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After a critical illness, ICU diaries given to patients after discharge reduce symptoms of posttraumatic stress disorder

Parker AM, Sricharoenchai T, Raparla S, et al. Posttraumatic Stress Disorder in Critical Illness Survivors: A Metaanalysis. Crit Care Med. 2015;43:1121-9.

Review question

In adults who survive a critical (life-threatening) illness, can interventions prevent or reduce symptoms of posttraumatic stress disorder (PTSD)?

Background

People who are critically ill are usually treated in intensive care units (ICUs).

PTSD can occur in people who were exposed to terrifying events. Symptoms may include severe anxiety, negative mood changes, flashbacks to the events, nightmares, or persistent, unwanted, and frightening memories.

After a critical illness, some people may develop symptoms of PTSD. Interventions may reduce the risk of getting PTSD or reduce symptoms of PTSD.

How the review was done

The reviewers did a systematic review, searching for studies that were published up to March 2014. They found 3 randomized controlled trials with 764 people.

The key features of the studies were:

  • people were adults who survived a critical illness;
  • interventions included ICU diaries, which were completed during the ICU stay and given to patients after discharge; a self-help rehabilitation manual; and a follow-up clinic led by nurses;
  • interventions were compared with usual care or no intervention; and
  • PTSD symptoms were assessed at least 1 month after people were discharged from the ICU and went home.

What the researchers found

Compared with usual care or no intervention:

  • ICU diaries reduced PTSD symptoms and the number of people who got PTSD by 3 months after ICU discharge;
  • a self-help rehabilitation manual reduced PTSD symptoms at 2 but not 6 months after discharge; and
  • a follow-up clinic led by nurses did not reduce PTSD symptoms at 6 or 12 months after discharge.

Conclusion

In adults who survive a critical illness, diaries completed in the ICU and given to patients after discharge reduced symptoms of posttraumatic stress disorder at 3 months. A follow-up clinic led by nurses did not reduce symptoms.

Effect of interventions to prevent PTSD or reduce PTSD symptoms in adults who survive a critical illness

Interventions*

Number of trials (people)

Effect of intervention on PTSD symptoms after discharge from the ICU

ICU diary

1 trial (352 people)

Reduced PTSD symptoms at 3 months

8 fewer people out of 100 (5% vs 13%) developed new PTSD at 3 months (from as few as 2 to as many as 15)

Self-help rehabilitation manual

1 trial (126 people)

Reduced PTSD symptoms at 2 months but not 6 months

Follow-up clinic led by nurses

1 trial (286 people)

No effect on PTSD symptoms at 6 months or 12 months

ICU = intensive care unit; PTSD = posttraumatic stress disorder.

*Interventions were compared with usual care or no intervention.




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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