Thread by @WellingtonICU

The first @wellingtonicu journal club of 2019 is a single centre pilot trial
investigating the use of ICU diaries and psychoeduction in prevention of PTSD
insights.ovid.com/pubmed?pmid=30…

ICU patients are particularly susceptible to PTSD due to things like:
1. the severity of their illnesses
2. loss of circadian rhythm
3. pain
4. sedation
5. paralysis
6. delirium
7. Requirements for unpleasant interventions.

The aim of this study was to investigate whether implementation of “ICU Diaries” and “Psychoeducation” was feasible in a trial setting

Eligible patients were adults with a predicted ICU stay of 72 hours & an expected duration of mechanical ventilation of 24 hours or more.

Patients with no caregivers/family available, life expectancy <6 months, pre existing cognitive deficit, and primary neurological or psychiatric admission diagnosis.

Patients were randomly assigned to 1 of the following 4 groups:
1. usual ICU
2. ICU diary
3. Psychoeducation
4. ICU diary and Psychoeducation

The “ICU diaries” were completed by family members and staff. They also included photos taken by the research nurses. Diaries were reviewed with the patient and a member of the research team 30 days post ICU discharge.

In the “psychoeducation” consisted of a brochure detailing common ICU procedures and experiences 30 days post discharge.

PTSD, Depression and Anxiety were assessed by various recognised instruments at 7, 30 and 90 days post ICU discharge.

Consent was obtained from 58 of 100 families; however, only 37 to 58 of enrolled patients (64%) completed the study:
21% died
10% withdrew
3% were lost to follow up

93% of the“ICU diary” participants claimed their diary
96% of the “Psychoeducation” participants received their brochure

A majority of patients reported distressing memories of their ICU stay.

Patients, families and staff involved with ICU diaries found them useful and not too burdensome.

Those who received the diary intervention had statistically significantly lower anxiety and depression scores

There was a higher than anticipated withdrawal from the “psychoeducation” arm. Such withdrawal might be more likely in people who have PTSD, which potentially introduces bias.

Overall, this pilot study suggests further investigation is feasible.

In @wellingtonICU we already offer diaries to long stay patients and their families but it would be nice to see this study prompt further research to determine whether or not this improves neuropsychiatric outcomes for patients and their families.

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