Acute psychological trauma in the critically ill: Patient and family perspectives

Volha Dziadzko; Mikhail A Dziadzko; Margaret M Johnson; Ognjen Gajic; Lioudmila V Karnatovskaia

doi:10.1016/j.genhosppsych.2017.04.009

Acute psychological trauma in the critically ill: Patient and family perspectives

Gen Hosp Psychiatry. 2017 Jul:47:68-74. doi: 10.1016/j.genhosppsych.2017.04.009. Epub 2017 Apr 27.

Authors

Volha Dziadzko¹, Mikhail A Dziadzko², Margaret M Johnson³, Ognjen Gajic¹, Lioudmila V Karnatovskaia⁴

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
² Division of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
³ Division of Pulmonary Medicine Mayo Clinic Florida, 4500 San Pablo Road Jacksonville, Florida 32224, United States.
⁴ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States. Electronic address: Karnatovskaia.lioudmila@mayo.edu.

PMID: 28807140
DOI: 10.1016/j.genhosppsych.2017.04.009

Abstract

Objective: Post-intensive care syndrome (PICS), which encompasses profound psychological morbidity, affects many survivors of critical illness. We hypothesize that acute psychological stress during the intensive care unit (ICU) confinement likely contributes to PICS. In order to develop strategies that mitigate PICS associated psychological morbidity, it is paramount to first characterize acute ICU psychological stress and begin to understand its causative and protective factors.

Methods: A structured interview study was administered to adult critical illness survivors who received ≥48h of mechanical ventilation in medical and surgical ICUs of a tertiary care center, and their families.

Results: Fifty patients and 44 family members were interviewed following ICU discharge. Patients reported a high level of psychological distress. The families' perception of patient's stress level correlated with the patient's self-estimated stress level both in daily life (rho=0.59; p<0.0001) and in ICU (rho=0.45; p=0.002). 70% of patients experienced fear of death, 38% had additional other fears, 48% had hallucinations. Concerns included inability to communicate (34%), environmental factors (30%), procedures and restraints (24%), and being intubated (12%). Emotional support of family/friend/staff/clergy (86%), and physical therapy/walking (14%) were perceived to be important mitigating factors. Clinicians' actions that were perceived to be very constructive included reassurance (54%), explanations (32%) and physical touch (8%).

Conclusions: Fear, hallucinations, and the inability to communicate, are identified as central contributors to psychological stress during an ICU stay; the presence of family, and physician's attention are categorized as important mitigating factors. Patients and families identified several practical recommendations which may help assuage the psychological burden of the ICU stay.

Keywords: Intensive care unit; Post intensive care syndrome; Post-traumatic stress disorder; Psychological stress.

Publication types

Observational Study

MeSH terms

Aged
Critical Care / psychology*
Critical Illness / psychology*
Critical Illness / therapy
Family
Female
Humans
Male
Middle Aged
Professional-Patient Relations
Prospective Studies
Psychological Trauma / etiology
Psychological Trauma / psychology*
Stress Disorders, Post-Traumatic / etiology
Stress Disorders, Post-Traumatic / psychology*
Stress, Psychological / etiology
Stress, Psychological / psychology*