Postintensive Care Syndrome-Family Associated With COVID-19 Infection.

To assess the prevalence of and risk factors for postintensive care syndrome in family (PICS-F) in the COVID-19 era. DESIGN: A single-center retrospective study using questionnaires and telephone calls. SETTING: An ICU at St. Luke's International Hospital. PATIENTS: Patients who were treated for COVID-19-related acute respiratory distress syndrome between March 23, 2020, and September 30, 2021, and their family members participated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: PICS-F refers to the psychologic distress such as anxiety, depression, and posttraumatic stress disorder (PTSD) experienced by the patient's family. The primary outcome was PICS-F occurrence. Furthermore, factors related to PICS-F development were identified using statistical analysis. Of 85 patients with COVID-19 who were admitted to the ICU, 57 family members consented to the study and completed the survey, and 54 family members' data were analyzed. The median age of family members was 53.5 years, 68.5% were female, and 46.3% were spouses. The median age of patients was 55.5 years, and 83.3% were male. During their ICU stay, 68.5% received invasive mechanical ventilation, 11.1% received venovenous extracorporeal membrane oxygenation, and 11.1% underwent tracheostomy. The median ICU and hospital stays were 7 and 22 days, respectively. Overall PICS-F occurred in 33%. Anxiety, depression, and PTSD occurred in 24%, 26%, and 4% of family members, respectively. The prevalence of all three components of PICS-F was 4%. Multivariable analysis showed that Family Satisfaction with the ICU Survey (FS-ICU) scores were independently associated with PICS-F development (odds ratio, 0.941; 95% CI, 0.891-0.983; p = 0.005). CONCLUSIONS: One-third of family members of COVID-19 patients admitted to the ICU had symptoms of PICS-F. These results suggest that measurement of FS-ICU may be helpful as a predictor of PICS-F development. In addition, increasing the level of ICU care satisfaction of the family members may prevent PICS-F.

Effects of a training workshop on suicide prevention among emergency room nurses.

BACKGROUND: Suicide attempts are frequently encountered by emergency department nurses. Such encounters can potentially provide a foundation for secondary suicide prevention. AIMS: The aim of the present investigation was to evaluate the effect of a 7-hr training program for emergency room nursing personnel in Japan. METHOD: In all, 52 nurses completed the questionnaires before the workshop and 1 month after the workshop. The nurses' understanding of and willingness to care for suicidal patients positively changed. RESULTS: It is feasible to provide a 7-hr, relatively short, workshop on suicidal prevention aimed at emergency medical staff and to improve attitudes during a follow-up of 1 month. CONCLUSION: It is uncertain whether the positive attitudes of emergency nurses toward suicide and/or educational interventions could impact the outcomes of these interventions. Further studies are needed to address these important questions in this field.

[Suicide re-attempt risk evaluation scale: a trial in a critical care center without an exclusive duty psychiatrist].

There is a general consensus that patients who attempt suicide require intervention for psychological as well as physical problems. However, among the institutions accepting patients who attempt suicide, there are few institutions employing a full-time psychiatrist in the emergency department. Therefore, it is difficult to conduct a suicide re-attempt risk evaluation in the presence of a psychiatric specialist. We developed a suicide re-attempt risk evaluation scale to be used by non-professional staff. We asked the medical staff that cared for patients who had attempted suicide to record all the evaluation items in the patient's medical record. We utilized an interview method and highlighted the types of answers that needed special attention. When there were two or more answers that needed special attention, we defined the patient as high risk. The number of days of hospitalization did not change as a result of the use of the suicide re-attempt risk estimate scale; however, the quantity of medical records addressing suicide intention and the rate of psychiatric intervention significantly increased. It is unclear whether this score directly led to the prevention of repeat suicide attempts. However, it is notable that use of the scale has led to a change in the behavior of medical staff by mandating a fixed-format risk evaluation.

Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation.

BACKGROUND: Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the "squeezing" technique in Japan. OBJECTIVE: To determine the effects of rib-cage compression on airway-secretion removal, oxygenation, and ventilation in patients receiving mechanical ventilation. SETTING: An intensive care unit of an emergency and critical care center at a tertiary-care teaching hospital in Tokyo, Japan. METHODS: Thirty-one intubated, mechanically ventilated patients in an intensive care unit were studied in a randomized, crossover trial. The patients received endotracheal suctioning with or without rib-cage compression, with a minimum 3-hour interval between the 2 interventions. Rib-cage compression was performed for 5 min before endotracheal suctioning. Arterial blood gas and respiratory mechanics were measured 5 min before endotracheal suctioning (baseline) and 25 min after suctioning. The 2 measurement periods were carried out on the same day. RESULTS: There were no significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, P(aCO2), or dynamic compliance of the respiratory system between the 2 periods (before and after endotracheal suctioning). Moreover, there were no significant differences in airway-secretion removal between the 2 periods. CONCLUSIONS: This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.