BrainWise
Summer 2015

People usually associate post-traumatic stress disorder with those who survive military combat, major catastrophes or assaults. But critically ill patients who survive an intensive care unit stay are at equally high risk for PTSD, says psychiatrist Joe Bienvenu. 

In a recently published literature review, Bienvenu, pulmonary and critical care medicine fellow Ann Parker and colleagues looked at 40 studies of 36 unique patient cohorts with a total of more than 3,000 patients who survived a critical illness and ICU stay. They found that the prevalence of PTSD in the studies ranged from 10 to 60 percent. And, after performing and then repeating a meta-analysis of a subset of the studies, the researchers found that seven to 12 months after being released from the ICU, one in five patients had PTSD.

“These rates are as high as you might see in combat soldiers or rape victims,” says Dale Needham, medical director of The Johns Hopkins Hospital critical care medicine and rehabilitation program.

The study also found that common risk factors for PTSD among the ICU survivors included being diagnosed with anxiety, depression or other mental health problem before coming in. Another risk factor was having received large amounts of sedation in the ICU, and patients who reported having frightening memories of being in the ICU were at higher risk.

With more than 5 million people annually requiring ICU care and 750,000 Americans needing mechanical ventilation, says Bienvenu, the potential for psychological trauma should not be taken lightly. “PTSD can drastically affect a person’s ability to communicate and connect with others, truly interrupting their lives and preventing experiences of joy,” he says.

 Bienvenu has found that the most effective way to prevent or mitigate PTSD symptoms is for nurses, other clinicians and family members to keep an ICU diary on behalf of patients, a project Bienvenu is piloting in the ICU. Every day, nurses chronicle patients’ medical treatments, conditions and behavior changes as a narrative record.

Often, says Bienvenu, patients perceive that they’re being tortured or are in prison. “That’s understandable,” he says. “Many of these patients are fighting for their lives, and their brain dysfunction from critical illness and sedation makes it difficult to determine what is actually occurring.” The diaries, he explains, allow patients to process the experience and helps convince them that their visions were not real.

Parker also encourages physicians to call the ICU survivor weekly for eight weeks postdischarge to address psychological and physical hurdles. 

These strategies, says Bienvenu, are part of a larger initiative that includes reducing sedation in the ICU, encouraging early mobility and physical therapy, and promoting better sleep habits—“ultimately improving the odds for better long-term mental health.”

To see a video about the ICU diary project, visit bit.ly/hopkinsicudiary.