ICU 日記が,機械呼吸器を施した患者のトラウマ後ストレス障害の症状に与える影響:ランダム化臨床試験
Maité Garrouste-Orgeas1,2,3, Cécile Flahault4, Isabelle Vinatier5
1Infection, Antimicrobials, Modelling, Evolution (IAME), UMR 1137, INSERM, Paris Diderot University, Department of Biostatistics - HUPNVS. - AP-HP, UFR de Médecine - Bichat University Hospital, Paris, France.
JAMA
|July 17, 2019
まとめ
ICUの日記は,メカニカル換気後の患者におけるトラウマ後ストレス障害 (PTSD) の症状を有意に軽減しませんでした. この研究は,この集団におけるPTSD症状の予防に ICU日記が効果的でないことを示唆しています.
科学分野:
- クリティカル ケア 医療
- 精神外傷学
- 健康心理学
背景:
- 集中治療室 (ICU) に 入院すると,トラウマ後ストレス障害 (PTSD) を含む精神的苦痛が引き起こされます.
- ICUの日記は 臨床医や家族によって保管されていて 心理的な影響を軽減する 介入の可能性があるのです
- 以前の研究では 集中治療室の日記がPTSDの症状を 軽減するのに役立つ可能性が示唆されていました
研究 の 目的:
- 集中治療室に収容された患者の間で重要なPTSD症状の発生率を減らすためのICU日記の有効性を評価する.
- 集中治療室の日記が患者とその家族の両方の不安やうつ病などの他の心理的結果に与える影響を評価する.
主な方法:
- 機械呼吸器を受けた657人の成人患者を対象とした多センター,評価者盲検,ランダム化臨床試験.
- 患者はICU日記 (介入群) または通常のICUケア (対照群) にランダムに割り当てられました.
- 主要なアウトカムであるPTSDの症状は,ICU退院後3ヶ月後にインパクト・イベント・スケール (IES- R) を使用して評価されました.
主要な成果:
- 介入群 (29. 9%) と対照群 (34. 3%) の間で,重大なPTSD症状の発生率の有意な差は認められませんでした (リスク差, - 4%; P=. 39).
- IES- Rの平均スコアもグループ間で比較可能でした.
- 不安,うつ,ICU滞在の患者の記憶を含む,事前に指定された二次的アウトカムでは,有意な違いは見つかりませんでした.
結論:
- 医療従事者や家族によって記入されたICU日記の使用は,ICUで機械呼吸器を受けた患者のPTSD症状を有意に軽減しませんでした.
- これらの発見は,この患者集団におけるPTSDの症状を予防するための戦略として,ICU日記を日常的に使用することを支持しません.
- ICU滞在後の心理的回復のための代替または補助的な介入を探るには,さらなる研究が必要です.
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