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Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year

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Abstract

Purpose

Reducing discomfort in the intensive care unit (ICU) should have a positive effect on long-term outcomes. This study assessed whether a tailored multicomponent program for discomfort reduction was effective in reducing post-traumatic stress disorder (PTSD) symptoms at 1 year in general ICU survivors.

Methods

This study is a prospective observational comparative effectiveness cohort study involving 30 ICUs. It was an extension of the IPREA3 study, a cluster-randomized controlled trial designed to assess the efficacy of a tailored multicomponent program to reduce discomfort in critically ill patients. The program included assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to the healthcare team, and site-specific tailored interventions. The exposure was the implementation of this program. The eligible patients were exposed versus unexposed general adult ICU survivors. The prevalence of substantial PTSD symptoms at 1 year was assessed based on the Impact of Event Scale–Revised (IES-R).

Results

Of the 1537 ICU survivors included in the study, 475 unexposed patients and 344 exposed patients had follow-up data at 1 year: 57 (12.0%) and 21 (6.1%) presented with PTSD at 1 year, respectively (p = 0.004). Considering the clustering and after adjusting for age, gender, McCabe classification, and ICU-related self-perceived overall discomfort score, exposed patients were significantly less likely than unexposed patients to have substantial PTSD symptoms at 1 year (p = 0.015).

Conclusions

Implementation of a tailored multicomponent program in the ICU that has proved to be effective for reducing self-perceived discomfort in general adult ICU survivors also reduced the prevalence of substantial PTSD symptoms at 1 year.

Trial registration

ClinicalTrials.gov identifier NCT02762409.

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Acknowledgments

This research was financially supported by a grant from the Programme de Recherche sur la Performance du Système de Soins, 2015, PREPS-15-000183, funded by the French Ministry of Health. We thank all of the nursing staff members and doctors whose enthusiasm and work have made this clinical trial possible. We particularly thank Anderson Loundou (Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France) for participating in the statistical analysis; Bénédicte Mauchien (CH de Chartres) for her major and invaluable role in providing technical and educational support to all the investigators under the supervision of the lead investigator; and Claude Martin and Marc Leone (CHU Hôpital Nord, AP-HM) for participating in the steering committee. Members of the IPREA-AQVAR study group: Co-investigators and collaborators (alphabetically by institution, all in France) from Centre Hospitalier (CH) d’Auxerre: Karine Vie; Centre Hospitalier (CHU) de Brest: Gwenaëlle Lannuzel; CHU Dijon Bourgogne: Jean-Philippe Parthiot, Isabelle Chazal, Philippe Charve, Caroline Prum, Nora Perrot, Francis Augier, Niloufar Behechti, Claudine Cocusse, Céline Foulon, Laurence Goncalves, Abdesselem Hanchi, Etienne Legros, Ana Isabel Mercier, Nicolas Meunier-Beillard, Nathalie Nuzillat, and Alicia Richard; CH de Douai: Benjamin Kowalski, and Elisa Klusek; CHU Raymond Poincaré, AP-HP: Andrea Polito, Caroline Duvallet, and Sonia Krim; Groupe Hospitalier de La Rochelle-Ré-Aunis: Nicolas Girard; CH de Chartres: Cécile Jourdain, and Stéphane Techer; CH Emile Roux, Le Puy-en-Velay: Corinne Chauvel, and Corinne Bruchet; CH de Lens: Johanna Temime, Stéphanie Beaussart, and Fabienne Jarosz; CHU Edouard Herriot, Hospices Civils de Lyon: Julien Crozon-Clauzel, Serge Olousouzian, Sylvie Pereira, Loïc Argentin, and Valérie Cerro; Hôpital Européen de Marseille: Déborah Levy; CHU Hôpital Nord, Assistance Publique Hôpitaux de Marseille: Sébastien Andre; Clinique Ambroise Paré, Neuilly/Seine: Philippe Estagnasie, Delphine Biet, and Steve Novak; CHU Nice: Jean-Christophe Orban, Aminata Diop, and Carole Ichai; CHU Cochin, AP-HP: Antoine Tesniere, Jean-Pascal Goupil, and Frédérique Laville; CHU Hôpital Européen Georges Pompidou, AP-HP: Nadège Rutter; Groupe Hospitalier Paris Saint-Joseph: Sandie Brochon, and Kelly Tiercelet; CHU Pitié-Salpêtrière, AP-HP: Nora Ait-Hamou, and Marjorie Leger; CHU Saint-Louis, AP-HP: Virginie Souppart; CHU La Milétrie, Poitiers: Emilie Griffault, Marie-Line Debarre, Céline Deletage, Anne-Laure Guerin, Carole Guignon, and Sabrina Seguin; CHU Strasbourg: Caroline Wuiot, Karine Sanches, and Stéphane Hecketsweiler; Centre Hospitalier Intercommunal Toulon/La Seyne sur mer: Catherine Sylvestre-Marconville and Vincent Gardan; and CH de Troyes: Georges Simon and Yana Chaban.

Author information

Authors and Affiliations

  1. Réanimation Polyvalente, Hôpital Louis Pasteur, Hôpitaux de Chartres, 28018, Le Coudray, France

    Pierre Kalfon & Juliette Audibert

  2. Unité de recherche CEReSS-EA3279, Aix-Marseille Université, Marseille, France

    Pierre Kalfon, Marine Alessandrini, Mohamed Boucekine, Karine Baumstarck & Pascal Auquier

  3. Réanimation, Clinique Ambroise Paré, Neuilly/Seine, France

    Stéphanie Renoult

  4. Département d’Anesthésie Réanimation, CHU Dijon Bourgogne, Dijon, France

    Marie-Agnès Geantot

  5. Réanimation, CH Troyes, Troyes, France

    Stéphanie Deparis-Dusautois

  6. Réanimation polyvalente, Centre Hospitalier Intercommunal Toulon/La Seyne sur mer, Toulon, France

    Audrey Berric

  7. Réanimation chirurgicale polyvalente, Hôpital Civil, CHU Strasbourg, Strasbourg, France

    Olivier Collange

  8. Réanimation polyvalente, CHU Edouard Herriot, Hospices Civils de Lyon, Lyon, France

    Bernard Floccard

  9. Réanimation chirurgicale, CHU La Milétrie, Poitiers, France

    Olivier Mimoz

  10. Réanimation de chirurgie cardiaque, CHU Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Amour Julien

  11. Réanimation médicale, CHU La Milétrie, Poitiers, France

    René Robert

  12. Réanimation médicale, CHU Brest, Brest, France

    Anne Renault

  13. Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, AP-HP, Paris, France

    Arnaud Follin

  14. Réanimation, CH Lens, Lens, France

    Didier Thevenin

  15. Réanimation Médico-Chirurgicale, Hôpital Pasteur, CHU Nice, Nice, France

    Nathalie Revel

  16. Réanimation Médicale, CHU Saint-Louis, AP-HP, Paris, France

    Marion Venot & Elie Azoulay

  17. Réanimation, CH Auxerre, Auxerre, France

    René-Gilles Patrigeon

  18. Réanimation, Hôpital Européen de Marseille, Marseille, France

    Thomas Signouret

  19. Réanimation chirurgicale, CHU Cochin, AP-HP, Paris, France

    Mélanie Fromentin

  20. Réanimation médicale adulte, CHU Raymond Poincaré, AP-HP, Paris, France

    Tarek Sharshar

  21. Réanimation chirurgicale, CHU Hôpital Nord, Assistance Publique–Hôpitaux de Marseille, Marseille, France

    Coralie Vigne

  22. Réanimation chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France

    Julien Pottecher

  23. Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France

    Quentin Levrat

  24. Réanimation, CH Émile Roux, Le Puy-En-Velay, France

    Achille Sossou

  25. Médecine intensive et réanimation, Groupe Hospitalier Paris Saint-Joseph, Paris, France

    Maïté Garrouste-Orgeas

  26. Réanimation médicale, CHU Dijon Bourgogne, Dijon, France

    Jean-Pierre Quenot

  27. Réanimation, CH Douai, Douai, France

    Claire Boulle

Authors
  1. Pierre Kalfon
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  2. Marine Alessandrini
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  3. Mohamed Boucekine
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  4. Stéphanie Renoult
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  5. Marie-Agnès Geantot
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  6. Stéphanie Deparis-Dusautois
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  7. Audrey Berric
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  8. Olivier Collange
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  9. Bernard Floccard
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  10. Olivier Mimoz
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  11. Amour Julien
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  12. René Robert
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  13. Juliette Audibert
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  14. Anne Renault
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  15. Arnaud Follin
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  16. Didier Thevenin
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  17. Nathalie Revel
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  18. Marion Venot
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  19. René-Gilles Patrigeon
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  20. Thomas Signouret
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  21. Mélanie Fromentin
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  22. Tarek Sharshar
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  23. Coralie Vigne
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  24. Julien Pottecher
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  25. Quentin Levrat
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  26. Achille Sossou
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  29. Claire Boulle
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  30. Elie Azoulay
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  31. Karine Baumstarck
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  32. Pascal Auquier
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Consortia

the IPREA-AQVAR Study Group

  • Karine Vie
  • , Gwenaëlle Lannuzel
  • , Jean-Philippe Parthiot
  • , Isabelle Chazal
  • , Philippe Charve
  • , Caroline Prum
  • , Nora Perrot
  • , Francis Augier
  • , Niloufar Behechti
  • , Claudine Cocusse
  • , Céline Foulon
  • , Laurence Goncalves
  • , Abdesselem Hanchi
  • , Etienne Legros
  • , Ana Isabel Mercier
  • , Nicolas Meunier-Beillard
  • , Nathalie Nuzillat
  • , Alicia Richard
  • , Benjamin Kowalski
  • , Elisa Klusek
  • , Andrea Polito
  • , Caroline Duvallet
  • , Sonia Krim
  • , Nicolas Girard
  • , Cécile Jourdain
  • , Stéphane Techer
  • , Corinne Chauvel
  • , Corinne Bruchet
  • , Johanna Temime
  • , Stéphanie Beaussart
  • , Fabienne Jarosz
  • , Julien Crozon-Clauzel
  • , Serge Olousouzian
  • , Sylvie Pereira
  • , Loïc Argentin
  • , Valérie Cerro
  • , Déborah Levy
  • , Sébastien Andre
  • , Philippe Estagnasie
  • , Delphine Biet
  • , Steve Novak
  • , Jean-Christophe Orban
  • , Aminata Diop
  • , Carole Ichai
  • , Antoine Tesniere
  • , Jean-Pascal Goupil
  • , Frédérique Laville
  • , Nadège Rutter
  • , Sandie Brochon
  • , Kelly Tiercelet
  • , Nora Ait-Hamou
  • , Marjorie Leger
  • , Virginie Souppart
  • , Emilie Griffault
  • , Marie-Line Debarre
  • , Céline Deletage
  • , Anne-Laure Guerin
  • , Carole Guignon
  • , Sabrina Seguin
  • , Caroline Wuiot
  • , Karine Sanches
  • , Stéphane Hecketsweiler
  • , Catherine Sylvestre-Marconville
  • , Vincent Gardan
  • , Georges Simon
  •  & Yana Chaban

Corresponding author

Correspondence to Pierre Kalfon.

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Conflicts of interest

Dr. Kalfon has received consulting fees from Philips Healthcare and General Electric Healthcare. On behalf of all remaining authors, the corresponding author states that the remaining authors have no conflict of interest.

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Members of the IPREA-AQVAR Study Group are listed in the “Acknowledgements” section.

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Kalfon, P., Alessandrini, M., Boucekine, M. et al. Tailored multicomponent program for discomfort reduction in critically ill patients may decrease post-traumatic stress disorder in general ICU survivors at 1 year. Intensive Care Med 45, 223–235 (2019). https://doi.org/10.1007/s00134-018-05511-y

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