背景:重症监护后综合征(PICS),定义为物理,认知,和精神健康症状在重症监护病房(ICU)出院后持续很长时间,越来越被认为是医疗保健的优先事项。筛查PICS的数据很少。我们的目的是描述法国的ICU筛查后,特别注意访问可用性和访问期间进行的评估。
方法:我们通过向法国ICU发送匿名的43项问卷,进行了一项在线多中心调查。对于每个ICU,向负责后续访问的负责人或专家发送了一项调查。
结果:在被邀请参加的252个ICU中,161(63.9%)返回了已完成的调查。其中,46人(28.6%)提供了随访。通常,ICU出院后3~6个月,安排了由重症医师主导的一次访视.大约50名患者/年/ICU,也就是说,大约5%的住院患者,参加ICU后就诊。用于选择患者进行随访的主要标准是ICU停留时间和/或有创机械通气持续时间超过48h。心脏骤停,感染性休克,和急性呼吸窘迫综合征。在提供访问的ICU中,80%使用经过验证的仪器来筛选PICS。在115个没有提供后续服务的ICU中,50人(43.5%)表示打算在明年开始跟进。提供后续行动的主要障碍是缺乏可用的人员和设备,或者没有将PICS筛查视为优先事项。一半提供就诊的ICU与已建立的ICU后护理专业人员网络合作,另有17%的人建立了这样的网络。网络创建的障碍是医疗保健专业人员缺乏兴趣,并且缺乏对PICS的特定培训。
结论:只有一小部分ICU幸存者接受了旨在检测PICS的随访。不到三分之一的ICU提供了后续访问,但将近三分之一的ICU计划在明年进行此类访问。法国卫生当局在2023年发布的建议有望改善ICU后随访的可用性和标准化。
BACKGROUND: Post-intensive care syndrome (PICS), defined as physical, cognitive, and mental-health symptoms persisting long after intensive-care-unit (ICU) discharge, is increasingly recognised as a healthcare priority. Data on screening for PICS are sparse. Our objective here was to describe post-ICU screening in France, with special attention to visit availability and evaluations done during visits.
METHODS: We conducted an online multicentre survey by emailing an anonymous 43-item questionnaire to French ICUs. For each ICU, a single survey was sent to either the head or the intensivist in charge of follow-up visits.
RESULTS: Of 252 ICUs invited to participate, 161 (63.9%) returned the completed survey. Among them, 46 (28.6%) offered follow-up visits. Usually, a single visit led by an intensivist was scheduled 3 to 6 months after ICU discharge. Approximately 50 patients/year/ICU, that is, about 5% of admitted patients, attended post-ICU visits. The main criteria used to select patients for follow-up were ICU stay and/or invasive mechanical ventilation duration longer than 48 h, cardiac arrest, septic shock, and acute respiratory distress syndrome. Among ICUs offering visits, 80% used validated instruments to screen for PICS. Of the 115 ICUs not offering follow-up, 50 (43.5%) indicated an intention to start follow-up within the next year. The main barriers to offering follow-up were lack of available staff and equipment or not viewing PICS screening as a priority. Half the ICUs offering visits worked with an established network of post-ICU care professionals, and another 17% were setting up such a network. Obstacles to network creation were lack of interest among healthcare professionals and lack of specific training in PICS.
CONCLUSIONS: Only a small minority of ICU survivors received follow-up designed to detect PICS. Less than a third of ICUs offered follow-up visits but nearly another third planned to set up such visits within the next year. Recommendations issued by French health authorities in 2023 can be expected to improve the availability and standardisation of post-ICU follow-up.