Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany.
Institute of General Practice and Family Medicine, Jena University Hospital, Germany; Center of Sepsis Control and Care, Jena University Hospital, Germany.
Am J Med. 2020 Mar;133(3):381-385.e5. doi: 10.1016/j.amjmed.2019.08.033. Epub 2019 Sep 13.
Sepsis survivors face mental and physical sequelae even years after discharge from the intensive care unit. The aim of this study was to evaluate the long-term courses of sepsis survivors and the effects of a primary care management intervention in sepsis aftercare.
This study presents a 24-month follow-up of a randomized controlled trial that recruited 291 patients who survived sepsis (including septic shock) from nine German intensive care units. Participants were randomized to usual care (n=143) or to a 12-month-intervention (n=148). The intervention included training of patients and their primary care physicians (PCP) in evidence-based post-sepsis care, case management provided by trained nurses, and clinical decision support for PCPs by consulting physicians. Usual care was provided by PCPs in the control group. At the 24-month follow-up, 12 months after the 1-year-intervention, survival and measures of mental and physical health were collected by telephone interviews.
One hundred eighty-six (63.9%, 98 intervention, 88 control) of 291 patients completed the 24-month follow-up, showing both increased mortality and recovery from functional impairment. Unlike the intervention group, the control group showed a significant increase of posttraumatic stress symptoms according to the Posttraumatic Symptom Scale (difference between baseline and 24-months follow-up values, mean [standard deviation] 3.7 [11.8] control vs -0.7 [12.1] intervention; P = .016). There were no significant differences in all other outcomes between the intervention and control groups.
Twelve months after completion, a primary care management intervention among survivors of sepsis did not improve mental health-related quality of life. Patients in the intervention group showed less posttraumatic stress symptoms.
脓毒症幸存者即使在离开重症监护病房多年后仍面临身心后遗症。本研究旨在评估脓毒症幸存者的长期病程以及初级保健管理干预对脓毒症后护理的影响。
本研究对一项随机对照试验进行了 24 个月的随访，该试验招募了来自德国 9 家重症监护病房的 291 名存活脓毒症（包括脓毒性休克）患者。参与者被随机分配至常规护理组（n=143）或 12 个月干预组（n=148）。干预措施包括对患者及其初级保健医生（PCP）进行基于证据的脓毒症后护理培训、由经过培训的护士提供病例管理以及通过会诊医生为 PCP 提供临床决策支持。对照组的常规护理由 PCP 提供。在 24 个月的随访中，即 12 个月干预结束后 12 个月，通过电话访谈收集了生存情况以及心理和身体健康的测量结果。
291 名患者中有 186 名（63.9%，98 名干预组，88 名对照组）完成了 24 个月的随访，结果显示死亡率增加，且功能障碍的恢复情况有所不同。与干预组不同的是，对照组的创伤后应激症状量表（Posttraumatic Symptom Scale）评分显示出显著增加（随访期间的基线值与 24 个月时的差值，对照组为 3.7 [11.8]，干预组为-0.7 [12.1]；P = .016）。干预组和对照组在所有其他结局指标上均无显著差异。
在完成干预 12 个月后，脓毒症幸存者的初级保健管理干预并未改善心理健康相关的生活质量。干预组患者的创伤后应激症状较少。
