Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

PTSD symptoms common among ICU survivors

26.02.2013
Condition long linked to war veterans found in one in 3 ventilated patients

One in three people who survived stays in an intensive care unit (ICU) and required use of a mechanical ventilator showed substantial post-traumatic stress disorder (PTSD) symptoms that lasted for up to two years, according to a new Johns Hopkins study of patients with acute lung injury.

Because acute lung injury (ALI) — a syndrome marked by excessive fluid in the lungs and frequent multi-organ failure — is considered an archetype for critical illness, the researchers suspect PTSD is common among other ICU survivors as well.

"We usually think of PTSD as something you develop if you go to war, are sexually assaulted or suffer a similar emotional trauma," says Dale Needham, M.D., Ph.D., a critical care specialist at the Johns Hopkins University School of Medicine and senior author of the study published online in Psychological Medicine. "Instead, it may be as common, or more common, in ICU patients as in soldiers, but it's something many doctors — including psychiatrists — don't fully appreciate."

"Physical weakness usually gets better, but these mental symptoms often just linger," says study leader O. Joseph Bienvenu, M.D., Ph.D., an associate professor of psychiatry and behavioral sciences at Johns Hopkins. "We need to pay more attention to preventing and treating PTSD in these patients."

Bienvenu says the unusual thing about PTSD in ICU survivors is that they often experience flashbacks about delusions or hallucinations they had in the hospital, rather than events that actually occurred. Having a life-threatening illness is itself frightening, but delirium in these patients — who are attached to breathing machines and being given sedatives and narcotics — may lead to "memories" of horrible things that didn't happen, he adds.

"One woman thought her husband and the nurse were plotting to kill her," Bienvenu recalls.

For the study, the Johns Hopkins team observed 520 mechanically ventilated patients with ALI, recruited from 13 ICUs at four Baltimore hospitals between October 2004 and October 2007. Fifty-three percent survived their hospitalization, and 186 patients had at least one research visit over the subsequent two-year follow-up period.

The researchers found that 66 of the 186 patients (35 percent) had clinically significant symptoms of PTSD, with the greatest apparent onset occurring by the initial, three-month follow-up visit. Sixty-two percent of the survivors who developed PTSD still had symptoms at their two-year visit. Half of this same group was taking psychiatric medications, and 40 percent had seen a psychiatrist in the two years since being hospitalized with ALI.

The researchers also found that patients with depression before hospitalization were twice as likely to develop PTSD, and that those who spent more time in the ICU were more likely to experience symptoms.

Those who had sepsis (a severe response to infection) during their ICU stay, and those who were given high doses of opiates, were more likely to develop PTSD as well. Those given corticosteroids while in the ICU were less likely to develop PTSD, though the exact reasons why are unknown.

The delirium often associated with ICU stays and post-ICU PTSD may be partially a consequence of inflammation caused by sepsis. This inflammation may lead to a breakdown in the blood-brain barrier, which alters the impact on the brain of narcotics, sedatives and other drugs prescribed in the ICU.

Bienvenu says patients who have these risk factors need special attention. Simply educating them and their primary care doctors about the increased risk for PTSD would be a step in the right direction, he adds.

Each year, almost 1 million patients in the United States are hooked up to ventilators in an ICU, and 200,000 are estimated to develop ALI, usually as the result of infection. The lungs of healthy people allow the easy exchange of gases to enable oxygen to enter the bloodstream, and carbon dioxide to exit the body. In ALI patients, the normally light and dry lungs become heavy and soggy like a wet sponge.

People with PTSD, a form of anxiety disorder, may feel severely stressed or frightened even when they're no longer in danger. The symptoms fall into three categories: reliving the traumatic experience (flashbacks, nightmares), avoidance (feeling numb, detached, staying away from people and places that serve as reminders of the experience), and hyperarousal (being easily startled, having difficulty sleeping, irritability).

PTSD can impair quality of life and slow patients' recovery from a critical illness, keeping victims from returning to work or performing usual activities of daily life.

Needham, Bienvenu and others at Johns Hopkins are interested in whether changing care in the ICU can reduce the incidence of PTSD. Needham's team has reported on studies showing that early physical rehabilitation for ICU patients can speed and enhance recovery, and he says "psychological rehab" now deserves attention.

One European study looked at the use of ICU diaries, where nurses and family members recorded what was happening with the patients daily while they were in the ICU, sometimes taking photographs. The diaries were then given to the patients a month after leaving the ICU, with phone debriefing from a nurse. The intervention reduced PTSD symptoms by helping patients make sense of their ICU memories, Bienvenu says.

Other Johns Hopkins researchers involved in the study include Jonathan Gellar, M.P.H.; Benjamin M. Althouse, Sc.M.; Elizabeth Colantuoni, Ph.D.; Thiti Sricharoenchai, M.D.; Pedro A. Mendez-Tellez, M.D.; Cheryl R. Dennison, R.N., Ph.D.; and Peter J. Pronovost, M.D., Ph.D.

This research was supported by the National Institutes of Health's National Heart, Lung, and Blood Institute (Acute Lung Injury SCCOR Grant P050 HL73994 and R01 HL88045).

For more information:

http://www.hopkinsmedicine.org/psychiatry/expert_team/faculty/B/Bienvenu.html

http://www.hopkinsmedicine.org/pulmonary/faculty/division_faculty/
needham_dm.html
http://www.hopkinsmedicine.org/pulmonary/research/outcomes_after_critical
_illness_surgery/oacis_videos_news.html

Stephanie Desmon | EurekAlert!
Further information:
http://www.jhmi.edu

More articles from Health and Medicine:

nachricht Nanotubes are beacons in cancer-imaging technique
23.05.2016 | Rice University

nachricht More light on cancer
20.05.2016 | Lomonosov Moscow State University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Atomic precision: technologies for the next-but-one generation of microchips

In the Beyond EUV project, the Fraunhofer Institutes for Laser Technology ILT in Aachen and for Applied Optics and Precision Engineering IOF in Jena are developing key technologies for the manufacture of a new generation of microchips using EUV radiation at a wavelength of 6.7 nm. The resulting structures are barely thicker than single atoms, and they make it possible to produce extremely integrated circuits for such items as wearables or mind-controlled prosthetic limbs.

In 1965 Gordon Moore formulated the law that came to be named after him, which states that the complexity of integrated circuits doubles every one to two...

Im Focus: Researchers demonstrate size quantization of Dirac fermions in graphene

Characterization of high-quality material reveals important details relevant to next generation nanoelectronic devices

Quantum mechanics is the field of physics governing the behavior of things on atomic scales, where things work very differently from our everyday world.

Im Focus: Graphene: A quantum of current

When current comes in discrete packages: Viennese scientists unravel the quantum properties of the carbon material graphene

In 2010 the Nobel Prize in physics was awarded for the discovery of the exceptional material graphene, which consists of a single layer of carbon atoms...

Im Focus: Transparent - Flexible - Printable: Key technologies for tomorrow’s displays

The trend-forward world of display technology relies on innovative materials and novel approaches to steadily advance the visual experience, for example through higher pixel densities, better contrast, larger formats or user-friendler design. Fraunhofer ISC’s newly developed materials for optics and electronics now broaden the application potential of next generation displays. Learn about lower cost-effective wet-chemical printing procedures and the new materials at the Fraunhofer ISC booth # 1021 in North Hall D during the SID International Symposium on Information Display held from 22 to 27 May 2016 at San Francisco’s Moscone Center.

Economical processing

Im Focus: Trojan horses for hospital bugs

Staphylococcus aureus usually is a formidable bacterial pathogen. Sometimes, however, weakened forms are found in the blood of patients. Researchers of the University of Würzburg have now identified one mutation responsible for that phenomenon.

Staphylococcus aureus is a bacterium that is frequently found on the human skin and in the nose where it usually behaves inconspicuously. However, once inside...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Networking 4.0: International Laser Technology Congress AKL’16 Shows New Ways of Cooperations

24.05.2016 | Event News

Challenges of rural labor markets

20.05.2016 | Event News

International expert meeting “Health Business Connect” in France

19.05.2016 | Event News

 
Latest News

Rutgers scientists help create world's largest coral gene database

24.05.2016 | Earth Sciences

New technique controls autonomous vehicles on a dirt track

24.05.2016 | Information Technology

Programmable materials find strength in molecular repetition

24.05.2016 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>