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New research discovers post-traumatic stress disorder can occur after a stay in an intensive care unit.

PTSD is often associated with warfare, major catastrophes and assault, not hospitalization. However, in a new study Johns Hopkins researchers found the disorder is present in almost one-quarter of patients who survive a critical illness and stay in the intensive care unit (ICU).

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New study of 645 ARDS survivors has identified subgroups of ARDS survivors who suffer what's been called post-intensive care syndrome, a collection of symptoms that can linger for years.

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Advancements in critical care medicine result in a growing population of survivors of critical illness. Many intensive care unit (ICU) patients have physical, mental and cognitive sequelae after discharge from the ICU, known as post-intensive care syndrome (PICS). These problems are associated with long-lasting restrictions in daily functioning and reduced health-related quality of life (QoL), and can also negatively affect family members (PICS-F). The nature of these restrictions require interdisciplinary rehabilitation care, but to date there is no structured pathway for the prevention and treatment of the symptoms of PICS. The aim of this thesis was to explore the course and prognosis of functioning in ICU survivors, and to investigate means for early identification of PICS. In the studies assembled in this thesis, we found that patients with prolonged ICU-stay, longer duration of mechanical ventilation (> 48 hours), and/or ICU-AW, have a higher risk of short- and long-term functional impairments, limitations in activities and restrictions in participation. A majority of ICU survivors do not receive adequate rehabilitation care after discharge from the hospital. This implies, that patients and their close relatives should be closely monitored after discharge from the ICU to initiate interdisciplinary rehabilitation treatment. In order to improve the quality of survivorship, we propose a structured, stepped care rehabilitation pathway, consisting of clinical assessments with validated screening instruments, interdisciplinary rehabilitation interventions, tailored to the patients’ abilities and needs, and adequate handover in the transition of care.

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Long-term follow-up of randomized prospective trials of treatments in the intensive care unit may allow us to attain some understanding of the causes of post-intensive care syndrome. This in turn may allow us to produce better long-term outcomes among survivors of critical illness.

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A stay in the intensive care unit (ICU) can be traumatic. Patients are confronted with their own mortality. They are rolled in and hooked up to machines. Perhaps they are ventilated or catheterised. They might drift in and out of consciousness, seeing a different set of faces each time they wake. Confusion, sedation, and delirium make it difficult to communicate; intubation makes it impossible. Mysterious alarms ring at strange times. If the stay is long enough, there is likely to be a death, perhaps more than one, elsewhere in the ward. Hallucinations are common, some of which sound like a scene from a horror movie. “I have had patients talk about seeing blood dripping down the walls, or children with no faces”, said Joseph Bienvenu (Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA).
Symptoms of post-traumatic stress disorder (PTSD) vary from person to person, but typically include a combination of flashbacks and nightmares, avoiding reminders of the traumatic event, emotional numbing, and hyperarousal. Symptoms generally develop within a month, but some patients experience delayed onset. Around 60% of patients recover naturally within 5 years.

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Post-traumatic stress disorder is often thought of as a symptom of warfare, major catastrophes and assault. It’s rarely considered in patients who survive a critical illness and stay in the intensive care unit (ICU). However, in a recent Johns Hopkins study, researchers found that nearly one-quarter of ICU survivors suffer from PTSD. They also identified possible triggers for PTSD and indicated a potential preventive strategy: having patients keep ICU diaries. The findings will be published in the May issue of Critical Care Medicine.

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The impact of complex trauma is very different to a one time or short-lived trauma. The effect of repeated/ongoing trauma – caused by people – changes the brain, and also changes the survivor at a core level. It changes the way survivors view the world, other people and themselves in profound ways.
This article provides some of the symptoms and impact most felt by complex trauma survivors.

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Following critical illness, it is not uncommon for one to experience new or worsened physical limitations or difficulties. This can be due to the critical illness/injury itself, prolonged time spent in bed with limited physical activity, or preexisting physical challenges that worsen following hospitalization. Of all of the aspects of Post Intensive Care Syndrome (body, mind, and emotions), the physical changes are the most easily recognized and are therefore more readily addressed.

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or many years, we believed that a good outcome for critically ill patients was for them to leave the intensive care unit (ICU) alive. Sadly, we now know from substantial research, including in-depth follow-up of individual patients, that this is not the case.

Many cohort studies of critically ill patients that prospectively followed people after hospital discharge raised concerns regarding long-term outcomes (1–4). Despite the importance of this work, such prospective cohort studies are limited in the type and amount of information they can provide because of small sample size or number of outcome events, uncertain generalizability, and a lack of information on prehospital trajectories. Perhaps most important, many of these exploratory studies lacked comparison with appropriate controls. Therefore, the burden of morbidity and mortality after critical illness was quantified, but with uncertainty regarding the level of attribution to the critical illness and its associated treatments and the contribution of either underlying comorbidity or hospitalization of any kind. In effect, these studies identified that “we have a problem,” but their limitations did not allow us to more fully understand the severity, duration, causation, and trajectory of these problems from the perspectives of our patients and our health systems.

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We are going to discuss Post Intensive Care Syndrome and Prevention Part II - what loved ones can do to help prevent PICS.

It is not uncommon for loved ones to feel overwhelmed when in the intensive care unit. The ICU is a very unfamiliar and scary environment for most people, and caring for your critically ill loved one can seem like too much at times. However, the physical presence through voice and touch that a loved one can provide can be as therapeutically beneficial as many of the interventions provided by the medical team.

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Family caregivers of intensive care unit (ICU) patients are exposed to high levels of stress (1). During ICU admission, family caregivers are in a position to witness the stress-provoking ICU environment more vividly than the patients who lack physical and cognitive capacity to control or understand surroundings. Because limited decisional capacity is common in patients during the critical phase of their illness, many family caregivers are expected to take the role of a surrogate decision maker to discuss options for life supporting treatments. Demands on family caregivers do not stop after patients’ ICU discharge. Recovering from critical illness leads to a new phase of complex and unpredictable illness experience. Over time, support from formal resources dissipate and more responsibilities are assumed by family caregivers. Decades of research have highlighted that ICU family caregivers are at risk for adverse psychological responses at various timelines across the trajectory of their loved one’s illness, recovery and/or death (2-4). Despite growing awareness, supportive and effective interventions targeted to family caregivers of ICU patients are lacking (2). One of major challenges in developing interventions may be limited knowledge of ways to identify family caregivers at high risk for severe stress response and other modifiable risk factors.

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More than a decade ago, Meredith Mealer embarked on research that has only increased in relevance with the passing years.

The study focused on the prevalence of post-traumatic stress disorder (PTSD) among survivors of acute respiratory distress syndrome, a devastating lung disorder. Mealer, PhD, RN, was then a research coordinator, working on the study with Marc Moss, MD, a pulmonary/critical care physician leading the effort. As Mealer paged through the symptoms patients and families reported – nightmares, high stress, emotional numbing, anxiety attacks – some struck her close to home. Prior to shifting her focus to clinical research, Mealer had been an intensive care unit nurse.