多学科联合诊所实施后，外科重症监护病房幸存者中重症监护后综合征的发生率很高。
High occurrence of postintensive care syndrome identified in surgical ICU survivors after implementation of a multidisciplinary clinic.
机构信息
From the Tufts University School of Medicine & Tufts Graduate School of Biomedical Sciences (S.F.B.-T.); Department of Pharmacy (J.O.P.), Tufts Medical Center; Department of General Surgery (M.T.L.), Tufts Medical Center, Tufts University School of Medicine; Department of Social Work Services (S.E.A., A.L.V.K., C.E.); Department of Physical and Occupational Therapy (A.B., E.P., E.D.), Tufts Medical Center; and Division of Trauma & Acute Care Surgery (H.M.H., N.B., B.P.J., E.J.M.), Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
出版信息
J Trauma Acute Care Surg. 2021 Aug 1;91(2):406-412. doi: 10.1097/TA.0000000000003231.
BACKGROUND
Postintensive care syndrome (PICS) has been identified in a large proportion of medical intensive care unit survivors; however, the occurrence surgical intensive care unit (SICU) survivors is unknown. We implemented a multidisciplinary critical care outpatient clinic (CCOC) to identify the occurrence of PICS in SICU survivors.
METHODS
Seventy acute care surgery and trauma patients, 18 years or older, who remained in the SICU for 72 hours or longer at a Level I trauma center were seen in CCOC at 2 weeks, 12 weeks, and 24 weeks after hospital discharge. The CCOC staffing included a nurse coordinator, social worker, critical care pharmacist, physical therapist, and acute care surgeon who identified PICS sequelae in their respective specialties by clinical criteria and screening questionnaires.
RESULTS
Of 82 eligible patients, 70 (85.4%) were seen at least once for 116 total visits. Forty-three (61.4%) patients suffered traumatic injuries and 27 (38.6%) underwent emergent general surgery. Sixty-seven (95.7%) demonstrated at least one PICS criterion. Over all visits, 26 (37.1%) patients presented with one PICS criterion, 24 (34.3%) patients with two, and 17 (24.3%) with three. Cognitive impairment was observed in 29 (41.4%) patients, psychiatric in 30 (42.9%), and physical symptoms in 65 (92.9%). Activity Measure for Post-Acute Care scores improved from severe impairment at admission to full function by 12 weeks postdischarge, yet 6 Minute Walk Test scores remained below age-matched references through all visits. Patients expressed mild to moderate depression based on Patient Health Questionnaire-9 scores. A medication reconciliation was completed at 96.5% (112/116) of the visits with 116 total medication recommendations. By 24 weeks following discharge, only 26.4% (14/53) of previously employed patients had resumed work.
CONCLUSION
Through the successful implementation of a multidisciplinary CCOC, this study identifies an exorbitant rate of PICS among SICU survivors.
LEVEL OF EVIDENCE
Therapeutic/epidemiological, level III.
背景
在大量接受重症监护的患者中发现了 ICU 后综合征（PICS）；然而，外科重症监护病房（SICU）幸存者的发生率尚不清楚。我们实施了多学科的重症监护门诊（CCOC），以确定 SICU 幸存者中 PICS 的发生情况。
方法
在一家一级创伤中心，对 70 名年龄在 18 岁及以上、在 SICU 中停留时间超过 72 小时的急性外科和创伤患者进行了 CCOC 评估，评估时间分别为出院后 2 周、12 周和 24 周。CCOC 的工作人员包括一名护士协调员、一名社会工作者、一名重症监护药剂师、一名物理治疗师和一名急性外科医生，他们根据临床标准和筛查问卷确定各自专业领域的 PICS 后遗症。
结果
在 82 名符合条件的患者中，有 70 名（85.4%）至少接受了一次 116 次总就诊。43 名（61.4%）患者遭受创伤性损伤，27 名（38.6%）患者接受了紧急普外科手术。67 名（95.7%）患者至少表现出一个 PICS 标准。在所有就诊中，26 名（37.1%）患者出现一个 PICS 标准，24 名（34.3%）患者出现两个标准，17 名（24.3%）患者出现三个标准。29 名（41.4%）患者存在认知障碍，30 名（42.9%）患者存在精神障碍，65 名（92.9%）患者存在身体症状。活动能力测量在出院后 12 周时从入院时的严重受损改善到完全功能，但在所有就诊中，6 分钟步行测试得分仍低于年龄匹配的参考值。根据患者健康问卷-9 评分，患者表示存在轻度至中度抑郁。在 96.5%（112/116）的就诊中完成了药物重整，共提出了 116 项药物建议。出院后 24 周时，仅有 26.4%（14/53）的既往在职患者恢复工作。
结论
通过成功实施多学科 CCOC，本研究发现 SICU 幸存者中存在极高的 PICS 发生率。
证据水平
治疗/流行病学，III 级。
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