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Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery

Schelling, Gustav MD; Richter, Markus MS; Roozendaal, Benno PhD; Rothenhäusler, Hans-Bernd MD; Krauseneck, Till MD; Stoll, Christian MD; Nollert, Georg MD; Schmidt, Michael MD; Kapfhammer, Hans-Peter MD

doi: 10.1097/01.CCM.0000069512.10544.40
CLINICAL INVESTIGATIONS
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Objective Up to 20% of patients do not show improvements in health-related quality of life (HRQL) after cardiac surgery, despite apparently successful surgical procedures. We sought to determine whether failed improvements in HRQL after cardiac surgery are associated with the development of traumatic memories and chronic stress states as a result of high perioperative stress exposure.

Design Prospective cohort study.

Setting A 10-bed cardiovascular intensive care unit of a tertiary care university hospital.

Patients A total of 148 cardiac surgical patients.

Interventions None.

Measurements and Main Results The patients were evaluated for traumatic memories from postoperative treatment in the cardiovascular intensive care unit (defined as the subjective recollection of pain, respiratory distress, anxiety/panic, and nightmares), symptoms of chronic stress, including those of posttraumatic stress disorder, and HRQL preoperatively (at baseline) and at 6 months after cardiac surgery. A state of chronic stress was defined as the development of posttraumatic stress disorder at 6 months after surgery. Factors predicting the decline in HRQL were determined by multivariable linear regression. Twenty-seven patients (18.2%) had posttraumatic stress disorder at 6 months after cardiac surgery; seven of these patients (4.8%) had evidence of preexisting posttraumatic stress disorder before undergoing cardiac surgery. Patients with new posttraumatic stress disorder at 6 months after cardiac surgery had a significantly higher number of traumatic memories from postoperative treatment in the cardiovascular intensive care unit (p = .01). A multiple regression model included the number of traumatic memories from the intensive care unit and stress symptom scores at 6 months after heart surgery as predictors for variations in physical HRQL outcome scores (R2 = .30, p < .04). Stress symptom scores were the most significant predictors of mental health HRQL outcomes (R2 = .52, p < .01).

Conclusions Exposure to high stress in the cardiovascular intensive care unit can have negative effects on HRQL outcomes of cardiac surgery.

From the Departments of Anesthesiology (GS, MR), Psychiatry (HBR, HPK, TKS), and Cardiac Surgery (GN) and the Institute for Medical Informatics, Biometry and Epidemiology (MS), Ludwig-Maximilians-University, Munich, Germany; and the Center for the Neurobiology of Learning and Memory and Department of Neurobiology and Behavior, University of California, Irvine, CA (BR).

Supported, in part, by grants from the Eli-Lilly International Foundation, Bad Homburg, and Hoffman-La Roche, Grenzach-Wyhlen.

Exposure to high stress in the cardiovascular intensive care unit can have negative effects on health-related quality-of-life outcomes of cardiac surgery.

© 2003 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins