals, drug charts and discharge letters. Data were descriptively analysed.
Patients treated with ECMO are exposed to almost all investigated PTSD risk factors. These included psychiatric history (psychiatric comorbidities), admission to ICU and treatment (prolonged ventilation during prolonged ICU stay), and drug therapy (all patients treated with PTSD risk related drugs).
ECMO patients are exposed to PTSD risk factors such as young age, mechanical ventilation, drug administration, delirium and agitation. Younger age, heterogeneous conditions, profound illness severity and prolonged ICU stay describe the case complexity of patients and may explain these findings. Patients in ICU are increasingly conscious during active treatment and this may have positive or negative psychological effects. "Awake" ECMO in which patients are conscious while on active life support may represent a unique PTSD risk factor in this perspective.
体外膜肺氧合（ECMO）是治疗急性心肺功能衰竭最具侵入性的抢救疗法之一。幸存者出现创伤后应激症状（PTSS）和明显创伤后应激障碍（PTSD）等不良心理健康后果的比例很高。然而，迄今为止尚无研究确定并探究这些患者的PTSD危险因素。
本研究的主要目的是确定并探究接受ECMO治疗患者的创伤后应激危险因素。其还旨在为这些患者未来关于危险因素暴露、暴露水平和创伤后应激结果的假设检验提供基线概况。
回顾性队列研究。
该研究在澳大利亚墨尔本阿尔弗雷德医院进行。
2012年从重症监护病房（ICU）登记册中选取患者，该登记册前瞻性纳入了所有入住ICU并接受ECMO治疗的患者。
数据从ICU的ECMO登记册、ICU和病房图表、病程记录、转诊记录、药物图表及出院小结中提取。进行描述性分析。
接受ECMO治疗的患者几乎暴露于所有研究的PTSD危险因素。这些因素包括精神病史（精神共病）、入住ICU及治疗（在ICU长期停留期间长时间机械通气）以及药物治疗（所有接受与PTSD风险相关药物治疗的患者）。
ECMO患者暴露于PTSD危险因素，如年轻、机械通气、药物使用、谵妄和躁动。年龄较小、病情各异、疾病严重程度高及ICU停留时间长描述了患者的病例复杂性，可能解释了这些发现。ICU患者在积极治疗期间意识越来越清醒，这可能产生积极或消极的心理影响。从这个角度来看，患者在接受积极生命支持时保持清醒的“清醒”ECMO可能代表一种独特的PTSD危险因素。
