- Title
- Early screening for the post intensive care syndrome in a tertiary ICU follow-up clinic in the Eastern Cape
- Creator
- van der Merwe, Elizabeth
- Subject
- Critical care medicine
- Subject
- Post-traumatic stress disorder -- Patients
- Subject
- Psychology, Pathological
- Date Issued
- 2024-04
- Date
- 2024-04
- Type
- Doctral theses
- Type
- text
- Identifier
- http://hdl.handle.net/10948/63915
- Identifier
- vital:73626
- Description
- The Post ICU Syndrome (PICS) is defined as a constellation of new or worsened impairments in physical, cognitive, and/or psychological health which persist after critical care discharge. These deficits are more related to the patients’ intensive care unit (ICU) stay rather than to their original ICU admission diagnosis. Between 25-50% of critical care survivors suffer from PICS. There is a paucity of research on PICS in South Africa (SA). The primary objective of this study is to describe the incidence and co-occurrence of PICS symptoms, as well as the changes in instrumental activities of daily living and life roles in ICU survivors.The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape. Inclusion criteria were respiratory support for ≥ 48 hours, or a shocked state, and/or organ failure requiring ICU stay for 48 hours. Patients were assessed at six weeks and six months after hospital discharge. Physical impairment was measured by the six-minute walk test and ICU-acquired weakness by the Medical Research Council scale. Instrumental activities of daily living score and employment/educational status were determined. The Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised questionnaires were used as screening tools for significant psychological symptoms. Screening for neurocognitive impairment was performed with the NeuroScreen application and compared to a matched control group. The Short Form-36 Health-Related Quality of Life questionnaire (HRQOL) was used to determine quality of life at baseline and study visits. 107 patients, half of whom had COVID-19, completed the six-month follow-up. Six months after hospital discharge, six out of ten patients were affected by PICS, five out of every ten suffered from physical impairment, four out of every ten reported significant psychological symptoms, with three out of every ten affected by both. Three out of ten experienced significant chronic pain. Overall, six out of every ten patients experienced significant psychological symptoms at either one or both study visits. Only one in ten had psychological symptoms in isolation at six months. Six out of every ten patients reported a significantly lower health-related quality of life at six months as compared to their baseline. Three out of every ten patients had not returned to their previous remunerative work, studying or home making. Neurocognitive impairment in this cohort was not verified, and this may have been due to the selection of the control group. However, there was a significant improvement in neurocognitive functioning from the six-week to the six-month study visits. Only 15% of patients received rehabilitation therapy after hospital discharge. Female sex, a higher co-morbidity score and an admission diagnosis of trauma were predictors of PICS symptoms. COVID-19 was not found to be associated with a higher incidence of PICS.
- Description
- Thesis (D.Phil) -- Faculty of Health Science, School of Behavioural & Lifestyle Sciences, 2024
- Format
- computer
- Format
- online resource
- Format
- application/pdf
- Format
- 1 online resource (205 pages)
- Format
- Publisher
- Nelson Mandela University
- Publisher
- Faculty of Health Sciences
- Language
- English
- Rights
- Nelson Mandela University
- Rights
- All Rights Reserved
- Rights
- Open Access
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Collections
NMU School of Behavioural Sciences
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | SOURCE1 | Van der Merwe, E April 2024.pdf | 5 MB | Adobe Acrobat PDF | View Details Download |