Pamela MacTavish

Caregiver strain following critical care discharge: An exploratory evaluation

OBJECTIVE The objective of this exploratory evaluation was to understand the impact of critical care survivorship on caregivers. DESIGN Family members who attended a quality improvement initiative within our critical care unit were asked to complete 4 questionnaires. SETTING The setting for this study was a 20-bedded mixed critical care unit in a large teaching hospital in Scotland. Data were collected as a part of an evaluation of a quality improvement initiative. PARTICIPANTS Thirty-six carers completed the questionnaire set. MEASUREMENTS AND MAIN RESULTS A total of 53% of caregivers suffered significant strain. Poor quality of life in the patient was significantly associated with higher caregiver strain (P= .006). Anxiety was present in 69% of caregivers. Depression was present in 56% of caregivers, with a significant association between carer strain and depression (P< .001). Those caregivers who were defined as being strained also had significantly higher Insomnia Severity Index scores than those without carers strain (P= .007). CONCLUSION This evaluation has demonstrated that there is a significant burden for caregivers of critical care survivors. Furthermore, they reported high levels of posttraumatic stress disorder, anxiety, depression, and insomnia. Future work on rehabilitation from critical care should focus on the inclusion of caregivers.

Peer support to improve recovery following critical care discharge: a case-based discussion

We report the case of a self-employed builder aged 58-years, with a medical history of ischaemic heart disease and type II diabetes. He was transferred to our intensive care unit (ICU) from another local hospital for treatment of gallstone pancreatitis. He stayed in critical care for 19 days, with a total hospital stay of 9 weeks. He and his wife have consented to the presentation of their case. This patient required level three care (ICU care) for 3 days. He required level two care (high dependency care) for a further 16 days due to complications related to his acute kidney injury and pancreatitis. He was mechanically ventilated for 3 days with a worst P/F ratio of 150 mmHg and underwent renal replacement therapy for 8 days. As per standard practice in the ICU at the time, he was visited by physical therapy on 17 of his 19 ICU days. This patient has two children and a wife who works as a Nursery Teacher. After discharge from hospital, he returned to his own home. At discharge from hospital, aerobic capacity was assessed using the incremental shuttle walk test. The patient scored a metabolic equivalent of 2.4 on this test (this represents an ability to undertake a low intensity exercise programme).1 Grip strength measurements were obtained and were 16 kg (right hand) and 12 kg (left hand), less than half of expected when compared with the population norm.2 At home, further nutritional support from a nasogastric tube (NGT) was required. The patient also had significant fatigue, limb weakness, lethargy, decreased balance and shortness of breath. At 2 months post-discharge from hospital, neither he nor his wife had returned to work. In light of these problems, at 2 months post-ICU discharge, both the patient and his wife were invited to participate in Intensive Care Syndrome: Promoting Independence and Return to Employment …

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention

Background Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors. Methods Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008–2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID. Results 40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07–0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15). Conclusions and relevance This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.

A study to explore the experiences of patient and family volunteers in a critical care environment: a phenomenological analysis

Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic pain [1, 2]. Methods: Discharged patients from ICU attended a 5 week multidisciplinary rehabilitation programme as part of a quality improvement initiative within Glasgow Royal Infirmary ICU. Participants completed a one-one musculoskeletal assessment with an ICU physiotherapist. Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected from 47 of the 48 patients who attended the programme (median age was 52 (IQR, 44-57), 67% of the patients were men, median ICU length of stay (LOS) was 15 days (IQR 9-25) and median APACHE II was 23 (IQR 18-27). 66% of participants (n = 47) reported a new incidence of pain since discharge from ICU, 28% reporting lower limb (LL) pain and 25% reporting shoulder pain. Bilateral symptoms were reported in 84% of those who complained of lower limb pain in contrast to 25% of those with shoulder pain. In relation to muscle weakness, 74% of participants presented with LL weakness compared with 51% in the upper limb (UL). UL joint range of movement was reduced in 40% of participants and a 19% reduction for the LL. 23% of all participants reported numbness in UL/LL or both. Conclusions: Musculoskeletal problems especially shoulder pain and bilateral LL pain and weakness remain a significant problem for survivors of critical illness. This may have implications regarding falls risks, exercise capacity and reduce the likelihood of patients returning to work. Shoulder pain was found to be one of the most common complaints of pain supporting other research [1] with contributing factors such as the position of ventilator tubing, dialysis lines or central lines hypothesised. Collecting this data has helped raise awareness of these problems and may strengthen the case for more equipment for active mobilisation in ICU and herald a need for increased understanding in downstream wards on ICUAW.

Musculoskeletal problems in intensive care unit patients post discharge

Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic pain [1, 2]. Methods: Discharged patients from ICU attended a 5 week multidisciplinary rehabilitation programme as part of a quality improvement initiative within Glasgow Royal Infirmary ICU. Participants completed a one-one musculoskeletal assessment with an ICU physiotherapist. Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected from 47 of the 48 patients who attended the programme (median age was 52 (IQR, 44-57), 67% of the patients were men, median ICU length of stay (LOS) was 15 days (IQR 9-25) and median APACHE II was 23 (IQR 18-27). 66% of participants (n = 47) reported a new incidence of pain since discharge from ICU, 28% reporting lower limb (LL) pain and 25% reporting shoulder pain. Bilateral symptoms were reported in 84% of those who complained of lower limb pain in contrast to 25% of those with shoulder pain. In relation to muscle weakness, 74% of participants presented with LL weakness compared with 51% in the upper limb (UL). UL joint range of movement was reduced in 40% of participants and a 19% reduction for the LL. 23% of all participants reported numbness in UL/LL or both. Conclusions: Musculoskeletal problems especially shoulder pain and bilateral LL pain and weakness remain a significant problem for survivors of critical illness. This may have implications regarding falls risks, exercise capacity and reduce the likelihood of patients returning to work. Shoulder pain was found to be one of the most common complaints of pain supporting other research [1] with contributing factors such as the position of ventilator tubing, dialysis lines or central lines hypothesised. Collecting this data has helped raise awareness of these problems and may strengthen the case for more equipment for active mobilisation in ICU and herald a need for increased understanding in downstream wards on ICUAW.

Physical outcome measure for critical care patients following intensive care discharge

Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic pain [1, 2]. Methods: Discharged patients from ICU attended a 5 week multidisciplinary rehabilitation programme as part of a quality improvement initiative within Glasgow Royal Infirmary ICU. Participants completed a one-one musculoskeletal assessment with an ICU physiotherapist. Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected from 47 of the 48 patients who attended the programme (median age was 52 (IQR, 44-57), 67% of the patients were men, median ICU length of stay (LOS) was 15 days (IQR 9-25) and median APACHE II was 23 (IQR 18-27). 66% of participants (n = 47) reported a new incidence of pain since discharge from ICU, 28% reporting lower limb (LL) pain and 25% reporting shoulder pain. Bilateral symptoms were reported in 84% of those who complained of lower limb pain in contrast to 25% of those with shoulder pain. In relation to muscle weakness, 74% of participants presented with LL weakness compared with 51% in the upper limb (UL). UL joint range of movement was reduced in 40% of participants and a 19% reduction for the LL. 23% of all participants reported numbness in UL/LL or both. Conclusions: Musculoskeletal problems especially shoulder pain and bilateral LL pain and weakness remain a significant problem for survivors of critical illness. This may have implications regarding falls risks, exercise capacity and reduce the likelihood of patients returning to work. Shoulder pain was found to be one of the most common complaints of pain supporting other research [1] with contributing factors such as the position of ventilator tubing, dialysis lines or central lines hypothesised. Collecting this data has helped raise awareness of these problems and may strengthen the case for more equipment for active mobilisation in ICU and herald a need for increased understanding in downstream wards on ICUAW.

Classification of pain and its treatment at an intensive care rehabilitation clinic

Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic pain [1, 2]. Methods: Discharged patients from ICU attended a 5 week multidisciplinary rehabilitation programme as part of a quality improvement initiative within Glasgow Royal Infirmary ICU. Participants completed a one-one musculoskeletal assessment with an ICU physiotherapist. Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected from 47 of the 48 patients who attended the programme (median age was 52 (IQR, 44-57), 67% of the patients were men, median ICU length of stay (LOS) was 15 days (IQR 9-25) and median APACHE II was 23 (IQR 18-27). 66% of participants (n = 47) reported a new incidence of pain since discharge from ICU, 28% reporting lower limb (LL) pain and 25% reporting shoulder pain. Bilateral symptoms were reported in 84% of those who complained of lower limb pain in contrast to 25% of those with shoulder pain. In relation to muscle weakness, 74% of participants presented with LL weakness compared with 51% in the upper limb (UL). UL joint range of movement was reduced in 40% of participants and a 19% reduction for the LL. 23% of all participants reported numbness in UL/LL or both. Conclusions: Musculoskeletal problems especially shoulder pain and bilateral LL pain and weakness remain a significant problem for survivors of critical illness. This may have implications regarding falls risks, exercise capacity and reduce the likelihood of patients returning to work. Shoulder pain was found to be one of the most common complaints of pain supporting other research [1] with contributing factors such as the position of ventilator tubing, dialysis lines or central lines hypothesised. Collecting this data has helped raise awareness of these problems and may strengthen the case for more equipment for active mobilisation in ICU and herald a need for increased understanding in downstream wards on ICUAW.

Pharmacy intervention at an intensive care rehabilitation clinic

Introduction: The aim of this study was to examine the incidence of musculoskeletal problems (i.e. pain, weakness, decreased joint range of movement) in critical care patients post discharge. Post intensive care syndrome (PICS) is now a widely used term to describe the collection of problems patients develop due to their stay in intensive care. ICU survivors have been found to have a high risk of developing not only psychological problems but physical problems such as Intensive Care Unit Acquired Weakness (ICUAW) and chronic pain [1, 2]. Methods: Discharged patients from ICU attended a 5 week multidisciplinary rehabilitation programme as part of a quality improvement initiative within Glasgow Royal Infirmary ICU. Participants completed a one-one musculoskeletal assessment with an ICU physiotherapist. Ethics approval was waived as the programme was part of a quality improvement initiative. Results: Data was collected from 47 of the 48 patients who attended the programme (median age was 52 (IQR, 44-57), 67% of the patients were men, median ICU length of stay (LOS) was 15 days (IQR 9-25) and median APACHE II was 23 (IQR 18-27). 66% of participants (n = 47) reported a new incidence of pain since discharge from ICU, 28% reporting lower limb (LL) pain and 25% reporting shoulder pain. Bilateral symptoms were reported in 84% of those who complained of lower limb pain in contrast to 25% of those with shoulder pain. In relation to muscle weakness, 74% of participants presented with LL weakness compared with 51% in the upper limb (UL). UL joint range of movement was reduced in 40% of participants and a 19% reduction for the LL. 23% of all participants reported numbness in UL/LL or both. Conclusions: Musculoskeletal problems especially shoulder pain and bilateral LL pain and weakness remain a significant problem for survivors of critical illness. This may have implications regarding falls risks, exercise capacity and reduce the likelihood of patients returning to work. Shoulder pain was found to be one of the most common complaints of pain supporting other research [1] with contributing factors such as the position of ventilator tubing, dialysis lines or central lines hypothesised. Collecting this data has helped raise awareness of these problems and may strengthen the case for more equipment for active mobilisation in ICU and herald a need for increased understanding in downstream wards on ICUAW.

575: Drug History As A Measure Of Comorbidity And Predictor Of Long Term Outcome Following Icu Admission

Learning Objectives: Comorbidity in patients in ICU has been shown to have an adverse effect on survival. While many scoring systems exist for assessing disease severity and estimating mortality in critically ill patients, they rarely take into consideration the full burden of comorbidity. Previous scoring systems have been developed for quantifying disease burden, but few have used drug history to directly measure this. This study aims to develop a prognostic tool based solely on patients’ repeat prescriptions, as a method of quantifying disease burden, and assess its ability to predict long term outcomes. Methods: The Medication-based Disease Burden Index (2006) was updated and modified. A retrospective search (using CareVue) for patients admitted to Glasgow Royal Infirmary ICU between 10/2007 and 11/2010 was carried out in order to obtain full drug histories from the time of admission. These patients were then individually scored using the modified MDBI. A second search was carried out using Clinical Portal to ascertain long-term survival. Survival analysis using Kaplan-Meier and Cox Proportional Hazards was carried out to illustrate any relationship between total score and survival probability, including correction for APACHE II score Results: 562 patients were included in the analysis. Survival probability dropped with increasing score: over 80% survival at 5 yr in those scoring zero, dropping to less than 40% in those with a high score. Log rank test was highly significant (p<0.0001). Hazard ratios for each of the 3 score groups showed an incremental increase in risk when compared to the zero score group, which was significant in each case (low score: HR 2.12(1.40–3.23) p<0.0001, medium score: HR 2.87(1.85–4.45) p<0.0001, high score: HR 5.16(3.08–8.64) p<0.0001). Results remained significant after adjusting for APACHE II score. Conclusions: This gives promising, significant evidence of a simple and useful predictive tool for quantifying comorbidity and the effect it has on long term survival following ICU admission. Further work is required to replicate its use in other populations, and in larger samples.