Journal Article Annotations
2023, 1st Quarter
Annotations by Natalie Fedotova, MD, PhD
This multicenter, retrospective cohort study examined the connection between preexisting mental health disorders (PMHDs) and various outcomes from first episode ICU admissions in calendar year 2019, from eight general hospital ICUs across New South Wales, Australia. Patients with PMHDs were more likely to require invasive ventilation and had longer ICU lengths of stay (LOS). These patients also tended to be younger—despite a similar severity of illness on admission (based on APACHE3), were more likely to have an unplanned admission, were more likely to be admitted with a trauma-related diagnosis, required ventilation for a greater duration, and were more likely to experience delirium. Patients with PMHDs did not differ in terms of mortality or readmission rate.
Strength and weaknesses:
This is a multicenter study that was able to include a high percentage of eligible patients and used natural language processing techniques on clinical progress notes rather than relying on ICD codes to identify PMHDs (90% accuracy compared to gold standard manual chart review). The main analysis, however, collapsed across various subtypes of mental health disorders (e.g., affective disorders, anxiety, schizophrenia, substance use, alcohol use, etc.), which may have different trajectories and pose distinct—though overlapping—challenges in the critical care setting.
The data on ICU outcomes—including mortality and length of stay (LOS)—for patients with PMHDs are mixed. This study adds to the existing literature in a unique way: by showing that LOS and need for ventilation appear to be higher in patients with PMHDs but without a comparable increase in mortality. C-L psychiatrists are particularly well positioned to address many of the potential reasons for less favourable outcomes in the PMHD population in the ICU, including addressing anxiety and motivation to engage in early mobilization, maintaining access to home psychotropic regimens as appropriate, preventing/diagnosing and effectively managing delirium, and managing agitation in the peri-extubation phase to facilitate a successful outcome.