Study protocol: Intensive care anxiety and emotional recovery (Icare) - A prospective study

Background: Survivors of intensive care units (ICUs) commonly present with symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) during recovery. A number of factors have been identified as predictors of these adverse emotional outcomes, but the role of state anxiety during critical illness in the development of these emotional problems remains unknown.Purpose: The Intensive Care Anxiety and Emotional Recovery (ICARe) study protocol proposes the development of a statistical model to determine the relationship between state anxiety during ICU stay and symptoms of anxiety, depression and PTSD at three occasions; after ICU discharge but prior to hospital discharge and at the third and sixth months post ICU discharge.Methods: Prospective study including adult patients admitted to the ICU of a tertiary metropolitan Australian hospital for ≥24 h who are able to: (1) communicate verbally or nonverbally; (2) understand English and (3) open their eyes spontaneously or in response to voice to respond to the Faces Anxiety Scale (state anxiety assessment). One hundred and seventy patients will be assessed for their levels of state anxiety during their ICU stay to achieve a sample size of about 104 patients six months after discharge. The outcomes of the ICARe study will include symptoms of anxiety, depression and PTSD assessed by standardised questionnaires widely used in intensive care research. Demographic, clinical, and social support information will also be collected.Results: The projected sample size will provide sufficient power to evaluate the association between state anxiety and adverse emotional outcomes, as well as a variety of variables that will be entered into a multivariate regression analysis.Conclusion: This study will provide new evidence to improve care during critical illness and reduce adverse outcomes during recovery with the potential to decrease unnecessary suffering, promote comfort and improve long-term recovery