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身体外膜酸素化の関連性と重症の成人生存者の新しい精神的健康診断

Shannon M Fernando ^1,2,3, Mary Scott ^2,4,5,6, Robert Talarico ^2,4

¹Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
²Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³Department of Critical Care, Lakeridge Health Corporation, Oshawa, Ontario, Canada.
⁴ICES, Toronto, Ontario, Canada.
⁵School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁶Bruyère Research Institute, Ottawa, Ontario, Canada.
⁷Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
⁸Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
⁹Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
¹⁰Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada.
¹¹Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹²Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
¹³Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁴Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁵Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, Victoria, Australia.
¹⁶Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁷Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
¹⁸Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
¹⁹Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore.
²⁰Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Republic of Singapore.
²¹Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
²²Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
²³Sorbonne Université, Institute of Cardiometabolism and Nutrition, Paris, France.
²⁴Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Institut de Cardiologie, Paris, France.
²⁵Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
²⁶Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York.
²⁷Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
²⁸Institut du Savoir Montfort, Hôpital Montfort, Ottawa, Ontario, Canada.

⁰Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

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2022年10月26日

PubMedで要約を見る

まとめ

外体膜酸素療法 (ECMO) の生存者は,他の集中治療室 (ICU) の生存者と比較して,退院後に新しい精神疾患の診断を受けるリスクが高い. この研究は,ECMO患者の継続的な精神的健康モニタリングの必要性を強調しています.

科学分野

クリティカルケア医療
精神科
流行病学について

背景

身体外膜酸素化 (ECMO) は,重症患者の心臓呼吸器系に不可欠なサポートを提供します.
ECMOの生存者の長期的な精神疾患の結果はよくわかっていません.

研究の目的

ECMOの生存率と退院後の精神疾患診断の発生率との関連を調べる.

主な方法

カナダのオンタリオ州 (2010-2020年) で人口ベースの遡及コホート研究が行われました.
ECMOを受けた成人のICU生存者は,ECMOを受けなかった者と比較され,傾向スコアを重み付けました.
精神疾患の診断は気分,不安,PTSD,精神障害などでした

主要な成果

ECMOの生存者は,非ECMOICUの生存者 (14. 5/100人年) と比較して,新しい精神疾患診断の発生率が高かった.
ECMOの生存率は,新しい精神疾患の診断のリスクの増加と有意に関連していた (HR1. 24).
薬物乱用や意図的な自傷はグループ間で有意な差異はなかった.

結論

ECMOは退院後の精神疾患と社会問題診断のリスクがわずかに増加している.
この関連性のメカニズムを理解するためにさらなる研究が必要です.

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