Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC.
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
Chest. 2021 Sep;160(3):890-898. doi: 10.1016/j.chest.2021.03.025. Epub 2021 Mar 19.
BACKGROUND: Family members of patients admitted to the ICU experience a constellation of sequelae described as postintensive care syndrome-family. The influence that an inter-ICU transfer has on psychological outcomes is unknown. RESEARCH QUESTION: Is inter-ICU transfer associated with poor psychological outcomes in families of patients with acute respiratory failure? STUDY DESIGN AND METHODS: Cross-sectional observational study of 82 families of patients admitted to adult ICUs (tertiary hospital). Data included demographics, admission source, and outcomes. Admission source was classified as inter-ICU transfer (n = 39) for patients admitted to the ICU from other hospitals and direct admit (n = 43) for patients admitted from the ED or the operating room of the same hospital. We used quantitative surveys to evaluate psychological distress (Hospital Anxiety and Depression Scale [HADS]) and posttraumatic stress (Post-Traumatic Stress Scale; PTSS) and examined clinical, family, and satisfaction factors associated with psychological outcomes. RESULTS: Families of transferred patients travelled longer distances (mean ± SD, 109 ± 106 miles) compared with those of patients directly admitted (mean ± SD, 65 ± 156 miles; P ≤ .0001). Transferred patients predominantly were admitted to the neuro-ICU (64%), had a longer length of stay (direct admits: mean ± SD, 12.7 ± 9.3 days; transferred patients: mean ± SD, 17.6 ± 9.3 days; P < .01), and a higher number of ventilator days (direct admits: mean ± SD, 6.9 ± 8.6 days; transferred: mean ± SD, 10.6 ± 9.0 days; P < .01). Additionally, they were less likely to be discharged home (direct admits, 63%; transferred, 33%; P = .08). In a fully adjusted model of psychological distress and posttraumatic stress, family members of transferred patients were found to have a 1.74-point (95% CI, -1.08 to 5.29; P = .30) higher HADS score and a 5.19-point (95% CI, 0.35-10.03; P = .03) higher PTSS score than those of directly admitted family members. INTERPRETATION: In this exploratory study, posttraumatic stress measured by the PTSS was higher in the transferred families, but these findings will need to be replicated to infer clinical significance.
背景：入住 ICU 的患者的家属经历了一系列被描述为 ICU 后综合征的后遗症。ICU 之间的转院对心理结果的影响尚不清楚。
研究问题：ICU 之间的转院是否与急性呼吸衰竭患者家属的不良心理结局有关？
研究设计和方法：这是一项对入住成人 ICU（三级医院）的 82 个患者家庭进行的横断面观察性研究。数据包括人口统计学、入院来源和结局。入院来源分为 ICU 间转院（n=39）和直接入院（n=43）。我们使用定量调查评估心理困扰（医院焦虑抑郁量表[HADS]）和创伤后应激（创伤后应激量表；PTSS），并检查与心理结局相关的临床、家庭和满意度因素。
结果：与直接入院的患者家属相比（平均±SD，65±156 英里），转院患者家属的旅行距离更长（平均±SD，109±106 英里；P≤0.0001）。转院患者主要被收入神经 ICU（64%），住院时间更长（直接入院：平均±SD，12.7±9.3 天；转院：平均±SD，17.6±9.3 天；P<.01），呼吸机使用天数更多（直接入院：平均±SD，6.9±8.6 天；转院：平均±SD，10.6±9.0 天；P<.01）。此外，他们更不可能出院回家（直接入院，63%；转院，33%；P=0.08）。在心理困扰和创伤后应激的完全调整模型中，转院患者的家属 HADS 评分平均高出 1.74 分（95%CI，-1.08 至 5.29；P=0.30），PTSS 评分平均高出 5.19 分（95%CI，0.35 至 10.03；P=0.03）。
解释：在这项探索性研究中，通过 PTSS 测量的创伤后应激在转院家庭中更高，但这些发现需要复制才能推断出临床意义。
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