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Helping Distressed Patients after the ICU

By Jadwiga A. Wedzicha, MD, editor, American Journal of Respiratory and Critical Care Medicine
Follow Dr. Wedzicha on Twitter @ATSBlueEditor

Effects of a Telephone- and Web-based Coping Skills Training Program Compared to an Education Program for Survivors of Critical Illness and Their Family Members: A Randomized Clinical Trial

After leaving the ICU, patients often experience psychological distress, which can diminish their health and quality of life. In their Jan. 1 American Journal of Respiratory and Critical Care Medicine article, Christopher E. Cox and coauthors report on the outcome of a randomized trial of 175 adults who had been on a ventilator for at least 48 hours and, after returning home, were either assigned to coping skills training (CST) or an education program. The CST, which was delivered via six weekly 30-minute telephone sessions and the web, included relaxation exercises, cognitive restructuring, and pleasant imagery. The education program focused on providing information about critical illness (e.g., muscle weakness, post-charge disability, explanations of respiratory failure), but omitted any mention of post-ICU distress, via six informational videos with complementary web content and two 30-minute calls.

Overall, CST did not improve psychological distress symptoms compared to an education program. CST did improve distress symptoms after six months in a subset of patients—those with high baseline distress--while the education program improved distress at three months among those ventilated for more than seven days.

The authors noted that retention was a problem for both interventions. “As expected, nearly two-thirds of missed interventions sessions were among those whose illness persisted or worsened,” they wrote, adding that “novel strategies” are needed to increase retention among this group of patients who can suffer for months and years from distress resulting from their ICU stay.

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