Supplemental Table 1: Included studies stratified by (a) patients admitted to the medical intensive care unit (ICU) and (b) admitted for traumatic injury.
(a)
Reference Year Study design n (intervention):
n (control)
Intervention Timing of
intervention Effect of intervention on outcome measures compared to control Garrouste-
Orgeas, et.
al.(33)
2012 Historical controls 49:94 (usual care)
ICU diary maintained by hospital staff and patient family members
Diary started day 4 of ICU stay and maintained until ICU discharge.
Primary: no difference in the HADS or the Peritraumatic Dissociative Experiences Questionnaire among patients or family members at 3 months.
Secondary: decreased posttraumatic stress–
related symptoms (assessed using IES-R) among patients and family members at 12 months.
Jones, et. al.
(34) 2010 RCT
162:160 (ICU diary given
after 3 month evaluation)
ICU diary maintained by hospital staff and patient family members.
Intervention group received diary prior to 3 month
evaluation
Diary started day 3 of ICU stay and maintained until ICU discharge.
Primary: decreased new onset PTSD diagnosis at 3 months (PTSD Diagnostic Scale).
Secondary: no change in PTSD symptoms between 1 and 3 months (PTSS-14 score).
Treggiari, et.
al.(37)
2009 RCT
64:65 (light sedation, Ramsay level 1-2)
Deep sedation (Ramsay level 3-4)
During ICU stay Primary: no difference in new diagnosis of PTSD at 4 months (IES-R or PCL).
Secondary: no difference in depression or anxiety at 4 weeks (HADS)
Weis, et. al.
(22) 2006 RCT
14:14 (placebo)
Hydrocortisone 100 mg bolus IV and 10 mg/h for 24h followed by a 4 day taper.
Started in operating room among cardio- pulmonary bypass patients
Primary: improved scores in 7 of the 8 scales on the SF-36 HRLQ at 6 months.
Secondary: lower PTSS-10 score, but no difference in number and type of traumatic memories at 6 months.
Schelling, et.
al.(21)
2004 RCT
26:22 (placebo)
Hydrocortisone 100 mg bolus IV and 10 mg/h for 24h followed by a 4 day taper.
Started in operating room among cardio- pulmonary bypass patients
Primary: no difference in the number and type of traumatic memories at 6 months.
Secondary: lower PTSS-10 score at 6 months.
Schelling, et.
al.(20) 2001 RCT
9:11 (saline placebo)
Hydrocortisone 100 mg IV
followed by infusion of 0.18
mg/kg/hour for 6 days, followed by 0.08 mg/kg/hour for 6 days and then tapered in steps of 24 mg per day.
During treatment of septic shock patients in the ICU
Primary: decreased incidence of PTSD (SCID-IV and PTSS-10) at 31 months (range 21–49 months).
Secondary: no difference with in the number of traumatic memories.
Tincu, et. al.
(39) 2016 RCT
30:30 (placebo)
300 mg of 5-
hydroxytryptophan During ICU stay Primary: increased serotonin levels at 14 days.
Secondary: decreased CAPS at 14 days.
(b)
Reference Year Study design n (intervention):
n (control)
Intervention Timing of intervention
Effect of intervention on outcome measures compared to control Mouthaan,
et. al.(40)
2013 RCT
151:149 (usual care)
Self-guided Internet- based intervention (Trauma TIPS) based on techniques from cognitive behavioral therapy
Within 72 hours (during ICU stay)
Primary: no difference in CAPS at 1, 3, 6, and 12 months.
Secondary: no difference in IES-R, HADS, or self-reported anxiety/depression, at 1, 3, 6, and 12 months.
No difference in PTSD diagnosis or mental health care utilization at 12 months.
Peris, et. al.
(30) 2011 Historical controls 123:86 (usual care)
5-6 interventions from clinical psychologists including educational interventions, counseling,
stress management, psychological support and coping strategies
During ICU stay Primary: Decreased IES-R scores at 12 months.
Secondary: decreased PTSD diagnosis and increased subjective perception of quality of life, but no difference in proportion of patients with HADS > 11 at 12 months.
Tecic, et. al.
(31) 2011 RCT
54:59 (8 sessions of
inpatient psychotherapy)
8 sessions of inpatient
psychotherapy plus up to 6 sessions of outpatient
psychotherapy
During ICU stay and over a period of 6 months after discharge
Primary: no difference in depression (BDI) or anxiety (State-Trait Anxiety Inventory X1) at hospital discharge, 6, 12, or 18 months.
Secondary: no difference in IES-R at hospital discharge, 6, 12, or 18 months.
Holmes, et.
al.(41) 2007 RCT
51:39 (usual care)
Interpersonal counseling by clinical psychologists
In the first 3 months after injury
Primary: no difference in PCL at 3 or 6 months.
Secondary: no difference in BDI, HADS, or Alcohol Use Disorders Identification Test at 3 or 6 months.
Shalev, et.
al.(42) 2012 RCT
63 (prolonged exposure):
40 (cognitive therapy):
23 (escitalopram 20 mg daily):
23 (placebo)
12 weekly sessions of prolonged exposure (PE) or cognitive therapy (CT)
Started within 29.8 ± 5.7 days of injury
Primary: decreased CAPS among PE and CT groups at 5 and 9 months
Matsumura,
et. al.(43) 2017 RCT
37:46 (placebo pill)
Omega-3 PUFA (1470 mg DHA/147 mg EPA daily) for 12 weeks
Initiated within 240 hours of exposure
Primary: reduced heart rate during standardized practice of the script-driven imagery procedure at 3 months.
Secondary: No difference in CAPS at 3 months.
Matsuoka,
et. al.(44) 2015 RCT
53:57 (placebo pill)
Omega-3 PUFA (1470 mg DHA/147 mg EPA daily) for 12 weeks
Initiated within
240 hours Primary: no difference in CAPS at 3 months.
Secondary: no difference in PTSD diagnosis or IES-R, MADRS, HADS, or CD-RISC at 3 months.
Delahanty, et. al.(19)
2013 RCT
31:33 (placebo)
20 mg
hydrocortisone every 12 h for 10 days, followed by a 6-day taper (halving the dose every 2 days)
Within 12 h of ICU admission
Primary: decreased PTSD symptoms at 1 and 3 months (CAPS).
Secondary: decreased depression symptoms (CES-D) at 1 and 3 months and improved health-related quality of life (SF-36) between 1 and 3 months.
Stein, et. al.
(45) 2007 RCT
17 (propranolol):
14 (gabapentin):
17 (placebo)
Propranolol 40mg PO 3 times a day or gabapentin 400mg PO 3 times a day
Within 48 hours of injury (during ICU stay) for 14 days.
Primary: no difference in PCL at 1, 4, or 8 months.
Secondary: no difference in acute stress disorder scale at 1 month or depressive symptoms at 1, 4, or 8 months (CES-D).
van Zuiden,
et. al.(46) 2017 RCT
53:54 (saline placebo)
Intranasal oxytocin (40 IU/dose) for 7 days.
Within 12 days
of injury Primary: no difference in CAPS total score at 1.5 months.
Secondary: no difference in IES-R or HADS.