Background

Intensive care unit (ICU) patients often endure discomfort and distress brought about by their medical environment and the subjective experience of their stay. Distress, pain, and loss of control are important predictors of future neuropsychiatric disorders. Depression, anxiety, and post-traumatic stress are common after discharge. We aimed at mitigating acute stress and discomfort via a novel intervention based on body image rehabilitation and rehabilitation of senses performed following a holistic approach guided by positive communication (corporeal rehabilitation care, CRC).

Results

We conducted a prospective observational study on 297 consecutively enrolled patients participating in at least one CRC session. Benefits of CRC were assessed on both subjective analogical scales of stress, pain, and well-being criteria, and objective clinical measures of dyspnea, respiratory rate, and systolic arterial pressure, just after CRC and long after (a median of 72 min later) to estimate its remote effect. Results showed that CRC had a positive effect on all overt measures of distress (acute stress, pain, discomfort) just after CRC and remotely. This beneficial effect was also observed on dyspnea and respiratory rate. Results also showed that best CRC responders had higher baseline values of stress and heart rate and lower baseline values of well-being score, indicating that the care targeted the population most at risk of developing psychological sequelae. Interestingly, a positive CRC response was associated with a better survival even after adjustment for physiologic severity, indicating a potential to identify patients prompt to better respond to other therapeutics and/or rehabilitation.

Conclusion

This study demonstrated the feasibility of an innovative holistic patient-centered care approach and its short-term positive effects on critical parameters that are considered risk factors for post-intensive care syndrome. Further studies are warranted to study long-term benefits for patients, and overall benefits for relatives as well as ICU staff.

中文翻译：

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躯体康复治疗危重病人的急性压力

背景

重症监护病房 (ICU) 患者经常忍受其医疗环境和住院期间的主观体验所带来的不适和痛苦。痛苦、痛苦和失控是未来神经精神疾病的重要预测因素。出院后抑郁、焦虑和创伤后压力很常见。我们的目标是通过一种基于身体形象康复和感官康复的新型干预措施来减轻急性压力和不适，遵循以积极沟通为指导的整体方法（身体康复护理，CRC）。

结果

我们对 297 名连续入组的至少参加一次 CRC 会议的患者进行了一项前瞻性观察研究。CRC 的益处在压力、疼痛和幸福标准的主观类比量表以及呼吸困难、呼吸频率和收缩动脉压的客观临床测量中评估，在 CRC 之后和之后很长时间（中位数为 72 分钟后）估计其远程影响。结果表明，CRC 在 CRC 之后和远程对所有明显的痛苦测量（急性压力、疼痛、不适）都有积极影响。在呼吸困难和呼吸频率方面也观察到了这种有益效果。结果还表明，最佳 CRC​​ 响应者的压力和心率基线值较高，而幸福感评分的基线值较低，表明该护理针对最有可能发生心理后遗症的人群。有趣的是，即使在调整了生理严重程度后，积极的 CRC 反应也与更好的生存率相关，这表明有可能识别出迅速对其他治疗和/或康复做出更好反应的患者。

结论

这项研究证明了创新的以患者为中心的整体护理方法的可行性及其对被认为是重症监护后综合征风险因素的关键参数的短期积极影响。需要进一步的研究来研究对患者的长期益处，以及对亲属和 ICU 工作人员的总体益处。