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      Screening for posttraumatic stress disorder in ARDS survivors: validation of the Impact of Event Scale-6 (IES-6)

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          Posttraumatic stress disorder (PTSD) symptoms are common in acute respiratory distress syndrome (ARDS) survivors. Brief screening instruments are needed for clinical and research purposes. We evaluated internal consistency, external construct, and criterion validity of the Impact of Event Scale-6 (IES-6; 6 items) compared to the original Impact of Event Scale—Revised (IES-R; 22 items) and to the Clinician Administered PTSD Scale (CAPS) reference standard evaluation in ARDS survivors.


          This study is a secondary analysis from two independent multi-site, prospective studies of ARDS survivors. Measures of internal consistency, and external construct and criterion validity were evaluated.


          A total of 1001 ARDS survivors (51% female, 76% white, mean (SD) age 49 (14) years) were evaluated. The IES-6 demonstrated internal consistency over multiple time points up to 5 years after ARDS (Cronbach’s alpha = 0.96; 95% confidence interval (CI) 0.94 to 0.97). The IES-6 demonstrated stronger correlations with related constructs (e.g., anxiety and depression; |r| = 0.32 to 0.52) and weaker correlations with unrelated constructs (e.g., physical function and healthcare utilization measures (|r| = 0.02 to 0.27). Criterion validity evaluation with the CAPS diagnosis of PTSD in a subsample of 60 participants yielded an area under receiver operating characteristic curve (95% CI) of 0.93 (0.86, 1.00), with an IES-6 cutoff score of 1.75 yielding 0.88 sensitivity and 0.85 specificity.


          The IES-6 is reliable and valid for screening for PTSD in ARDS survivors and may be useful in clinical and research settings.

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          β₂-Adrenergic receptor agonists accelerate resolution of pulmonary edema in experimental and clinical studies. This clinical trial was designed to test the hypothesis that an aerosolized β₂-agonist, albuterol, would improve clinical outcomes in patients with acute lung injury (ALI). We conducted a multicenter, randomized, placebo-controlled clinical trial in which 282 patients with ALI receiving mechanical ventilation were randomized to receive aerosolized albuterol (5 mg) or saline placebo every 4 hours for up to 10 days. The primary outcome variable for the trial was ventilator-free days. Ventilator-free days were not significantly different between the albuterol and placebo groups (means of 14.4 and 16.6 d, respectively; 95% confidence interval for the difference, -4.7 to 0.3 d; P = 0.087). Rates of death before hospital discharge were not significantly different between the albuterol and placebo groups (23.0 and 17.7%, respectively; 95%confidence interval for the difference,-4.0 to 14.7%;P = 0.30). In the subset of patients with shock before randomization, the number of ventilator-free days was lower with albuterol, although mortality was not different. Overall, heart rates were significantly higher in the albuterol group by approximately 4 beats/minute in the first 2 days after randomization, but rates of new atrial fibrillation (10% in both groups) and other cardiac dysrhythmias were not significantly different. These results suggest that aerosolized albuterol does not improve clinical outcomes in patients with ALI. Routine use of β₂-agonist therapy in mechanically ventilated patients with ALI cannot be recommended. Clinical trial registered with www.clinicaltrials.gov (NCT 00434993).
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            To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors.
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              The SF36 Version 2: critical analyses of population weights, scoring algorithms and population norms.

              The SF36 Version 2 (SF36V2) is a revision of the SF36 Version 1, and is a widely used health status measure. It is important that guidelines for interpreting scores are available. A population sample of Australians (n = 3015) weighted to achieve representativeness was administered the SF36V2. Comparisons between published US weights and sample derived weights were made, and Australian population norms computed and presented. Significant differences were observed on 7/8 scales and on the mental health summary scale. Possible causes of these findings may include different sampling and data collection procedures, demographic characteristics, differences in data collection time (1998 vs. 2004), differences in health status or differences in cultural perception of the meaning of health. Australian population norms by age cohort, gender and health status are reported by T-score as recommended by the instrument developers. Additionally, the proportions of cases within T-score deciles are presented and show there are important data distribution issues. The procedures reported here may be used by other researchers where local effects are suspected. The population norms presented may be of interest. There are statistical artefacts associated with T-scores that have implications for how SF36V2 data are analysed and interpreted.

                Author and article information

                Crit Care
                Critical Care
                BioMed Central (London )
                7 August 2019
                7 August 2019
                : 23
                [1 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Physical Medicine and Rehabilitation, , Johns Hopkins School of Medicine, ; Baltimore, MD USA
                [2 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Psychiatry and Behavioral Sciences, , Johns Hopkins School of Medicine, ; Baltimore, MD USA
                [3 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Biostatistics, , Johns Hopkins Bloomberg School of Public Health, ; Baltimore, MD USA
                [4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Division of Pulmonary and Critical Care Medicine, , Johns Hopkins School of Medicine, ; Baltimore, MD USA
                [5 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of Psychiatry and Behavioral Sciences, , Johns Hopkins School of Medicine, ; Baltimore, MD USA
                [6 ]ISNI 0000 0004 0609 0182, GRID grid.414785.b, Department of Medicine, Pulmonary and Critical Care Division, , Intermountain Medical Center, ; Murray, UT USA
                [7 ]ISNI 0000 0004 0460 774X, GRID grid.420884.2, Center for Humanizing Critical Care, Intermountain Health Care, ; Murray, UT USA
                [8 ]ISNI 0000 0004 1936 9115, GRID grid.253294.b, Neuroscience Center and Psychology Department, Psychology Department and Neuroscience Center, , Brigham Young University, ; Provo, UT USA
                [9 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Outcomes After Critical Illness and Surgery (OACIS) Group, , Johns Hopkins School of Medicine, ; Baltimore, MD USA
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: R24 HL111895
                Award ID: R01HL091760-02S1
                Award ID: R01HL088045
                Award ID: P50HL073944
                Award Recipient :
                Funded by: National Heart, Lung, and Blood Institute (US)
                Award ID: R01HL091760
                Award Recipient :
                Funded by: Johns Hopkins Institute for Clinical and Translational Research
                Award ID: UL1 TR 000424-06
                Award Recipient :
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                © The Author(s) 2019


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