It is known that survivors of severe sepsis experience physical and mental impairment after discharge from the intensive care unit. However, a 12-month intervention by primary care clinicians did not result in improved mental health-related quality of life or physical function among survivors of sepsis, according to a study published in the American Journal of Medicine. The intervention did reduce the rate of posttraumatic stress disorder (PTSD) among participants.
Researchers conducted a multicenter, randomized controlled trial between February 2011 and December 2013 to study the effects of a primary care management intervention in sepsis aftercare. A total of 291 patients who had survived severe sepsis or septic shock were recruited from 9 German intensive care units to be randomly assigned to either usual care or a 12-month intervention. The intervention included training for both the patients and their primary care physicians in evidence-based postsepsis care, case management provided by trained nurses, and clinical decision support for the primary care physician by a consulting physician.
The primary outcome was change in mental health-related quality of life (Mental Component Summary of the 36-Item Short-Form Health Survey) between intensive care unit discharge and 6 months after discharge. Secondary outcomes included survival and PTSD symptoms, as well as physical and sleep function. Patients were followed up for 24 months.
A total of 148 patients were randomly assigned to the intervention group, and 143 to the control group. The mean age of patients was 61.6 years, 66.2% were men, and 62.6% suffered from >3 chronic conditions. Overall mortality increased from 13.7% (n=40) at 6 months and 18.2% (n=53) at 12 months to 21.7% (n=63) at 24 months.
At 24 months, no difference was found between the 2 groups for the mental health component. Differences between the groups in activities of daily living, motor function, and sleep quality identified in the 6- and 12-month follow-up periods did not persist to the 24-month follow-up. However, patients in the control group reported increased PTSD symptoms at 24 months. “Criteria for PTSD prevalence were met by 23 (27.4%) patients in the control group vs. 10 patients (10.3%) in the intervention group,” noted the investigators.
Although the study did not find long-term evidence of improvement in mortality or mental health-related quality of life with primary care interventions, “it can be hypothesized that the intervention described [in the study] may have contributed to reduction of late-onset PTSD symptoms in the intervention group, possibly mediated by providing general social support and opportunities for narration of the trauma by trained [primary care physicians] and case managers,” the investigators noted. They concluded that the study could serve as a primary care based approach to the management of PTSD after ICU stays.
Schmidt KF, Schwarzkopf D, Baldwin LM, et al. Long-term courses of sepsis survivors: effects of a primary care management intervention. Am J Med. doi: 10.1016/j.amjmed.2019.08.033