Patel Mayur B, Jackson James C, Morandi Alessandro, Girard Timothy D, Hughes Christopher G, Thompson Jennifer L, Kiehl Amy L, Elstad Mark R, Wasserstein Mitzi L, Goodman Richard B, Beckham Jean C, Chandrasekhar Rameela, Dittus Robert S, Ely E Wesley, Pandharipande Pratik P
1 Surgical Services, Nashville VA Medical Center, Tennessee Valley Healthcare System, U.S. Department of Veterans Affairs, Nashville, Tennessee.
2 Division of Trauma and Surgical Critical Care, Departments of Surgery and Neurosurgery, Section of Surgical Sciences, Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.
Am J Respir Crit Care Med. 2016 Jun 15;193(12):1373-81. doi: 10.1164/rccm.201506-1158OC.
The incidence and risk factors of post-traumatic stress disorder (PTSD) related to the intensive care unit (ICU) experience have not been reported in a mixed veteran and civilian cohort.
To describe the incidence and risk factors for ICU-related PTSD in veterans and civilians.
This is a prospective, observational, multicenter cohort enrolling adult survivors of critical illness after respiratory failure and/or shock from three Veterans Affairs and one civilian hospital. After classifying those with/without preexisting PTSD (i.e., PTSD before hospitalization), we then assessed all subjects for ICU-related PTSD at 3 and 12 months post hospitalization.
Of 255 survivors, 181 and 160 subjects were assessed for ICU-related PTSD at 3- and 12-month follow-up, respectively. A high probability of ICU-related PTSD was found in up to 10% of patients at either follow-up time point, whether assessed by PTSD Checklist Event-Specific Version (score ≥ 50) or item mapping using the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). In the multivariable regression, preexisting PTSD was independently associated with ICU-related PTSD at both 3 and 12 months (P < 0.001), as was preexisting depression (P < 0.03), but veteran status was not a consistent independent risk factor for ICU-related PTSD (3-month P = 0.01, 12-month P = 0.48).
This study found around 1 in 10 ICU survivors experienced ICU-related PTSD (i.e., PTSD anchored to their critical illness) in the year after hospitalization. Preexisting PTSD and depression were strongly associated with ICU-related PTSD.
创伤后应激障碍（PTSD）与重症监护病房（ICU）经历相关的发病率及风险因素在退伍军人和平民混合队列中尚未见报道。
描述退伍军人和平民中与ICU相关的PTSD的发病率及风险因素。
这是一项前瞻性、观察性、多中心队列研究，纳入来自三家退伍军人事务医院和一家民用医院的呼吸衰竭和/或休克后危重病成年幸存者。在对有/无既往PTSD（即住院前的PTSD）的患者进行分类后，我们在患者出院后3个月和12个月对所有受试者进行了与ICU相关的PTSD评估。
在255名幸存者中，分别在3个月和12个月随访时对181名和160名受试者进行了与ICU相关的PTSD评估。无论使用PTSD检查表特定事件版本（评分≥50）还是使用《精神障碍诊断与统计手册》第四版（DSM-IV）进行条目映射评估，在任一随访时间点，高达10%的患者被发现有与ICU相关的PTSD的高可能性。在多变量回归分析中，既往PTSD在3个月和12个月时均与ICU相关的PTSD独立相关（P<0.001），既往抑郁症也是如此（P<0.03），但退伍军人身份并非与ICU相关的PTSD一致的独立风险因素（3个月时P=0.01，12个月时P=0.48）。
本研究发现约十分之一的ICU幸存者在出院后一年内经历了与ICU相关的PTSD（即与他们的危重病相关的PTSD）。既往PTSD和抑郁症与ICU相关的PTSD密切相关。
