Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1208
C. E. Cox, J. Gu, E. H. Pratt, D. Ashana, I. Riley, A. Parish, M. Olsen, K. Haines, Y. Ali, M. Al-Hegelan, R. Harrison, C. Naglee, D. Casarett, A. Frear, K. Johnson, S. Docherty
{"title":"Palliative Care Triggers vs Actual Unmet Needs Among ICU Patients and Family Members","authors":"C. E. Cox, J. Gu, E. H. Pratt, D. Ashana, I. Riley, A. Parish, M. Olsen, K. Haines, Y. Ali, M. Al-Hegelan, R. Harrison, C. Naglee, D. Casarett, A. Frear, K. Johnson, S. Docherty","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1208","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1208","url":null,"abstract":"","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115083779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1209
S. Hochendoner, T. Amass, J. Curtis, M. Ambler, P. Armstrong, M. Burhani, J. Chiurco, L. Fonseca, M. Green, K. Halvorson, R. Hammer, J. Heywood, M. Hua, J. Huang, L. Johnson, T. Lane, M. Lee, A. Lévi, K. Likosky, D. Lipnick, T. Milinic, O. Orea, S. Puckey, J. Reilly, S. Rhoads, O. Toyobo, X. Weng, P. Witt, L. V. Van Scoy
RATIONALE: Currently, there are over 20,000 COVID-19 positive patients requiring intensive care unit (ICU) care in the United States (US). Even prior to the pandemic, up to 30% of family members of ICU patients experience post-traumatic stress disorder and up to 50% sustain potentially prolonged anxiety and/or depression. Although family bedside engagement improves both short-and long-term outcomes for patients and their families, nationwide social distancing recommendations have curtailed hospital visitation, potentially heightening the risk of stress-related disorders in these family members. The goal of this analysis is to explore the experiences of physically distanced family members of COVID-19 ICU patients in order to inform future best practices. Methods: This qualitative analysis is part of a multisite, observational, mixed-methods study of 12 US hospitals. Qualitative interviews were conducted with 75 participants from five sites;14 interviews were analyzed in this preliminary analysis. Adult family members of COVID-19 positive patients admitted to the ICU from March-June 2020 were interviewed three months post-discharge. After sequential screening by site coordinators, participants were contacted by the qualitative team until all interviews (10-15 per site) were completed. Qualitative interviews explored the illness stories, communication perceptions, and explored stressors. Thematic analysis was applied to the verbatim transcripts of the phone interviews. Four coders utilized an iteratively-developed codebook to analyze transcripts using a round-robin method with two analysts per transcript. Discrepant codes were adjudicated by a third analyst to attend to inter-rater reliability. Results: Five preliminary themes and seven subthemes emerged (Table 1). Positive communication experiences were more common than negative ones. Communication themes were: 1) Participants were reassured by proactive and frequent communication, leaving them feeling informed and included in care;and 2) Mixed feelings were expressed about the value of video-conferencing technology. Themes from the emotional and stress experiences were: 3) Profound sadness and distress resulted from isolation from patients, clinicians, and supportive family;4) Stress was amplified by external factors;and 5) Positive experiences centered upon appreciation for healthcare workers and gratitude for compassionate care. Conclusion: Incorporating the voices of family members during the COVID-19 pandemic establishes a foundation to inform family-centered, best practice guidelines to support the unique needs of family members who are physically distant from their critically ill and dying loved ones.
{"title":"Stress Related Disorders in Family Members of Covid-19 Patients Admitted to the Intensive Care Unit - A Multi-Site Qualitative Study","authors":"S. Hochendoner, T. Amass, J. Curtis, M. Ambler, P. Armstrong, M. Burhani, J. Chiurco, L. Fonseca, M. Green, K. Halvorson, R. Hammer, J. Heywood, M. Hua, J. Huang, L. Johnson, T. Lane, M. Lee, A. Lévi, K. Likosky, D. Lipnick, T. Milinic, O. Orea, S. Puckey, J. Reilly, S. Rhoads, O. Toyobo, X. Weng, P. Witt, L. V. Van Scoy","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1209","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1209","url":null,"abstract":"RATIONALE: Currently, there are over 20,000 COVID-19 positive patients requiring intensive care unit (ICU) care in the United States (US). Even prior to the pandemic, up to 30% of family members of ICU patients experience post-traumatic stress disorder and up to 50% sustain potentially prolonged anxiety and/or depression. Although family bedside engagement improves both short-and long-term outcomes for patients and their families, nationwide social distancing recommendations have curtailed hospital visitation, potentially heightening the risk of stress-related disorders in these family members. The goal of this analysis is to explore the experiences of physically distanced family members of COVID-19 ICU patients in order to inform future best practices. Methods: This qualitative analysis is part of a multisite, observational, mixed-methods study of 12 US hospitals. Qualitative interviews were conducted with 75 participants from five sites;14 interviews were analyzed in this preliminary analysis. Adult family members of COVID-19 positive patients admitted to the ICU from March-June 2020 were interviewed three months post-discharge. After sequential screening by site coordinators, participants were contacted by the qualitative team until all interviews (10-15 per site) were completed. Qualitative interviews explored the illness stories, communication perceptions, and explored stressors. Thematic analysis was applied to the verbatim transcripts of the phone interviews. Four coders utilized an iteratively-developed codebook to analyze transcripts using a round-robin method with two analysts per transcript. Discrepant codes were adjudicated by a third analyst to attend to inter-rater reliability. Results: Five preliminary themes and seven subthemes emerged (Table 1). Positive communication experiences were more common than negative ones. Communication themes were: 1) Participants were reassured by proactive and frequent communication, leaving them feeling informed and included in care;and 2) Mixed feelings were expressed about the value of video-conferencing technology. Themes from the emotional and stress experiences were: 3) Profound sadness and distress resulted from isolation from patients, clinicians, and supportive family;4) Stress was amplified by external factors;and 5) Positive experiences centered upon appreciation for healthcare workers and gratitude for compassionate care. Conclusion: Incorporating the voices of family members during the COVID-19 pandemic establishes a foundation to inform family-centered, best practice guidelines to support the unique needs of family members who are physically distant from their critically ill and dying loved ones.","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114815454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1212
K. Wolfe, D. Douglas, S. Pearson, M. Stutz, P. Lecompte-Osorio, J. Lin, C. Ward, P. Herbst, C. Thompson, J.B. Hall, J. Kress, B. Patel
RATIONALE: Survivors of critical illness are at risk for long-term physical disability and poor quality of life. Changes in health care delivery, such as visitor restrictions and limited availability of therapy services coupled with economic hardship due to the COVID-19 pandemic may exacerbate these long-term consequences. Methods: Patients with respiratory failure requiring advanced respiratory support (endotracheal tube, noninvasive ventilation, or high-flow nasal cannula) and/or shock admitted to the intensive care unit (ICU) with COVID-19 were eligible for enrollment in this prospective observational study. We assessed quality of life (using short form-36 [SF-36]), work status, and independence in activities of daily living (ADLs) in survivors at hospital discharge and 6 months. Quality of life scores were compared to US population norms. An SF-36 score ≥50 is the population norm for both physical and mental scores;scores <45 define significant physical or mental health impairment. Patients underwent assessment for ICU-acquired weakness (ICU-AW) and functional impairment (using Functional Status Score for the ICU (FSS-ICU)) by physical and occupational therapists upon hospital discharge. An FSS-ICU score ≥28 is associated with discharge to home. Analysis of changes over time for the quality of life assessment were performed using paired t-test and tests of proportions. Results: 100 patients were enrolled from April to November 2020. On hospital discharge, 39% of patients had ICU-AW. The median FSS-ICU score on discharge was 24 [20-29], consistent with functional impairment. Fifty-six patients completed the 6-month evaluation with 74.7% follow-up (56/75 alive patients). Mental health impairment was reported by 33% of patients on hospital discharge and declined to 13% at 6 months (p=0.007). Physical health impairment was reported by 70% at discharge and persisted in 46% of patients at 6 months (p=0.007). Patients were independent in ADLs at both hospital admission and 6 months post discharge (90 vs 91%). Only 56% of patients who had been working prior to hospitalization had returned to work at 6 months. Conclusions: Impairments in quality of life and neuromuscular weakness were present at hospital discharge in a significant number of ICU survivors of COVID-19. Similar to the trajectory described in survivors of acute respiratory distress syndrome, despite relatively normal mental health quality of life, persistent physical health impairment was noted in almost half of the survivors at 6 months. Further investigation of the long-term effects of COVID-19 related critical illness and its distinction from post-ICU syndromes from non-COVID-19 critical illness is warranted.
理由:危重疾病的幸存者面临长期身体残疾和生活质量差的风险。卫生保健服务的变化，如访客限制和治疗服务有限，再加上COVID-19大流行造成的经济困难，可能会加剧这些长期后果。方法:在重症监护病房(ICU)收治的COVID-19患者中，需要高级呼吸支持(气管内插管、无创通气或高流量鼻插管)和/或休克的呼吸衰竭患者符合纳入本前瞻性观察性研究的条件。我们在出院和6个月时评估幸存者的生活质量(使用简表-36 [SF-36])、工作状态和日常生活活动的独立性(ADLs)。生活质量得分与美国人口标准进行了比较。SF-36得分≥50为生理和心理得分的总体标准，得分≥45为显著的生理或心理健康损害。出院时，物理和职业治疗师对患者进行了ICU获得性虚弱(ICU- aw)和功能损害(使用ICU功能状态评分(FSS-ICU))的评估。FSS-ICU评分≥28分与出院相关。使用配对t检验和比例检验对生活质量评估随时间的变化进行分析。结果:2020年4月至11月入组100例患者。出院时，39%的患者有ICU-AW。出院时FSS-ICU评分中位数为24分[20-29]，与功能障碍相符。56例患者完成了6个月的评估，随访率为74.7%(56/75例存活患者)。出院时有33%的患者报告精神健康受损，6个月后下降到13% (p=0.007)。70%的患者在出院时报告身体健康受损，46%的患者在6个月时持续存在(p=0.007)。患者在入院和出院后6个月的adl均独立(90% vs 91%)。在住院前工作的患者中，只有56%在6个月后重返工作岗位。结论:大量COVID-19 ICU存活患者出院时存在生活质量下降和神经肌肉无力。与急性呼吸窘迫综合征幸存者所描述的轨迹类似，尽管精神健康生活质量相对正常，但在6个月时，几乎一半的幸存者出现了持续的身体健康损害。有必要进一步调查COVID-19相关危重疾病的长期影响及其与icu后综合征和非COVID-19危重疾病的区别。
{"title":"Functional and Quality of Life Outcomes of Critically Ill COVID-19 Survivors at Hospital Discharge and Six Months","authors":"K. Wolfe, D. Douglas, S. Pearson, M. Stutz, P. Lecompte-Osorio, J. Lin, C. Ward, P. Herbst, C. Thompson, J.B. Hall, J. Kress, B. Patel","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1212","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1212","url":null,"abstract":"RATIONALE: Survivors of critical illness are at risk for long-term physical disability and poor quality of life. Changes in health care delivery, such as visitor restrictions and limited availability of therapy services coupled with economic hardship due to the COVID-19 pandemic may exacerbate these long-term consequences. Methods: Patients with respiratory failure requiring advanced respiratory support (endotracheal tube, noninvasive ventilation, or high-flow nasal cannula) and/or shock admitted to the intensive care unit (ICU) with COVID-19 were eligible for enrollment in this prospective observational study. We assessed quality of life (using short form-36 [SF-36]), work status, and independence in activities of daily living (ADLs) in survivors at hospital discharge and 6 months. Quality of life scores were compared to US population norms. An SF-36 score ≥50 is the population norm for both physical and mental scores;scores <45 define significant physical or mental health impairment. Patients underwent assessment for ICU-acquired weakness (ICU-AW) and functional impairment (using Functional Status Score for the ICU (FSS-ICU)) by physical and occupational therapists upon hospital discharge. An FSS-ICU score ≥28 is associated with discharge to home. Analysis of changes over time for the quality of life assessment were performed using paired t-test and tests of proportions. Results: 100 patients were enrolled from April to November 2020. On hospital discharge, 39% of patients had ICU-AW. The median FSS-ICU score on discharge was 24 [20-29], consistent with functional impairment. Fifty-six patients completed the 6-month evaluation with 74.7% follow-up (56/75 alive patients). Mental health impairment was reported by 33% of patients on hospital discharge and declined to 13% at 6 months (p=0.007). Physical health impairment was reported by 70% at discharge and persisted in 46% of patients at 6 months (p=0.007). Patients were independent in ADLs at both hospital admission and 6 months post discharge (90 vs 91%). Only 56% of patients who had been working prior to hospitalization had returned to work at 6 months. Conclusions: Impairments in quality of life and neuromuscular weakness were present at hospital discharge in a significant number of ICU survivors of COVID-19. Similar to the trajectory described in survivors of acute respiratory distress syndrome, despite relatively normal mental health quality of life, persistent physical health impairment was noted in almost half of the survivors at 6 months. Further investigation of the long-term effects of COVID-19 related critical illness and its distinction from post-ICU syndromes from non-COVID-19 critical illness is warranted.","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"3 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132120398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1213
J. Falvey, T. Murphy, L. Leo‐Summers, J. O’Leary, A. Cohen, L. Ferrante
{"title":"The Impact of Social Isolation on Disability and Mortality Among Older Survivors of Critical Illness","authors":"J. Falvey, T. Murphy, L. Leo‐Summers, J. O’Leary, A. Cohen, L. Ferrante","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1213","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1213","url":null,"abstract":"","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125531975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1211
J. Maley, D. Sandsmark, A. Trainor, G. Bass, C. Dabrowski, B. Magdamo, B. Durkin, M. Hayes, T. Quinn, R. Schwartzstein, J. Stevens, L. Kaplan, M. Mikkelsen, M. Lane-Fall
RATIONALE: Prior to the emergence of coronavirus disease 2019 (COVID-19), critical illness survivors were known to suffer long-term impairments in physical function, mental health, and cognition. These deficits, collectively termed the post-intensive care syndrome (PICS), impact health-related quality-of-life. Survivors of COVID-19-associated respiratory failure may be at particularly high risk of PICS due to delirium and prolonged mechanical ventilation, and factors unique to the pandemic, including physical isolation from medical staff, lack of in-hospital family presence, limited post-acute care rehabilitation, and widespread economic recession. Given this context, we describe the prevalence of PICS 6 months following hospital discharge among survivors of COVID-19-associated respiratory failure. METHODS: We conducted a multicenter prospective cohort study from March to December 2020 at Beth Israel Deaconess Medical Center and the Hospital of the University of Pennsylvania. We identified ICU survivors who underwent at least 48 hours of mechanical ventilation for COVID-19. We contacted eligible patients via telephone at 6 months post-hospital discharge. Sample size was determined by thematic saturation of interviews within a concurrent qualitative assessment. We used the Society of Critical Care Medicine international consensus recommendations for PICS assessment. We assessed anxiety, depression, and post-traumatic stress disorder (PTSD) using the Hospital Anxiety and Depression Scale and Impact-of-Events Scale, respectively. We assessed physical impairment with the EQ-5D questionnaire, and cognitive impairment using the Montreal Cognitive Assessment-Blind. Data are means + standard deviation or number (percent). RESULTS: We completed telephone interviews with 50 of 173 eligible patients (53 contacted, 3 declined). Age was 57+13 years, duration of invasive mechanical ventilation was 14+8.2 days and PaO2:FiO2 ratio at intubation was 174±46. Delirium developed in 35 patients (70%). Six months post-discharge, 38 patients (76%) met criteria for PICS, with 1 or more domains impaired. Among patients with PICS, 22 (44%) were impaired in at least 2 domains, and 9 (18%) impaired in all 3 domains. PTSD was present in 17 patients (34%), anxiety in 19 (38%), and depression in 20 (40%). Twenty-four patients (48%) had impairments in activities of daily living. Nineteen patients (37%) demonstrated cognitive impairment. CONCLUSIONS Over three quarters of COVID-19-associated respiratory failure survivors demonstrated PICS 6 months after hospital discharge. Patients were commonly impaired in at least two domains. These estimates of PICS prevalence appear broadly similar to those reported in the pre-COVID-19 literature and should drive focused efforts to identify COVID-19 survivors at high risk for PICS prior to discharge.
{"title":"Long-Term Impairment in Cognition, Mental Health, and Physical Function Following COVID-19-Associated Respiratory Failure","authors":"J. Maley, D. Sandsmark, A. Trainor, G. Bass, C. Dabrowski, B. Magdamo, B. Durkin, M. Hayes, T. Quinn, R. Schwartzstein, J. Stevens, L. Kaplan, M. Mikkelsen, M. Lane-Fall","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1211","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1211","url":null,"abstract":"RATIONALE: Prior to the emergence of coronavirus disease 2019 (COVID-19), critical illness survivors were known to suffer long-term impairments in physical function, mental health, and cognition. These deficits, collectively termed the post-intensive care syndrome (PICS), impact health-related quality-of-life. Survivors of COVID-19-associated respiratory failure may be at particularly high risk of PICS due to delirium and prolonged mechanical ventilation, and factors unique to the pandemic, including physical isolation from medical staff, lack of in-hospital family presence, limited post-acute care rehabilitation, and widespread economic recession. Given this context, we describe the prevalence of PICS 6 months following hospital discharge among survivors of COVID-19-associated respiratory failure. METHODS: We conducted a multicenter prospective cohort study from March to December 2020 at Beth Israel Deaconess Medical Center and the Hospital of the University of Pennsylvania. We identified ICU survivors who underwent at least 48 hours of mechanical ventilation for COVID-19. We contacted eligible patients via telephone at 6 months post-hospital discharge. Sample size was determined by thematic saturation of interviews within a concurrent qualitative assessment. We used the Society of Critical Care Medicine international consensus recommendations for PICS assessment. We assessed anxiety, depression, and post-traumatic stress disorder (PTSD) using the Hospital Anxiety and Depression Scale and Impact-of-Events Scale, respectively. We assessed physical impairment with the EQ-5D questionnaire, and cognitive impairment using the Montreal Cognitive Assessment-Blind. Data are means + standard deviation or number (percent). RESULTS: We completed telephone interviews with 50 of 173 eligible patients (53 contacted, 3 declined). Age was 57+13 years, duration of invasive mechanical ventilation was 14+8.2 days and PaO2:FiO2 ratio at intubation was 174±46. Delirium developed in 35 patients (70%). Six months post-discharge, 38 patients (76%) met criteria for PICS, with 1 or more domains impaired. Among patients with PICS, 22 (44%) were impaired in at least 2 domains, and 9 (18%) impaired in all 3 domains. PTSD was present in 17 patients (34%), anxiety in 19 (38%), and depression in 20 (40%). Twenty-four patients (48%) had impairments in activities of daily living. Nineteen patients (37%) demonstrated cognitive impairment. CONCLUSIONS Over three quarters of COVID-19-associated respiratory failure survivors demonstrated PICS 6 months after hospital discharge. Patients were commonly impaired in at least two domains. These estimates of PICS prevalence appear broadly similar to those reported in the pre-COVID-19 literature and should drive focused efforts to identify COVID-19 survivors at high risk for PICS prior to discharge.","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132853452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1214
S. Jain, T. Murphy, J. O’Leary, L. Leo‐Summers, L. Ferrante
{"title":"The Effect of Socioeconomic Disadvantage on Development of Functional Decline Following Critical Illness Among Older Adults","authors":"S. Jain, T. Murphy, J. O’Leary, L. Leo‐Summers, L. Ferrante","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1214","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1214","url":null,"abstract":"","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130510725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1210
J. Westrich, K. Wolfe, M. Stutz, S. Pearson, P. Lecompte-Osorio, J. Lin, C. Ward, C. Thompson, P. Herbst, A. Pohlman, J.B. Hall, J. Kress, B. Patel
RationaleThe novel coronavirus, COVID-19, can cause critical illness in up to 5% of infected patients. Although the sequelae of surviving critical illness are known, limited data exist regarding the psychological and cognitive outcomes specifically in survivors of COVID-19. Given the social isolation, scarcity of multidisciplinary staff, and socio-economic impact of the pandemic, understanding the cognitive and psychological impact of surviving critical illness due to COVID-19 is of utmost importance. MethodsA prospective observational cohort study at an academic medical center enrolled critically ill patients with confirmed COVID-19 infection. Upon hospital discharge, cognitive and psychological sequelae were measured using the following validated assessments: Montreal Cognitive Assessment (MoCA), Impact of Event Score (IES), and the Hospital Anxiety and Depression scale (HADS). Cognitive impairment was defined as a MoCA score 32. Significant symptoms of anxiety and depression were defined as a HADS subscale score of ≥8. ResultsFrom April 10, 2020 through November 17, 2020, 100 adult critically ill patients were enrolled, of which 27 were invasively mechanically ventilated. Eighty-nine patients underwent cognitive and psychological evaluation upon hospital discharge. Of the 11 patients who did not complete the evaluation, 2 died prior to discharge, 4 had significant cognitive impairment, 2 were discharged prior to survey completion, and 3 refused. Cognitive impairment was present in 93% of patients (n=83) with a median MoCA score of 17 [13-22]. Patients with cognitive impairment tended to be older (62 years old [53-71] vs 50 [41-58];p=0.17). Ten patients (11%) had probable PTSD with a median IES score of 4 [0-17] in the overall cohort. Seventeen patients (19%) reported significant depressive symptoms and twenty patients (22%) noted significant symptoms of anxiety. ConclusionPrior coronavirus outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were associated with anxiety, depression, impaired memory and confusion occurring in approximately one-third of patients at hospital discharge. In contrast, cognitive impairment in ICU survivors of COVID-19 infection was nearly universal on hospital discharge. This impairment is not completely explained by coexistent psychiatric symptoms of anxiety or depression, which were present in only one-fifth of the ICU survivors.
{"title":"Psychological and Cognitive Outcomes of Critically Ill COVID-19 Patients at Hospital Discharge","authors":"J. Westrich, K. Wolfe, M. Stutz, S. Pearson, P. Lecompte-Osorio, J. Lin, C. Ward, C. Thompson, P. Herbst, A. Pohlman, J.B. Hall, J. Kress, B. Patel","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1210","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1210","url":null,"abstract":"RationaleThe novel coronavirus, COVID-19, can cause critical illness in up to 5% of infected patients. Although the sequelae of surviving critical illness are known, limited data exist regarding the psychological and cognitive outcomes specifically in survivors of COVID-19. Given the social isolation, scarcity of multidisciplinary staff, and socio-economic impact of the pandemic, understanding the cognitive and psychological impact of surviving critical illness due to COVID-19 is of utmost importance. MethodsA prospective observational cohort study at an academic medical center enrolled critically ill patients with confirmed COVID-19 infection. Upon hospital discharge, cognitive and psychological sequelae were measured using the following validated assessments: Montreal Cognitive Assessment (MoCA), Impact of Event Score (IES), and the Hospital Anxiety and Depression scale (HADS). Cognitive impairment was defined as a MoCA score 32. Significant symptoms of anxiety and depression were defined as a HADS subscale score of ≥8. ResultsFrom April 10, 2020 through November 17, 2020, 100 adult critically ill patients were enrolled, of which 27 were invasively mechanically ventilated. Eighty-nine patients underwent cognitive and psychological evaluation upon hospital discharge. Of the 11 patients who did not complete the evaluation, 2 died prior to discharge, 4 had significant cognitive impairment, 2 were discharged prior to survey completion, and 3 refused. Cognitive impairment was present in 93% of patients (n=83) with a median MoCA score of 17 [13-22]. Patients with cognitive impairment tended to be older (62 years old [53-71] vs 50 [41-58];p=0.17). Ten patients (11%) had probable PTSD with a median IES score of 4 [0-17] in the overall cohort. Seventeen patients (19%) reported significant depressive symptoms and twenty patients (22%) noted significant symptoms of anxiety. ConclusionPrior coronavirus outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were associated with anxiety, depression, impaired memory and confusion occurring in approximately one-third of patients at hospital discharge. In contrast, cognitive impairment in ICU survivors of COVID-19 infection was nearly universal on hospital discharge. This impairment is not completely explained by coexistent psychiatric symptoms of anxiety or depression, which were present in only one-fifth of the ICU survivors.","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"464 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131955958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1206
A. Law, J. Stevens, E. Choi, C. Shen, A. Walkey
{"title":"Pre-ICU Health States and Patient Outcomes After Tracheostomy and Gastrostomy Placement in the Critically Ill","authors":"A. Law, J. Stevens, E. Choi, C. Shen, A. Walkey","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1206","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1206","url":null,"abstract":"","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123748934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1207
W. Kiker, R. Rutz Voumard, Erin K Kross, J. Curtis, C. Creutzfeldt
{"title":"Predicting Prognosis for Patients with Severe Acute Brain Injury: How Well Do Families, Physicians, and Nurses Align?","authors":"W. Kiker, R. Rutz Voumard, Erin K Kross, J. Curtis, C. Creutzfeldt","doi":"10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1207","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2021.203.1_meetingabstracts.a1207","url":null,"abstract":"","PeriodicalId":400837,"journal":{"name":"D9. D009 A BROADER VIEW OF OUTCOMES AFTER CRITICAL ILLNESS","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132122393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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