| Part I A meta-analysis of risk factors for PTSD in intensive care unit survivorsObjective To conduct a meta-analysis of risk factors for posttraumatic stress disorder symptoms in intensive care unit survivors.Methods Electric databases and references of included studies were searched.Two reviewers independently screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the quality of included studies.Meta-analysis was conducted using Rev Man5.3.Results Totally 29 studies were identified from 864 papers including 5125 cases.A total of 115 risk factors were involved,and female,low education status,Charlson Comorbidity index,usage of hydrocortisone,usage of depressant,history of psychiatric disease were identified as having cumulative effects on PTSD among ICU survivors [OR/RR and 95%CI were 1.39(1.17,1.66),0.88(0.80,0.97),1.31(1.03,1.65),0.13(0.04,0.39),3.70(1.7,8.05),and 3.75(1.96,7.18),respectively].Conclusions Because of insufficient evidence on risk factors for PTSD and inconsistent evaluation methods of PTSD and different follow-up time,more strictly designed original studies are needed to provide supports for early clinical interventions.Part II The effect of non-pharmacological interventions on PTSD and long-term outcomes in adult ICU survivorsObjective To evaluate the viability and effectiveness of psychosocial interventions for post-ICU PTSD and their long-term stress-related disorders.To determine the effect of ICU diary on ICU memory,PTSD and stress-related symptoms of adults in two cardiac surgery intensive care unit.Methods There were two stages: First stage,we searched MEDLINE,EMBASE,CENTRAL,psyc INFO,CINAHL,CBM-disc,CNKI,Wan Fang and VIP from 1980 to June 2016.Eligible studies included RCTs and quasi-RCTs compered psychosocial interventions with usual care in critically ill adults,and that reported PTSD,health-related quality of life(HRQOL)or other stress-related disorders after more than one month discharge from ICU.Two reviewers independently identified trials,extracted data,and assessed the risk of bias of eligible studies.We calculated pooled relative risk(RR)for dichotomous outcomes and mean difference for continuous outcomes,with the corresponding 95% confidence interval(CI).Second stage,a RCT to determine the effects of ICU diary on ICU memory,PTSD and stress-related symptoms of adults in two cardiac surgery intensive care unit.was performed.One hundred and twenty-six patients were randomlyassigned to intervention group(n=63)and the control group(n=63).Intervention group got their ICU diary post-ICU,when control group under usual care.ICU memory was evaluated after one month post-ICU,and after three month post-ICU,PTSD symptoms and prevalence,sleep quality,anxiety,depression and health-related quality of life were evaluated too.Results1.Results of meta-analysisSeven studies were included with a total of 1082 participants.The results of meta-analysis showed that psychosocial intervention didn't significantly reduce the prevalence of PTSD in ICU survivors(RR= 0.91;95% CI,0.72-1.15;p=0.43).Psychosocial interventions did reduce the “caseness” of anxiety(RR=0.61;95%CI,0.41-0.91;p=0.02)and depression(RR=0.51;95%CI,0.31-0.86;p=0.009).ICU diary is the most common psychosocial intervention to protect PTSD,anxiety and depression.Insufficient data could be extracted from included studies about the effect on health-related quality of life,sleep quality and cost.2.Results of clinical trials(1)16 cases dropped out of the experimental group and 11 cases in the control group.After one month post ICU,the final analysis of the experimental group and the control group were 44 and 46 cases,out of the ICU after three months into the final analysis of the intervention group and the control group were 43 and 47 cases.(2)ICU memory:(1)After intervention,the pre-ICU memory differences was not statistically significant between the intervention group and the control group(P>0.05).(2)There was significant difference in memory during ICU between the two groups(P <0.05).The difference between the two groups in “remember all the stay clearly” was statistically significant(P <0.05).The number of factual memory was significant increased in intervention group(P <0.05),but was not significant in control group(P> 0.05).(3)The difference between the two groups in “had any intrusive memories from your time in hospital or of the event that lead up to your admission” was statistically significant(P <0.05).There was no significant difference in “had any unexplained feelings of panic or apprehension” between the two groups(P> 0.05).(3)PTSD:(1)The difference of PTSD symptoms between the two groups were statistically significant(P <0.05).Especially,the scores of hyperarousal of the intervention group was significantly lower than those of the control group.(2)There was no significant difference in the prevalence of PTSD between the intervention group and the control group after the intervention(P> 0.05).(4)Sleep: The difference of sleep score between the intervention group and the control group was statistically significant(P <0.05).The sleep of the intervention group was better than the control group.The differences in total sleep time and sleep efficiency dimension were statistically significant between the two groups(P <0.05),and the score of the intervention group was lower than that of the control group.The difference was not statistically significant in sleep quality,latency,sleep disorder,hypnotic drugs,daytime dysfunction between two groups(P> 0.05).(5)Anxiety and depression: There was no significant difference in the scores of anxiety and depression between the intervention group and the control group(P>0.05).There was significant difference in the positive rate of anxiety between pre-intervention and post-intervention,both the intervention group and the control group(P <0.05).But the differences was not significant in depression.(6)HRQoL: The difference of SF-36 score between the intervention group and the control group was statistically significant(P <0.05).The total score of SF-36 in the intervention group was higher than that in the control group.The differences of dimension scores in role-physical(RP),Vitality(VT),social functioning(SF)and mental component summary(MCS)were statistically significant(P <0.05).The scores of the intervention group were higher than those of the control group.There were no significant differences in body pain(BP),physiological function(PF),general health(GH),role-emotional(RE),mental health(MH)and physical component summary(PCS)dimension scores(P> 0.05).Conclusions1.Psychosocial intervention can't protect PTSD in ICU survivors.However,it is effective in reducing the risk of anxiety disorder and depression disorder among adult ICU survivors.ICU diaries are useful to reduce PTSD prevalence,but the number of study is limited.Further high quality and rigorous designed RCTs are needed to validate the effect of psychosocial intervention.2.ICU diary could improve ICU memory,especially to increase the factual memory and to improve the self-perceived level of memory during ICU.3.ICU diary was not efficient in reducing the prevalence of PTSD patients,but could decresea some part of the PTSD symptoms.4.ICU diary resulted in better subjective sleep quality of ICU survivors,the improvement of anxiety and depression were not obvious.5.ICU diary was an effective intervention on improving the health-related quality of life of ICU survivors after three months post-ICU. |
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