Tripathy Swagata, Acharya Swati Priyadarshini, Sahoo Alok Kumar, Hansda Upendra, Mitra Jayanta Kumar, Goel Kishen, Ahmad Suma Rabab, Kar Nilamadhab
Department of Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India.
Pdf Critical Care, Department of Anesthesia & Critical Care, AIIMS Bhubaneswar, Bhubaneswar, India.
Crit Care Explor. 2022 Jul 29;4(8):e0742. doi: 10.1097/CCE.0000000000000742. eCollection 2022 Aug.
Optimal time for ICU diary delivery and impact on mental health (MH), anxiety-depression, post-traumatic stress symptoms (PTSS), quality of life (QOL), and memories is unclear. We evaluated the effect of ICU diaries, dispatched at different time points, on outcomes in an Indian cohort.
Double-blind randomized controlled trial.
A 1,000-bedded teaching hospital in East India.
Mechanically ventilated (>24 hr) adults were recruited, excluding those dead or incapable of meaningful-communication at discharge or follow-up. Eighty-three patients, aged 46.2 ± 17.2 years, Acute Physiology and Chronic Health Evaluation II scores 13.7 ± 4.9 were assessed. Length of ICU stay was 8.2 ± 7.1 days with 3.7 ± 3.2 ventilator days.
Of 820 screened, 164 had diaries created. Including photographs, diaries were comaintained by healthcare workers and family members. Ninety patients were randomized at 1-month follow-up: diary sent to 45 at 1 month (group ID1) and to 45 at 3 months (ID3).
Anxiety-depression, memory, and QOL were assessed telephonically or home visits by a psychologist using the Hospital Anxiety-Depression Scale (HADS) and other tools at ICU discharge, 1-month (prerandomization), and 3 months of discharge. ID3 was reassessed after receiving diaries at 3.5 months. Primary outcome was anxiety-depression; secondary outcomes included PTSS, QOL, and memories. There was 100% follow-up. At 3 months, ID1 patients had a significant ( < 0.001) reduction in HADS from baseline when compared with ID3 that had not received diaries (4.16 ± 2.9 vs 2.15 ± 1.8; 95% CI, 2.8-1.2). PTSS scores were likewise better ( < 0.001). ID3 patients demonstrated significant improvement ( < 0.01) in QOL and memories along with HADS and PTSS when assessed at 3.5 months.
ICU diaries improve MH but not QOL when delivered at 1 month and assessed 2 months thereafter. Assessed after 15 days, delayed exposure at 3 months significantly improved QOL and memories in addition to MH.
重症监护病房（ICU）日记的最佳交付时间以及对心理健康（MH）、焦虑抑郁、创伤后应激症状（PTSS）、生活质量（QOL）和记忆的影响尚不清楚。我们评估了在不同时间点发放的ICU日记对一组印度患者结局的影响。
双盲随机对照试验。
印度东部一家拥有1000张床位的教学医院。
招募了机械通气（>24小时）的成年人，排除出院或随访时已死亡或无法进行有效沟通的患者。评估了83例患者，年龄46.2±17.2岁，急性生理与慢性健康状况评分II为13.7±4.9。ICU住院时间为8.2±7.1天，机械通气时间为3.7±3.2天。
在820例筛查患者中，164例创建了日记。包括照片在内的日记由医护人员和家庭成员共同保存。90例患者在1个月随访时随机分组：1个月时向45例发送日记（ID1组），3个月时向45例发送日记（ID3组）。
在ICU出院时、1个月（随机分组前）和出院3个月时，由心理学家通过电话或家访使用医院焦虑抑郁量表（HADS）和其他工具评估焦虑抑郁、记忆和生活质量。ID3组在3.5个月收到日记后重新进行评估。主要结局指标为焦虑抑郁；次要结局指标包括创伤后应激症状、生活质量和记忆。随访率为100%。3个月时，与未收到日记的ID3组相比，ID1组患者的HADS评分较基线显著降低（<0.001）（4.16±2.9对vs 2.15±1.8；95%CI，2.8 - 1.2）。创伤后应激症状评分同样更好（<0.001）。在3.5个月评估时，ID3组患者的生活质量、记忆以及HADS和创伤后应激症状评分均有显著改善（<0.01）。
在1个月发放并在其后2个月进行评估时，ICU日记可改善心理健康，但不能改善生活质量。在15天后进行评估时，3个月延迟发放除改善心理健康外还能显著改善生活质量和记忆。
