Recent PICS in the News Stories
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February 14, 2018
By Megan Hosey, PhD
December 21, 2017
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By AICU Staff
December 12, 2017
September 7, 2017
By Constance Williams
July 28, 2017
High Morning Cortisol Tied to Long-term
Anxiety in Family Members of ICU Patients
December 12, 2017
A new study published in the journal Critical Care Medicine finds that a biomarker may help identify which family members will be most emotionally impacted by their loved one’s ICU stay. In particular, family members who showed a morning spike in cortisol were more likely to still be suffering from anxiety three months later.
Cortisol is known as the “stress hormone,” because it can spike during stressful times, such as when a loved one is critically ill.
Study leader Elliotte L. Hirshberg, M.D., MS, a critical care physician at Intermountain Medical Center and director of the Center for Humanizing Critical Care asserts that family members need time to adjust to their new roles, situations, and responsibilities.
“This study confirms the long-held belief that family members are experiencing stress during an ICU stay. This is important,” said Hirshberg. “The next step we hope to take in the future is to study support interventions that can reduce this stress and the associated anxiety, depression, and PTSD that may follow.”
For the study, the researchers followed the family members of patients who’d been admitted to Intermountain Medical Center’s medical/surgical intensive care unit. Three months after the patient was discharged, the researchers found that 32 percent of the family members in the study suffered from anxiety, 16 percent had symptoms of depression, and 15 percent reported signs of post-traumatic stress.
Researchers also discovered an increase of about 50 percent in family members’ cortisol levels first thing in the morning, which was associated with anxiety in family members three months after hospital discharge.
Unlike the surge in cortisol shortly after awakening, general cortisol levels weren’t found to predict long-term symptoms of mood disorders among study participants.
Researchers focused on family members because they’re an important part of a patient’s recovery team and often have their own unmet needs. After an ICU discharge, family members must face new challenges, including caring for a sick loved one, learning how to provide medical care, and perhaps experiencing a change in employment.
Post-intensive care syndrome in families, sometimes called PICS-F, is a widely recognized syndrome and can impact up to 60 percent of family members. PICS-F includes anxiety, depression, PTSD, and difficulty transitioning to a new state of well-being, according to Hirshberg.
There’s likely a link between family member wellness and a patient’s trajectory for recovery, said Hirshberg.
For the study, researchers enrolled families of patients who were gravely ill. Some groups were excluded, including those with a history of PTSD, dementia, or schizophrenia and those on medications containing steroids, which impacts cortisol secretion.
Besides confirming a link between mood disorders and cortisol, the researchers also found that having a history of anxiety is associated with anxiety three months after the hospitalization. Depression and anxiety are likely to co-exist, so more work needs to be done to identify interventions that can decrease the symptoms of PICS in family members.
Of the 100 participants registered for the study, 92 continued through the follow-up at three months. The average age was 54 and nearly two-thirds were female, while 71 percent lived with the patient before the ICU admission. Fifty-three percent of participants were married to the patient.
Cortisol was measured using saliva samples at five predetermined times over 24 hours. The study had some limitations: The link between general cortisol secretion and chronic stress is unclear, and the levels reported in the study may have reflected a combination of chronic and acute stress. In addition, the study did not account for stresses unrelated to the ICU.
“Because participants had to leave the patient’s room briefly and some declined, it’s possible that those family members have higher stress and they were not included in the study,” said Hirshberg.
Source: Intermountain Medical Center
The Critical Care Recovery Center (CCRC) care model developed by the Regenstrief Institute and IU Center for Aging Research scientists is the nation's first collaborative care concept focusing on the extensive cognitive, physical, and psychological recovery needs of intensive care unit survivors and decreasing the likelihood of serious illness after discharge from an ICU. The CCRC is an outpatient clinic with an interdisciplinary care team working closely with family caregivers as well as the ICU survivors themselves after hospital or rehabilitation facility discharge.
Myongji opens next-generation smart intensive care unit
By Constance Williams
Approval 2017.09.07 16:36
Myongji Hospital명지병원, known as the “icon of medical innovation,” has opened the next- generation “Smart ICU” based on IT technology that can suit world-class criteria of infection and critical care management.
The new intensive care unit, which has been in operation since Tuesday, is the next generation ICU with separate single rooms, an optimized isolation room for infection control, an IT-based smart system, and quality control that meets international standards.
It is the first hospital in Korea that has a nationally designated quarantine facility in the intensive care unit, a preemptive measure for the management of critical illness with new infectious diseases such as the Middle East respiratory syndrome (MERS).
The new facility adopts a ceiling pendant system for a centralized control which can manage patients remotely. It is also equipped with a smart window system that operates transparently and opaque as needed, ensuring patient safety and privacy, and a monolithic hemodialyzer, a machine that uses dialysis to remove impurities and waste products from the bloodstream before returning the blood to the patient's vein with water and drain pipes.
Myongji Hospital in Goyang, Gyeonggi Province, has recently opened its third-generation smart intensive care unit, the first nationally designated state-of-the-art quarantine facility.
In particular, the moving wall system of the ICU, inspired by the movie “Transformers,” was opened to the public. It is a state-of-the-art system that transforms into a complete sound pressure structure, with a gradual closing of doors, rooms, corridors, as well as isolation sound pressure rooms in case of infectious diseases such as MERS.
For the best patient management, a nurse takes care of only two patients, which improved the quality of the intensive care unit and the patient survival. According to a study by the Korean Society of Critical Care Medicine중환자의학회, if one nurse takes care of four patients, the mortality rate for sepsis was 41.6 percent but it falls to 38.75 percent when a nurse takes care of three patients, and to 20 percent when the number of patients for a nurse drops to two.
"The next-generation smart ICU is a type of advanced facility that can meet all of the issues of future healthcare such as infection control, emergency room infrastructure, and intensive care unit management,” said Lee Wang-jun이왕준, chairman of the Myongji Medical Foundation. “We will improve the quality of medical attention and dedicate to ‘patient-first’ principle through advanced infection management system."
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