What is a trauma intensive care unit

Often in intensive care patients

"The physical weakness usually improves, the psychological symptoms can persist over a long period of time," says Joseph Bienvenu of the Johns Hopkins University in Baltimore, according to a press release. Many patients who have been in the intensive care unit experience flashbacks of delusions and hallucinations that they had in the clinic. They remember these more than the actual events, says Bienvenu.


With his working group, he investigated how often psychological problems as a result of an operation lead to post-traumatic stress disorder (PTSD). The scientists recruited 520 patients who were treated for acute lung failure in an intensive care unit and mechanically ventilated in four clinics in Baltimore between 2004 and 2007. 186 of the surviving patients had at least one appointment during the two-year follow-up period.


Of these, 35 percent subsequently developed clinically significant symptoms of PTSD. The rate was highest in the first follow-up examination after three months, report Bienvenu and his colleagues in the journal ┬╗Psychological Medicine┬ź. But two-thirds of the patients who had developed PTSD continued to suffer from symptoms two years after their stay in the clinic. Half of them were taking psychotropic drugs, 40 percent had seen a psychiatrist.


"When we think of post-traumatic stress disorder, we think of something that affects soldiers or people who have experienced sexual abuse or similar emotional trauma," said Dale Needham, senior researcher on the study. The disorder is just as common, if not more common, in intensive care patients, which many medical professionals are not aware of. The symptoms can be divided into three categories: Either patients relive the event in the form of nightmares or flashbacks of hallucinations, or they react with avoidance behavior and isolation, or they show excessive excitement, which manifests itself as frightfulness, irritability or sleep disorders.


Possible causes


How the psychological symptoms arise has not yet been conclusively clarified. Medical causes can include severe pain, lack of oxygen, infection and fever, dehydration, and side effects of the medication. The changed metabolism as well as disturbances of the sleep-wake cycle, lack of sleep and the high noise level in the intensive care unit can contribute to the development of the symptoms. During their investigation, the scientists found that patients with depression that had already existed before they went to the hospital were twice as likely as mentally stable patients. A long stay in the intensive care unit also seems to have a negative effect. The researchers identified high-dose sedation and sepsis as additional risk factors.


In order to prevent possible long-term consequences and their negative effects on quality of life, patients at risk should receive special care, the authors recommend. Early physical mobilization seems to have a protective effect. The patient also benefits from the presence of familiar people. /


O. J. Bienvenu, et al. Post-traumatic stress disorder symptoms after acute lung injury: a 2-year prospective longitudinal study. Psychological Medicine, available on CJO. doi: 10.1017 / S0033291713000214.