Fig. 1.
Fig. 2.
Fig. 3
Details for PICS-F symptoms and occupation status of patient relatives at six months after ICU admission
| Overall (N=104) | Non-PICS-F (N=57) | PICS-F (N=47) | P value | |
|---|---|---|---|---|
| PICS-F symptoms | ||||
| HADS-A, median [IQR] | 6 [3–9] | 3 [2–5] | 9 [7–13] | < 0.001 |
| HADS-D, median [IQR] | 5.5 [3–10] | 4 [3–5] | 11 [8–12] | < 0.001 |
| IES-R, median [IQR] | 12 [6–24] | 6 [3–9] | 27 [19–35] | < 0.001 |
| Occupation statusa | 0.101 | |||
| Continue in the same work, N (%) | 48 (73.8) | 29 (85.3) | 19 (61.3) | 0.047 |
| Change in occupation status, N (%) | 12 (18.5) | 4 (11.8) | 8 (25.8) | 0.204 |
| Leaving or losing the job, N (%) | 5 (7.7) | 1 (1.8) | 4 (12.9) | 0.184 |
Characteristics of patients and patient relatives
| Overall (N=104) | Non-PICS-F (N=57) | PICS-F (N=47) | P value | |
|---|---|---|---|---|
| Characteristics of patients | ||||
| Age, years, median [IQR] | 74 [61–81] | 74 [66–81] | 74 [53.5–81] | 0.427 |
| Female, N (%) | 34 (32.7) | 18 (31.6) | 16 (34.0) | 0.836 |
| APACHE II score, median [IQR] | 21 [17–25] | 20 [16–25] | 23 [18–26] | 0.113 |
| SOFA score, median [IQR] | 8 [5–10] | 7 [5–9] | 8 [6–11] | 0.045 |
| Clinical frailty score, median [IQR] | 3 [2–4] | 3 [2–4] | 3 [2–4]a | 0.841 |
| ICU length of stay, days, median [IQR] | 8 [5–14] | 8 [6–13] | 7 [5–14.5] | 0.906 |
| Hospital length of stay, days, median [IQR] | 37 [21–67] | 35 [18–57] | 45 [21.5–82.5] | 0.213 |
| Duration of mechanical ventilation, days, median [IQR] | 5 [4–11] | 5 [3–9] | 5 [2–10] | 0.755 |
| Discharged from hospital among survivors | 0.050 | |||
| Another facility, N (%) | 55 (52.9) | 25 (43.9) | 30 (63.8) | |
| Nursing home, N (%) | 0 (0) | 0 (0) | 0 (0) | |
| Home, N (%) | 49 (47.1) | 32 (56.1) | 17 (36.2) | |
| PICS, N (%) | 57 (54.8)d | 28 (49.1)b | 29 (61.7)c | 0.197 |
| Characteristics of patient relatives | ||||
| Age, years, median [IQR] | 66 [56–72] | 66 [58–72]e | 65 [51.5–74]f | 0.637 |
| Female, N (%) | 76 (73.0) | 44 (77.2) | 32 (68.1) | 0.375 |
| No regular employment at study enrollment, N (%) | 39 (37.5) | 23 (40.4) | 16 (34.0) | 0.547 |
| Relationship to patient | 0.330 | |||
| Spouse, N (%) | 51 (49.0) | 29 (50.9) | 22 (46.8) | |
| Parent, N (%) | 14 (13.5) | 5 (8.8) | 9 (19.1) | |
| Child, N (%) | 29 (27.9) | 15 (26.3) | 14 (29.8) | |
| Sibling, N (%) | 6 (5.8) | 5 (8.8) | 1 (2.1) | |
| Others, N (%) | 4 (3.8) | 3 (5.3) | 1 (2.1) | |
Implementation of bundle F during ICU stay
| Overall (N=104) | Relatives with/without PICS | P value | Type of facilities | P value | |||
|---|---|---|---|---|---|---|---|
| Non-PICS-F (N=57) | PICS-F (N=47) | University-affiliated hospital (N=27) | Tertiary teaching hospital (N=77) | ||||
| Implementation of at least one of interventions, N (%) | 66 (63.5) | 36 (63.2) | 30 (63.8) | 1.00 | 25 (92.6) | 41 (53.2) | < 0.001 |
| Bundle components | |||||||
| Family conference *, N (%) | 103 (33.3) | 49 (28.6) | 54 (39.0) | 0.290 | 37 (46.9) | 66 (28.6) | 0.0026 |
| Flexible visitation, N (%) | 7 (6.7) | 4 (7.0) | 3 (6.4) | 1.00 | 3 (11.1) | 4 (5.2) | 0.372 |
| Involvement of family in interdisciplinary rounds, N (%) | 6 (5.8) | 4 (7.0) | 2 (4.3) | 0.687 | 0 (0) | 6(7.8) | 0.335 |
| Family participation in bedside care, N (%) | 19 (18.3) | 11 (19.3) | 8 (17.0) | 0.804 | 4 (14.8) | 15 (19.5) | 0.774 |
| ICU diary, N (%) | 6 (5.8) | 6 (10.5) | 0 (0) | 0.031 | 2 (7.4) | 4 (5.2) | 0.648 |
Definitions of the interventions included in Bundle F_
| Interventions | Definitions |
|---|---|
| Family conference | A structured meeting held by the third day of ICU admission using the VALUE approach (Valuing family input, Acknowledging emotions, Listening, Understanding the patient as a person, and Eliciting questions) [30]. |
| Flexible visitation | Family members were permitted to visit with relaxed restrictions regarding time of day and visitor’s age. |
| Involvement of family in interdisciplinary rounds | Family members were invited to participate in the multidisciplinary team rounds during the patient’s ICU stay. |
| Family participation in bedside care | Family members were engaged in bedside care or rehabilitation activities during the patient’s ICU stay. |
| ICU diary | A written journal was maintained to record the patient’s ICU course and facilitate communication with family members. |