IntroductionTo study the level and predictors of posttraumatic stress, anxiety and depression symptoms in medical, surgical and trauma patients during the first year post intensive care unit (ICU) discharge.MethodsOf 255 patients included, 194 participated at 12 months. Patients completed the Impact of Event Scale (IES), Hospital Anxiety and Depression Scale (HADS), Life Orientation Test (LOT) at 4 to 6 weeks, 3 and 12 months and ICU memory tool at the first assessment (baseline). Case level for posttraumatic stress symptoms with high probability of a posttraumatic stress disorder (PTSD) was ≥ 35. Case level of HADS-Anxiety or Depression was ≥ 11. Memory of pain during ICU stay was measured at baseline on a five-point Likert-scale (0-low to 4-high). Patient demographics and clinical variables were controlled for in logistic regression analyses.ResultsMean IES score one year after ICU treatment was 22.5 (95%CI 20.0 to 25.1) and 27% (48/180) were above case level, IES ≥ 35. No significant differences in the IES mean scores across the three time points were found (P = 0.388). In a subgroup, 27/170 (16%), patients IES score increased from 11 to 32, P < 0.001. No differences in posttraumatic stress, anxiety or depression between medical, surgical and trauma patients were found. High educational level (OR 0.4, 95%CI 0.2 to 1.0), personality trait (optimism) OR 0.9, 95%CI 0.8 to 1.0), factual recall (OR 6.6, 95%CI 1.4 to 31.0) and memory of pain (OR 1.5, 95%CI 1.1 to 2.0) were independent predictors of posttraumatic stress symptoms at one year. Optimism was a strong predictor for less anxiety (OR 0.8, 0.8 to 0.9) and depression symptoms (OR 0.8, 0.8 to 0.9) after one year.ConclusionsThe mean level of posttraumatic stress symptoms in patients one year following ICU treatment was high and one of four were above case level Predictors of posttraumatic stress symptoms were mainly demographics and experiences during hospital stay whereas clinical injury related variables were insignificant. Pessimism was a predictor of posttraumatic stress, anxiety and depression symptoms. A subgroup of patients developed clinically significant distress symptoms during the follow-up period.

Introduction. Nurses and physicians working in the intensive care unit (ICU) may be exposed to considerable job stress. The study aim was to assess the level of and the relationship between (1) job satisfaction, (2) job stress, and (3) burnout symptoms. Methods. A cross-sectional study was performed at ICUs at Oslo University Hospital. 145 of 196 (74%) staff members (16 physicians and 129 nurses) answered the questionnaire. The following tools were used: job satisfaction scale (scores 10–70), modified Cooper's job stress questionnaire (scores 1–5), and Maslach burnout inventory (scores 1–5); high score in the dimension emotional exhaustion (EE) indicates burnout. Personality was measured with the basic character inventory. Dimensions were neuroticism (vulnerability), extroversion (intensity), and control/compulsiveness with the range 0–9. Results. Mean job satisfaction among nurses was 43.9 (42.4–45.4) versus 51.1 (45.3–56.9) among physicians, P < 0.05. The mean burnout value (EE) was 2.3 (95% CI 2.2–2.4), and mean job stress was 2.6 (2.5–2.7), not significantly different between nurses and physicians. Females scored higher than males on vulnerability, 3.3 (2.9–3.7) versus 2.0 (1.1–2.9) (P < 0.05), and experienced staff were less vulnerable, 2.7 (2.2–3.2), than inexperienced staff, 3.6 (3.0–4.2) (P < 0.05). Burnout (EE) correlated with job satisfaction (r = −0.4, P < 0.001), job stress (r = 0.6, P < 0.001), and vulnerability (r = 0.3, P = 0.003). Conclusions. The nurses were significantly less satisfied with their jobs compared to the physicians. Burnout mean scores are relatively low, but high burnout scores are correlated with vulnerable personality, low job satisfaction, and high degree of job stress.

Background: Skin conductance (SC) as a measure of emotional state or arousal may be a tool for monitoring surgical stress in anaesthesia. When an outgoing sympathetic nervous burst occurs to the skin, the palmar and plantar sweat glands are filled up, and the SC increases before the sweat is removed and the SC decreases. This creates a SC fluctuation. The purpose of this study was to measure SC during laparoscopic cholecystectomy with propofol and remifentanil anesthaesia and to evaluate whether number and amplitude of SC fluctuations correlate with perioperative stress monitoring. Methods: Eleven patients were studied nine times before, during and after anaesthesia. SC was compared to changes in stress measures such as blood pressure, heart rate, norepinephrine and epinephrine levels. SC was also compared to changes in Bispectral index (BIS). Results: The blood pressure, epinephrine levels and norepinephrine levels were positively correlated with both the number (P Ͻ 0.001) and amplitude (P Ͻ 0.01) of the SC fluctu-

Intensive care unit survivors had significantly lower health-related quality of life at 1 yr compared to the general population and significantly reduced compared to their states before intensive care unit admission. Less posttraumatic stress and optimism were predictors of higher health-related quality of life and return to work/school. Trauma patients had the largest decrease in both physical and mental scores. Only half of the patients had returned to work/school.

Plasma noradrenaline increases during pneumoperitoneum and is associated with changes in total peripheral resistance. Plasma adrenaline is unchanged and there is no evidence of increased sympathetic outflow to the drainage area of the superior vena cava. Thus, the increase in plasma noradrenaline may be due to more local activation of the sympathetic nervous system, probably somewhere from the drainage area of the inferior vena cava.

Psychological distress symptoms were frequent among ICU survivors. Relatives expected the patients to be more distressed after ICU treatment than the patients reported. The strongest predictors of posttraumatic stress symptoms from the ICU were memoris about pain, lack of control and inability to express needs. Pessimism may be a reason for psychological distress and should be addressed during follow up, as pessimistic patients may need more motivation and support.

To examine left ventricular responses to aortic occlusion, changes in end-diastolic volume (EDV) and end-systolic volume (ESV) were estimated by ultrasonic recordings of myocardial distances in atropinized open-chest dogs. During aortic occlusion EDV and ESV increased equally, systolic left ventricular pressure (LVP) rose by 86 +/- 8 mmHg, and blood flow more than doubled in the superior vena cava and fell by 90% in the inferior vena cava. During combined occlusion of aorta and inferior vena cava, systolic LVP and superior vena cava flow did not rise above control and EDV declined. By infusing 25 +/- 2 ml/kg body wt of blood during combined occlusion, the effects of aortic occlusion could be reproduced; control values before blood infusion were reestablished by withdrawal of only one-third of the infused volume, indicating a shunt line along the spinal column. Thus during aortic occlusion, transfer of blood accounts for the rise in EDV and increased activation of the Frank-Starling mechanism; increased afterload raises ESV as much as EDV in anesthetized dogs not subjected to sympathetic stimulation. Consequently, stroke volume is maintained and systolic LVP increased.

The significance of the intact pericardium for cardiac performance was examined in 18 open-chest dogs. Myocardial chord lengths (MCL) in the right and left ventricle were measured simultaneously by ultrasonic crystals implanted in the myocardium of the anterior walls. In 14 dogs, the ultrasonic elements were inserted into the myocardium through needle openings in the pericardium (intact pericardium). In four other dogs, the elements were inserted through 6-to 7-cm-long incisions in the pericardium which were sutured afterward (sutured pericardium). Stroke volume was calculated in each of seven dogs with an intact pericardium from electromagnetic measurement of flow in the superior and inferior venae cavae. After blood volume expansion to about 13 mm Hg, the pericardium was opened and the end-diastolic pressure-MCL relationships and stroke volumes before and after pericardiotomy were compared. By opening the intact pericardium, the right and left ventricular enddiastolic MCL rose by 2.7 ± 0.7% and by 3.7 ± 1.1%, respectively, and stroke volume increased by 13 ± 4%. However, by reopening the sutured pericardium, the increases in both right and left ventricular end-diastolic MCL were clearly greater (12.2 ± 5.6% and 9.9 ± 2.9%, respectively), and the restrictive effect of the pericardium was therefore overestimated when the pericardium was not left intact. Thus, after a moderate blood volume expansion, the intact pericardium exerts a certain, although moderate restrictive effect on cardiac performance.