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Review Posttraumatic stress disorder following critical illness. 2008
Kross EK, Gries CJ, Curtis JR. · Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, School of Medicine, University of Washington, Seattle, WA 98104-2499, USA. · Crit Care Clin. · Pubmed #18929945 No free full text.
Abstract: Posttraumatic stress disorder (PTSD) is a common psychiatric condition that can occur after a traumatic event. Individuals exposed to traumatic events are at risk for PTSD and other psychologic morbidity, such as depression, panic disorder, generalized anxiety disorder, and substance abuse. The burden of PTSD can be high, with inability to work or return to prior levels of functioning. Emerging literature suggests a significantly increased risk for symptoms of PTSD among survivors of critical illness and the families of patients who survive or die after critical illness. This review summarizes these studies and provides suggestions for current clinical implications and for future research.
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Article A communication strategy and brochure for relatives of patients dying in the ICU. free! 2007
Lautrette A, Darmon M, Megarbane B, Joly LM, Chevret S, Adrie C, Barnoud D, Bleichner G, Bruel C, Choukroun G, Curtis JR, Fieux F, Galliot R, Garrouste-Orgeas M, Georges H, Goldgran-Toledano D, Jourdain M, Loubert G, Reignier J, Saidi F, Souweine B, Vincent F, Barnes NK, Pochard F, Schlemmer B, Azoulay E. · Saint-Louis Hospital and Paris 7 University, Assistance Publique-Hôpitaux de Paris, France. · N Engl J Med. · Pubmed #17267907 links to free full text
Abstract: BACKGROUND: There is a need for close communication with relatives of patients dying in the intensive care unit (ICU). We evaluated a format that included a proactive end-of-life conference and a brochure to see whether it could lessen the effects of bereavement. METHODS: Family members of 126 patients dying in 22 ICUs in France were randomly assigned to the intervention format or to the customary end-of-life conference. Participants were interviewed by telephone 90 days after the death with the use of the Impact of Event Scale (IES; scores range from 0, indicating no symptoms, to 75, indicating severe symptoms related to post-traumatic stress disorder [PTSD]) and the Hospital Anxiety and Depression Scale (HADS; subscale scores range from 0, indicating no distress, to 21, indicating maximum distress). RESULTS: Participants in the intervention group had longer conferences than those in the control group (median, 30 minutes [interquartile range, 19 to 45] vs. 20 minutes [interquartile range, 15 to 30]; P<0.001) and spent more of the time talking (median, 14 minutes [interquartile range, 8 to 20] vs. 5 minutes [interquartile range, 5 to 10]). On day 90, the 56 participants in the intervention group who responded to the telephone interview had a significantly lower median IES score than the 52 participants in the control group (27 vs. 39, P=0.02) and a lower prevalence of PTSD-related symptoms (45% vs. 69%, P=0.01). The median HADS score was also lower in the intervention group (11, vs. 17 in the control group; P=0.004), and symptoms of both anxiety and depression were less prevalent (anxiety, 45% vs. 67%; P=0.02; depression, 29% vs. 56%; P=0.003). CONCLUSIONS: Providing relatives of patients who are dying in the ICU with a brochure on bereavement and using a proactive communication strategy that includes longer conferences and more time for family members to talk may lessen the burden of bereavement. (ClinicalTrials.gov number, NCT00331877.)
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