Psychological Outcomes in Family Members of Patients With Acute Respiratory Failure: Does Inter-ICU Transfer Play a Role?

Chest. 2021 Sep;160(3):890-898. doi: 10.1016/j.chest.2021.03.025. Epub 2021 Mar 19.


Background: Family members of patients admitted to the ICU experience a constellation of sequelae described as postintensive care syndrome-family. The influence that an inter-ICU transfer has on psychological outcomes is unknown.

Research question: Is inter-ICU transfer associated with poor psychological outcomes in families of patients with acute respiratory failure?

Study design and methods: Cross-sectional observational study of 82 families of patients admitted to adult ICUs (tertiary hospital). Data included demographics, admission source, and outcomes. Admission source was classified as inter-ICU transfer (n = 39) for patients admitted to the ICU from other hospitals and direct admit (n = 43) for patients admitted from the ED or the operating room of the same hospital. We used quantitative surveys to evaluate psychological distress (Hospital Anxiety and Depression Scale [HADS]) and posttraumatic stress (Post-Traumatic Stress Scale; PTSS) and examined clinical, family, and satisfaction factors associated with psychological outcomes.

Results: Families of transferred patients travelled longer distances (mean ± SD, 109 ± 106 miles) compared with those of patients directly admitted (mean ± SD, 65 ± 156 miles; P ≤ .0001). Transferred patients predominantly were admitted to the neuro-ICU (64%), had a longer length of stay (direct admits: mean ± SD, 12.7 ± 9.3 days; transferred patients: mean ± SD, 17.6 ± 9.3 days; P < .01), and a higher number of ventilator days (direct admits: mean ± SD, 6.9 ± 8.6 days; transferred: mean ± SD, 10.6 ± 9.0 days; P < .01). Additionally, they were less likely to be discharged home (direct admits, 63%; transferred, 33%; P = .08). In a fully adjusted model of psychological distress and posttraumatic stress, family members of transferred patients were found to have a 1.74-point (95% CI, -1.08 to 5.29; P = .30) higher HADS score and a 5.19-point (95% CI, 0.35-10.03; P = .03) higher PTSS score than those of directly admitted family members.

Interpretation: In this exploratory study, posttraumatic stress measured by the PTSS was higher in the transferred families, but these findings will need to be replicated to infer clinical significance.

Keywords: critical illness; family member of ICU patients; psychological distress.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Critical Care* / methods
  • Critical Care* / psychology
  • Critical Care* / statistics & numerical data
  • Critical Illness / epidemiology
  • Critical Illness / psychology*
  • Cross-Sectional Studies
  • Family / psychology*
  • Female
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Patient Transfer* / methods
  • Patient Transfer* / statistics & numerical data
  • Psychological Distress
  • Respiratory Insufficiency* / epidemiology
  • Respiratory Insufficiency* / psychology
  • Respiratory Insufficiency* / therapy
  • Stress Disorders, Post-Traumatic* / diagnosis
  • Stress Disorders, Post-Traumatic* / etiology
  • United States / epidemiology

Supplementary concepts

  • postintensive care syndrome