Institute of General Practice and Family Medicine, LMU Klinikum, Munich, Germany.
Institute of General Practice and Family Medicine, Charité University Medicine Berlin, Berlin, Germany; Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany.
J Crit Care. 2021 Oct;65:268-273. doi: 10.1016/j.jcrc.2021.07.006. Epub 2021 Jul 16.
Post-intensive care syndrome (PICS) is a combination of cognitive, psychiatric and physical impairments in survivors of critical illness and intensive care. There is little data on long-term co-occurrence of associated impairments.
Analysis of data from 289 sepsis survivors from a German multicenter RCT. Impairments associated with PICS (depression, PTSD, cognitive impairment, chronic pain, neuropathic symptoms, dysphagia) during 24 months follow-up are used to explore the frequency and risk factors of PICS components in three classification models.
The majority of participants showed impairments in 2-3 of 6 domains during follow-up. The overall frequency of PICS according to the classification models ranged from 32.9% to 98.6%. In regression analyses, there were no significant effects in selected ICU-related exposures or covariates for PICS classification models. Regarding individual components, only higher age and longer duration of ICU treatment and mechanical ventilation showed significant positive associations with the occurrence of cognitive impairment during follow-up, as did male gender and higher age for dysphagia.
Almost all study participants showed impairments associated with PICS in at least one domain. The proposed classification models for PICS appear to be too broad to identify specific risk factors beyond its individual components.
重症监护后综合征(PICS)是指危重病和重症监护幸存者出现认知、精神和身体损伤的综合症状。关于相关损伤的长期同时发生的资料很少。
对来自德国多中心 RCT 的 289 例脓毒症幸存者的数据进行分析。在 24 个月的随访中,使用与 PICS 相关的损伤(抑郁、创伤后应激障碍、认知障碍、慢性疼痛、神经病理性症状、吞咽困难)来探索三个分类模型中 PICS 成分的频率和危险因素。
大多数参与者在随访期间有 2-3 个领域存在损伤。根据分类模型,PICS 的总体发生率从 32.9%到 98.6%不等。在回归分析中,在选定的 ICU 相关暴露或协变量中,没有显著影响 PICS 分类模型。对于个别成分,只有较高的年龄和 ICU 治疗和机械通气的持续时间较长与随访期间认知障碍的发生有显著的正相关,而男性和较高的年龄与吞咽困难有关。
几乎所有研究参与者都至少在一个领域出现了与 PICS 相关的损伤。拟议的 PICS 分类模型似乎过于宽泛,无法识别其个别成分之外的特定危险因素。