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Post-traumatic stress disorder following the Intensive Care Unit

Fortunately, more and more people are surviving stays in hospital intensive care units (ICU), but psychiatrists are discovering that a significant number of people, after leaving the hospital, develop post-traumatic stress disorder.

These individuals may experience—sometimes lasting for years after their hospital experience—symptoms of panic, sleeping problems including nightmares, phobias, flashbacks, feelings of detachment, depression, or generalized anxiety. Longer stays in the ICU, along with more intense interventions such as being on a ventilator with prolonged sedation, increase the risk.

Post-traumatic stress disorder (PTSD) is an anxiety disorder that was first described in soldiers returning from wars in the 19th century, but since then it is recognized sometimes after a number of severely stressful experiences such as a natural disaster, assault, rape, domestic abuse or even a car accident.

Recent studies have shown that PTSD can occur in up to 35% of people after they leave the ICU. It can also even affect family members and loved ones who spent time in ICUs along with the patient. Being in that situation as an observer can be quite traumatic for someone not accustomed to medical environments.

Particularly patients who are sedated and intubated (plastic breathing tube down throat) can suffer hallucinations during their hospital stays. Patients may, for example, imagine a hurricane is outside their window, or that the nurses are plotting to throw them in a lake, or any number of paranoid thoughts.

Being in an ICU can be a severely traumatic experience. Patients might be on a ventilator for weeks, sometimes restrained all that time so they won’t pull out their tube. They have multiple tests done, needle sticks, x-rays, catheters, and so forth, all in an alien environment with bad lighting at all hours, and strange sounds from monitors and alarms.

When you consider this, it almost makes sense that so many patients suffer PTSD. And sometimes the reason they actually entered the ICU—for example after a gunshot wound or an accident—was severely traumatic itself, and the ICU experience just compounds what brought them into the hospital.

Now that doctors are beginning to recognize PTSD in ex-ICU patients, some are working to minimize traumatic events in the hospital, and lower the risk. Sedation is often necessary when a patient has to endure a breathing tube, but there are ways to minimize the risks, and the Society of Critical Care Medicine recently released new guidelines to orient doctors.

The thinking is that sedation will produce less problems later on if it is lighter than “heavy”, and that it is critical to ensure the patient’s pain is well controlled. The basic act of keeping a simple diary of what happened in the ICU, made by the nurses or the family, and given to the patient when they leave, may be of help to counter whatever hallucinations they may have experienced.

If you or any loved ones have been in the ICU, it is a good to be aware of this problem, or if a loved one enters the ICU in the future, keep this in mind and discuss ways to diminish the patient’s trauma with the nurses and doctors.

But if PTSD symptoms occur after leaving the hospital (and symptoms sometimes only start months later), know that psychiatric counseling and sometimes medications can help and cure this condition.

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Post-traumatic stress disorder following the Intensive Care Unit was last modified: July 26th, 2013 by

Esta postagem também está disponível em: Portuguese (Brazil)