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A4885 - Feasibility of a Behavioural Intervention to Reduce Psychological Distress in the ICU in Mechanically Ventilated Patients
Author Block: Y. Tan1, O. Gajic2, M. Clark2, K. Philbrick2, L. Karnatovskaia2; 1Anaesthesia, National University Hospital, Singapore, Singapore, 2Mayo Clinic, Rochester, MN, United States.
Rationale Up to two thirds of survivors of acute respiratory distress syndrome suffer from mood disorders following discharge. Memories of frightening/delusional experiences in the ICU are the strongest potentially modifiable risk factor. Research on the formation of fear demonstrates that if mitigating information about a traumatic event is introduced during the time following memory formation and its subsequent recall - the reconsolidation window - the emotional experience of the memory can potentially be rewritten. Given that semantic processing continues during altered states of consciousness, and that the thinking process of the critically ill is characterized by heightened suggestibility, we adapted an approach based on positive suggestions to provide early psychological support for the critically ill (EPSCI) in parallel with medical treatment. Methods Mechanically ventilated patients were recruited the day of intubation. EPSCI was administered daily by the study intensivist. EPSCI was individualized based on each clinical scenario but consisted of three main phases: informing the patient about aspects of ICU care and the nature of treatment while providing positive reframing of the situation; actively involving the patient in the treatment process once they were able to communicate; and debriefing to clarify potential memory distortions. Institutional review board allowed for deferred consent by patient or proxy, enabling prompt initiation of the intervention. Results Twenty patients (10 male, 10 female) in medical and surgical ICUs received EPSCI administered by three separate study intensivists. Median patient age was 61 (IQR 48-71), median duration of ventilation was 3 days (IQR 1-5), median ICU length of stay was 6 days (IQR 3-9). EPSCI was administered on median of 4 days (IQR 2-6), with each session lasting a median of 7 minutes (IQR 5-12). Intervention was discontinued in four patients when the status changed to comfort care. Barriers and interruptions were minimal. 13 patients were able to complete follow up surveys. Of those, 9 remembered the ICU physician talking to them, and 7 described it as comforting. Five patients (38%) met criteria for anxiety, depression, and acute stress by Hospital Anxiety and Depression Scale and Impact of Events-Revised questionnaires. Conclusions EPSCI is a novel, unique intervention to reduce formation of traumatic memories and to humanize critical care. In this feasibility project, we were able to successfully enroll and intervene on 20 ICU patients. Testing EPSCI on a wider scale with a control group is therefore warranted.