Division of Pulmonary Diseases and Critical Care Medicine (B.W., A.C., S.S.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
Division of Neurocritical Care (C.O.-S.), Departments of Neurology and Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
J Pain Symptom Manage. 2022 Jun;63(6):e633-e639. doi: 10.1016/j.jpainsymman.2022.02.336.
Severe Acute Brain Injury (SABI) is neurologically devastating, and surrogates for these patients may struggle with particularly complex decisions due to substantial prognostic uncertainty.
To compare anxiety and depression symptoms over time between SABI surrogates and non-SABI surrogates for patients requiring prolonged mechanical ventilation (PMV).
We conducted a secondary analysis of the data from a multicenter randomized trial of a decision aid intervention for surrogates of adults experiencing PMV. Eligible patients were enrolled from medical, surgical, trauma, cardiac, and neurologic intensive care units (ICUs). ICU admitting diagnoses were used to identify patients experiencing SABI. We compared anxiety and depression symptoms as measured by the Hospital Anxiety and Depression Scale score 6 months after trial enrollment between surrogates of patients with SABI and surrogates of patients experiencing PMV for other reasons.
Our analysis included 206 patients, 60 (29%) with SABI and 146 (71%) without SABI, and their primary surrogate decision makers. After adjusting for potential confounders including surrogate demographics, surrogate financial distress, patient severity of illness baseline GCS, and patient health status at 6 months, we found that surrogates of patients experiencing SABI had higher symptoms of anxiety and depression than surrogates of non-SABI patients (adjusted mean difference 3.6, 95% CI 1.2-6.0).
Surrogates of PMV patients with SABI experience persistently elevated anxiety and depression symptoms over 6 months compared to surrogates of PMV patients without SABI. Further work is needed to understand contributors to prolonged distress in this higher risk population.
严重急性脑损伤（SABI）对神经系统具有破坏性，由于预后存在很大的不确定性，这些患者的代理人在做出特别复杂的决策时可能会感到困难。
比较需要长时间机械通气（PMV）的 SABI 患者和非 SABI 患者的代理人在不同时间的焦虑和抑郁症状。
我们对一项多中心随机试验的决策辅助干预措施的代理人数据进行了二次分析，该试验针对经历 PMV 的成年人的代理人。从医学、外科、创伤、心脏和神经重症监护病房（ICU）招募符合条件的患者。使用 ICU 入院诊断来识别经历 SABI 的患者。我们比较了 6 个月后试验登记时，SABI 患者代理人和因其他原因经历 PMV 的患者代理人的医院焦虑和抑郁量表（HADS）评分焦虑和抑郁症状。
我们的分析包括 206 名患者，60 名（29%）患有 SABI，146 名（71%）没有 SABI，以及他们的主要代理人。在调整了潜在混杂因素后，包括代理人人口统计学特征、代理人经济困难、患者基线 GCS 严重程度和患者 6 个月时的健康状况，我们发现经历 SABI 的患者的代理人比没有 SABI 的患者的代理人焦虑和抑郁症状更严重（调整后的平均差异为 3.6，95%CI 1.2-6.0）。
与经历非 SABI 的 PMV 患者的代理人相比，经历 SABI 的 PMV 患者的代理人在 6 个月后持续出现更严重的焦虑和抑郁症状。需要进一步研究以了解这一高风险人群中持续困扰的原因。
