Bienvenu O Joseph, Colantuoni Elizabeth, Mendez-Tellez Pedro A, Shanholtz Carl, Dennison-Himmelfarb Cheryl R, Pronovost Peter J, Needham Dale M
1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. 2Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD. 3Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 4Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 5Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 6Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. 7Johns Hopkins University School of Nursing, Baltimore, MD. 8Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. 9Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 10Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
Crit Care Med. 2015 Mar;43(3):642-53. doi: 10.1097/CCM.0000000000000752.
To evaluate the cooccurrence, and predictors of remission, of general anxiety, depression, and posttraumatic stress disorder symptoms during 2-year follow-up in survivors of acute lung injury treated in an ICU.
Prospective cohort study, with follow-up at 3, 6, 12, and 24 months post-acute lung injury.
Thirteen medical and surgical ICUs in four hospitals.
Survivors among 520 patients with acute lung injury.
The outcomes of interest were measured using the Hospital Anxiety and Depression Scale anxiety and depression subscales (scores ≥ 8 indicating substantial symptoms) and the Impact of Event Scale-Revised (scores ≥ 1.6 indicating substantial posttraumatic stress disorder symptoms). Of the 520 enrolled patients, 274 died before 3-month follow-up; 186 of 196 consenting survivors (95%) completed at least one Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised assessment during 2-year follow-up, and most completed multiple assessments. Across follow-up time points, the prevalence of suprathreshold general anxiety, depression, and posttraumatic stress disorder symptoms ranged from 38% to 44%, 26% to 33%, and 22% to 24%, respectively; more than half of the patients had suprathreshold symptoms in at least one domain during 2-year follow-up. The majority of survivors (59%) with any suprathreshold symptoms were above threshold for two or more types of symptoms (i.e., general anxiety, depression, and/or posttraumatic stress disorder). In fact, the most common pattern involved simultaneous general anxiety, depression, and posttraumatic stress disorder symptoms. Most patients with general anxiety, depression, or posttraumatic stress disorder symptoms during 2-year follow-up had suprathreshold symptoms at 24-month (last) follow-up. Higher Short-Form-36 physical functioning domain scores at the prior visit were associated with a greater likelihood of remission from general anxiety and posttraumatic stress disorder symptoms during follow-up.
The majority of acute lung injury survivors had clinically significant general anxiety, depression, or posttraumatic stress disorder symptoms, and these symptoms tended to co-occur across domains. Better physical functioning during recovery predicted subsequent remission of general anxiety and posttraumatic stress disorder symptoms.
评估重症监护病房（ICU）治疗的急性肺损伤幸存者在2年随访期间广泛性焦虑、抑郁和创伤后应激障碍症状的共现情况及缓解的预测因素。
前瞻性队列研究，在急性肺损伤后3、6、12和24个月进行随访。
四家医院的13个内科和外科ICU。
520例急性肺损伤患者中的幸存者。
使用医院焦虑抑郁量表的焦虑和抑郁子量表（得分≥8表明存在明显症状）以及事件影响量表修订版（得分≥1.6表明存在明显的创伤后应激障碍症状）来测量相关结果。在520例入组患者中，274例在3个月随访前死亡；196例同意参与的幸存者中有186例（95%）在2年随访期间至少完成了一次医院焦虑抑郁量表和事件影响量表修订版评估，且大多数完成了多次评估。在各个随访时间点，阈上广泛性焦虑、抑郁和创伤后应激障碍症状的患病率分别为38%至44%、26%至33%和22%至24%；超过一半的患者在2年随访期间至少在一个领域存在阈上症状。大多数有任何阈上症状的幸存者（59%）在两种或更多类型症状（即广泛性焦虑、抑郁和/或创伤后应激障碍）方面高于阈值。实际上，最常见的模式是同时存在广泛性焦虑、抑郁和创伤后应激障碍症状。在2年随访期间有广泛性焦虑、抑郁或创伤后应激障碍症状的大多数患者在24个月（最后）随访时仍有阈上症状。前次就诊时简短健康调查问卷36项身体功能领域得分较高与随访期间广泛性焦虑和创伤后应激障碍症状缓解的可能性较大相关。
大多数急性肺损伤幸存者存在具有临床意义的广泛性焦虑、抑郁或创伤后应激障碍症状，且这些症状往往在各领域同时出现。恢复期间较好的身体功能预示着随后广泛性焦虑和创伤后应激障碍症状的缓解。
