Prolonged intensive care stay and subsequent psychological distress: a study in cardiac patients

Introduction

The study aim was to determine whether patients who stay in the ICU for >24 hours after cardiac surgery develop persisting psychological symptoms.

Methods

After Institutional Review Board and Local Research Ethics Committee approval, we approached consecutive patients who underwent first-time coronary artery bypass graft surgery with ICU stay >24 hours (long stay group (LS)). For each LS patient, we recruited a short stay (SS) patient with <24 hours ICU stay, matched by age and sex. Patients with known psychological disorder or previous ICU admission were excluded. At 3, 6 and 12 months following hospital discharge, patients completed four psychological questionnaires: Experience after Treatment in Intensive Care 7 Item Scale (ECTI-7), Hospital Anxiety and Depression (HAD), Short-Form 36 (SF-36), adapted Trauma Symptom Checklist-33 (TSC-33). Results were analysed using repeated measures analysis of variance, using SPSS. Preoperative EuroScore and left ventricular function were included to adjust for baseline disease severity.

Results

We studied 302 paired patients. Table 1 presents the mean differences and significance level between LS and SS groups for each questionnaire (HAD components anxiety 1 and depression 2, SF-36 components physical 3 and mental 4, TSC-33). Patients who stayed >24 hours in ICU had significantly poorer scores on all scales up to 12 months post surgery, even when adjusted for baseline disease severity.

Table 1 Mean differences and significance levels between LS and SS groups

Conclusion

Patients who stayed in the ICU for >24 hours post cardiac surgery scored higher on several psychological evaluation questionnaires when compared with patients who stayed <24 hours. This indicates the possibility of greater psychological distress for at least 12 months after cardiac surgery.