Inactivity May Identify Older Intensive Care Unit Survivors at Risk for Post-Intensive Care Syndrome.

BACKGROUND: Older adults (≥age 65) admitted to an intensive care unit (ICU) are profoundly inactive during hospitalization. Older ICU survivors often experience life-changing symptoms, including cognitive dysfunction, physical impairment, and/or psychological distress, which are components of post-intensive care syndrome (PICS). OBJECTIVES: To explore trends between inactivity and symptoms of PICS in older ICU survivors. METHODS: This study was a secondary analysis of pooled data obtained from 2 primary, prospective, cross-sectional studies of older ICU survivors. After ICU discharge, 49 English- and Spanish-speaking participants who were functionally independent before admission and who had received mechanical ventilation while in the ICU were enrolled. Actigraphy was used to measure post-ICU hourly activity counts (12:00 AM to 11:59 PM). Selected instruments from the National Institutes of Health Toolbox and Patient-Reported Outcomes Measurement Information System were used to assess symptoms of PICS: cognitive dysfunction, physical impairment, and psychological distress. RESULTS: Graphs illustrated trends between inactivity and greater symptom severity of PICS: participants who were less active tended to score worse than one standard deviation of the mean on each outcome. Greater daytime activity was concurrently observed with higher performances on cognitive and physical assessments and better scores on psychological measures. CONCLUSIONS: Post-ICU inactivity may identify older ICU survivors who may be at risk for PICS and may guide future research interventions to mitigate symptom burden.

Associations Between Inactivity and Cognitive Function in Older Intensive Care Unit Survivors.

BACKGROUND/INTRODUCTION: Critically ill older adults are profoundly inactive while in the intensive care unit (ICU), and this inactivity persists after discharge from the ICU. Older ICU survivors who were mechanically ventilated are at high risk for post-ICU cognitive impairment. OBJECTIVES/AIMS: The present study examined the relationship between the ratio of daytime to nighttime activity and executive function in older ICU survivors. METHODS: This was a secondary analysis of pooled data from 2 primary studies of older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24 to 48 hours post-ICU discharge. Actigraphy recorded daytime activity (mean activity counts per minute, 6 am to 9:59 pm) and nighttime activity (mean activity counts per minute, 10 pm to 5:59 am). A daytime-to-nighttime activity ratio was calculated by dividing daytime activity by nighttime activity. The NIH Toolbox Dimensional Change Card Sort Test assessed cognitive flexibility (DCCST: fully corrected T score). Multivariate regression examined the association between the daytime-to-nighttime activity ratio and DCCST scores, adjusting for 2 covariates (age in years and NIH Toolbox Grip Strength fully corrected T score). RESULTS: The mean daytime-to-nighttime activity ratio was 2.10 ± 1.17 (interquartile range, 1.42). Ratios for 6 participants (13.6%) were less than 1, revealing higher activity during nighttime hours rather than daytime hours. Higher daytime-to-nighttime ratios were associated with better DCCST scores (ß = .364, P = .005). CONCLUSIONS: The proportion of daytime activity versus nighttime activity was considerably low, indicating severe alterations in the rest/activity cycle. Higher daytime-to-nighttime activity ratios were associated with better executive function scores, suggesting that assessment of daytime activity could identify at-risk older ICU survivors during the early post-ICU transition period. Promotion of daytime activity and nighttime sleep may accelerate recovery and improve cognitive function.

Randomized Controlled Study of Self-Managed Music-Guided Exercise Intervention Following Intensive Care.

BACKGROUND: Patients who are discharged from the intensive care unit (ICU; termed ICU survivors) often experience persistent physical impairment. OBJECTIVE: The aim of this study was to explore the effects of a self-managed, music-guided exercise intervention on physical outcomes and adherence rates among ICU survivors. METHODS: A randomized controlled design was used. Following ICU discharge, participants admitted to the ICU for at least 5 days were randomly assigned to a music group ( n = 13) or an active control group ( n = 13). Activity counts were measured using an Actiwatch, and the physical health score was measured using the Patient-Reported Outcomes Measurement Information System global health subscale. Adherence to exercise was documented daily. Independent t -tests were used for data analysis. RESULTS: Data were analyzed for 26 participants. The mean age was 62.8 ± 13.8 years, 53.8% were male, 65.4% were White, and mean Acute Physiology and Chronic Health Evaluation severity of illness score was 59 ± 23.4. Global health physical scores were significantly higher in the music group than in the active control group. Although not significantly different, music group participants tended to be more active and had higher physical activity and adherence rates compared to those in the active control group. CONCLUSION: A self-managed, music-guided exercise intervention demonstrated positive benefits on physical outcomes. Future clinical trials with a larger sample size should be conducted to examine the effects of this tailored, cost-effective, innovative, self-managed exercise intervention among ICU survivors.

Psychological distress, social support, and family satisfaction among family members of non-COVID-19 critical care patients: A cross-sectional study.

PURPOSE: This study aims to explore the associations among psychological distress, perceived social support, and family satisfaction among family members of non-COVID-19 intensive care unit (ICU) patients during the COVID-19 pandemic. DESIGN: A cross-sectional study. METHODS: Family members of patients with at least 48 h in the ICU and without a COVID-19 diagnosis were screened between January and March 2021. For enrolled ICU family members, five questionnaires for perceived stress (Perceived Stress Scale), anxiety symptoms (General Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), perceived social support (Medical Outcomes Study Social Support Survey), and family satisfaction (Family Satisfaction with Care in the Intensive Care Unit-24) were administered by phone either in English or Spanish language. Sociodemographic and patient clinical data were also collected. Data were analyzed using descriptive statistics, Pearson's correlations, Mann-Whitney U, and Fisher's exact tests. FINDINGS: Of 87 eligible ICU family members, 63 were enrolled (72.4%); 27% of the sample presented with clinically significant symptoms of anxiety, 25.4% with depression, and 76.2% had a high perception of social support. ICU family members with low/fair perceived social support reported statistically significantly higher perceived stress and lower family satisfaction. Perceived stress was negatively correlated with family satisfaction. Clinically significant symptoms of anxiety and depression were not statistically associated with family satisfaction or perceived social support. CONCLUSIONS: While ICU admission-related stress may undermine family satisfaction, perceived social support may be positively associated with the way that ICU family members of non-COVID-19 patients evaluate the quality of care in the ICU. Knowing the factors that influence family satisfaction in the ICU may assist stakeholders and policy developers to improve family-centered care in the hospital setting. CLINICAL RELEVANCE: Early screening for psychological distress and social support levels during admission should be included in updates of visiting and communication policies in the ICU. Prompt identification of family members at risk of a poor ICU experience may enhance efforts to support them, particularly in acute care settings where differentiated approaches to COVID-19 and non-COVID-19 ICU family members are established.