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Long-term effect of the ICU-diary concept on quality of life after critical illness
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Burn Center. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Plastic Surgery, Hand surgery UHL. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
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2010 (English)In: ACTA ANAESTHESIOLOGICA SCANDINAVICA, ISSN 0001-5172, Vol. 54, no 6, 736-743 p.Article in journal (Refereed) Published
Abstract [en]

Background Critically ill patients often spend time in the intensive care unit (ICU) either unconscious or sedated. On recovery, they are often in a state of confusion with memory loss that may be associated with a longstanding reduction in health-related quality of life (QoL). We hypothesised that the ICU-diary concept could improve their QoL by filling in their memory gaps. Methods A non-randomised, prospective study in a non-academic eight-bedded general ICU. A group of patients (n=38) were selected to receive the ICU-diary concept (keeping a diary with photos while on the ICU plus a follow-up meeting) when a long and complicated course was expected. Health-related QoL at 6, 12, 24 and 36 months was compared with a group that did not receive the ICU-diary (n=224). The Medical Outcomes Study 36-Item Short-Form (SF-36) was used to measure health-related QoL. Multiple regression models adjusted for age, sex, illness severity, pre-existing disease and diagnostic category was used to analyse the effects of the ICU-diary concept at 6 months, and changes over time were analysed using repeated measures MANOVA. Results Crude and adjusted scores for two dimensions of SF-36 (general health and vitality) and the physical component summary score were significantly higher at 6 months in the ICU-diary group (P andlt; 0.05) and some of the effects remained during the 3-year follow-up period (P andlt; 0.05). Conclusion The ICU-diary concept was associated with improved health-related QoL during the 3-year follow-up period after a critical illness. The effect of this intervention needs to be confirmed in a larger randomised study.

Place, publisher, year, edition, pages
Blackwell Publishing Ltd , 2010. Vol. 54, no 6, 736-743 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-57425DOI: 10.1111/j.1399-6576.2010.02230.xISI: 000278292400011OAI: oai:DiVA.org:liu-57425DiVA: diva2:325448
Available from: 2010-06-18 Created: 2010-06-18 Last updated: 2012-03-13
In thesis
1. The photo-diary and follow-up appointment on the ICU: Giving back the time to patients and relatives.: A descriptive and interventional study
Open this publication in new window or tab >>The photo-diary and follow-up appointment on the ICU: Giving back the time to patients and relatives.: A descriptive and interventional study
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients on the ICU often spend a great deal of their time either unconscious or heavily sedated. When they return from the zone between life and death they are often in a state of confusion where dreams and delusions are intertwined with reality and it is not always easy to distinguish them apart. These experiences could lead to psychological problems and post-traumatic stress disorder (PTSD). Recovery may be improved by filling in the significant memory gaps and explaining what really happened during the “chaotic” time on the ICU. The provision of a diary describing the patients’ stay in ICU on a day to day basis and a follow-up meeting (together named the ICU-diary concept), may help the whole family to understand.

Aim: The principal aim of this thesis was to see if the ICU-diary concept was of help to patients and relatives in the recovery after critical illness. A further aim was to look for precipitants in the ICU of PTSD.

Material and Methods: ICU patients in a handful of European countries and their relatives have been studied. The studies have been single and multi-centred and we have used descriptive observational, randomised controlled and cohort study designs, including matched case-control designs. Quantitative methods have been used with questionnaires and structured interviews using established instruments (i.e Post-traumatic stress syndrome screening-14, Post-traumatic diagnostic scale, ICU memory tool, Short Form-36, Pearlin-Schooler Mastery Scale, Hopelessness scale) as the principal means of data collection.

Results: The ICU-diary concept was seen to be a positive and useful aid in helping patients and their relatives understand the events that took place during the time on the ICU. It also decreased the risk for PTSD among patients and relatives. Patients that were supported with the ICU-diary concept perceived a better health-related quality of life even 3 years after the ICU stay. We did not find any definite improvement by the ICU-diary concept in mastery and hope. Variations in how the patients were cared for in the ICU had a significant effect on the development of PTSD. The implementation of an ICU diary, for instance, was associated with a lower frequency of PTSD.

Conclusions: The ICU-diary concept was found helpful by patients and their relatives. It was associated with a reduction in new onset PTSD and improved health-related quality of life. The results are encouraging and suggest that an ICU diary may represent an important first step to help patients and relatives come to terms with their experiences during critical illness.ISBN 978-

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 44 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1259
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70485 (URN)978-91-7393-076-5 (ISBN)
Public defence
2011-09-30, Fornborgen, Vrinnevisjukhuset, Norrköping, 13:00 (Swedish)
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Available from: 2011-09-09 Created: 2011-09-09 Last updated: 2012-06-20Bibliographically approved

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Bäckman, CarlOrwelius, LottiSjöberg, FolkeFredrikson, MatsWalther, Sten

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