February 22, 2017
During the last decade, the field of critical care medicine has been undergoing a sea change, says Dale Needham, medical director of the Johns Hopkins Critical Care Physical Medicine and Rehabilitation Program and professor of physical medicine and rehabilitation. It wasn’t enough for a patient to leave the ICU alive, the longtime benchmark for success. Rather, he explains, doctors began devoting more attention to patients’ long-term recovery while still in the ICU, offering physical and occupational therapy in addition to lifesaving care.
Though it’s now increasingly common for doctors to focus on patients’ physical well-being, comparatively little is devoted to health of the mind. That’s a mistake, says Needham, whose research is focused on how time spent in the ICU affects mental health.
One of his recent studies, a meta-analysis of 40 studies, showed that about a quarter of patients who leave the ICU have post-traumatic stress disorder. Most doctors consider PTSD a consequence of warfare, major catastrophes or assault. But the condition can also result from delusions of events that never happened, which are common in patients with critical illness and associated organ failures.
Needham says that some of his patients have reported gruesome visions of blood running down the walls, waking up next to deceased people or being harmed by their care providers—none of which actually happened.
“These events can feel like real memories and are incredibly frightening, even though they never took place,” Needham says. “As a result, patients may suffer PTSD.”
Other recent work by Needham and his colleagues shows that about two-thirds of patients who survive acute respiratory distress syndrome, a prototypical ailment in the ICU, have symptoms of depression, anxiety and PTSD afterward. About a third of these have symptoms of all three.
These ICU-related disorders can be extremely debilitating, Needham says, leading to suicidal ideation for some patients and anxiety so severe that some panic when they get a common cold—they’re fearful that they’ll have to return to the ICU or will die.
Needham says that research from around the world is raising awareness of these conditions, a key to helping patients get the help they need. In addition, certain changes at hospitals may help reduce the risk of mental health problems after ICU stays. For example, Needham and his colleagues hope to improve patients’ awareness and ability to process their experiences through the use of lighter sedation and interventions, such as ICU diaries, in which clinicians and family members write daily messages about what happens to a patient.
“Our hope is to improve their ability to move on from ICU stays, both physically and mentally,” says Needham, “and get them back to living their lives.”
About 25 percent of patients who leave the ICU have PTSD.