Nurse-led psychological intervention does not reduce PTSD symptoms in ICU patients

1. In this randomized clinical trial, nurse-led psychological interventions did not reduce PTSD risk at 6 months compared to care as usual for patients in the ICU.

2. There was no difference in anxiety or depression rates in patients who received psychological interventions.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Up to 1 in 4 patients who receive care in the ICU develop PTSD due to the highly stressful nature of their illness and subsequent intensive care. Because early interventions have been shown to prevent PTSD development, psychological interventions in ICU patients by ICU staff could reduce the risk of developing PTSD. In this randomized controlled trial, a nurse-led psychological intervention based on CBT did not reduce the rate of developing PTSD at 6 months. In addition, there was no difference in anxiety nor depression with the psychological intervention.

Though this study was difficult to implement, with only a two thirds of patients receiving all three intervention sessions, the study results are likely to reflect that this type of intervention is not effective in reducing PTSD. While the intervention may have been more successful with a highly trained expert, such as a psychologist or psychiatrist, it is also possible that the high incidence of delirium and reduced mentation in the ICU precludes appropriate participation in the interventions.

Click to read the study in JAMA

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In-Depth [ randomized controlled trial]: 1453 patients were recruited to the multicenter Psychological Outcomes Following a Nurse-Led Preventive Psychological Intervention for Critically Ill Patients (POPPI) trial. ICUs were assigned to the intervention or care as usual group and began the intervention after a 6 month baseline period. The intervention, drawing on theories and techniques from CBT, was taught to the nurses who would administer the interventions over three days with the goal of delivering three 30 minute sessions while the patient was in the ICU. Patients were eligible if they were ≥18 years of age, stayed in the ICU at least 48 hours receiving level 3 care, had a RAAS between a score of +1 and −1, >13 GCS, and were able to communicate in English. 63.6% of patients who received the intervention completed all three sessions. 79.3% of survivors were able to complete the final questionnaire at 6 months. There was no difference in PTSD symptoms at 6 months (treatment effect -0.03; CI95 -2.58 to 2.52) and no difference in the secondary outcomes, including anxiety and depression scores on the Hospital Anxiety and Depression Scale, days alive and free from sedation at day 30, and the European Quality of Life-5 scale (p > 0.05).

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