Patients’ memory and psychological distress after ICU stay compared with expectations of the relatives

Myhren, Hilde; Tøien, Kirsti; Ekeberg, Øivind; Karlsson, Stig; Sandvik, Leiv; Stokland, Olav

doi:10.1007/s00134-009-1614-1

Cited by 88 publications

(63 citation statements)

References 37 publications

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“…Weinert and Sprenkle found that PTSD symptoms were highest in the groups with intermediate or fluctuating levels of wakefulness (sedation scores not provided) and lower for patients who were more consistently deeply sedated or completely alert and that the alert group was the least affected. A possible explanation for the relationship between alertness and PTSD symptoms in that study 20 and in the 4 studies I examined may be related to findings by Myhren et al 30 that "memory of pain, lack of control, and inability to express needs" were among the independent risk factors for PTSD. Similarly, in a qualitative study, Rattray et al 31 found that patients who were less aware of the surroundings or who had frightening experiences had more PTSD symptoms after discharge than did other patients.…”

Section: Discussionmentioning

confidence: 64%

Sedation and Its Association With Posttraumatic Stress Disorder After Intensive Care

Rock

2014

Critical Care Nurse

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Overuse of sedation in patients treated with mechanical ventilation can increase duration of ventilation, duration of delirium, and time to discharge. Although current principles of care include implementation of sedation protocols and/or daily interruptions in sedation to improve patients’ outcomes, these strategies remain underused. Historically, a barrier to use of protocols has been a perception that being awake and aware while intubated is intrinsically distressing and could cause psychological harm. Evidence of a link between lighter sedation and decreased signs and symptoms of posttraumatic stress disorder has partially dispelled these fears and even prompted the adoption of no-sedation (eg, analgosedation) strategies. Published studies on posttraumatic stress disorder and sedation are limited by small sample size, heterogeneous sedation practices, and inadequate follow-up. Despite limitations, current data suggest contemporary sedation practices to keep patients calm and comfortable but awake, as appropriate, are not associated with increased rates or severity of posttraumatic stress disorder.

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Section: Discussionmentioning

confidence: 64%

Sedation and Its Association With Posttraumatic Stress Disorder After Intensive Care

Rock

2014

Critical Care Nurse

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“…Many who show distress will return quickly to normal function and some with a psychological disorder will follow a recovery trajectory [6]. Cross-sectional and cohort studies have reported anxiety and depression conditions in patients recovering from ICU admission at a higher rate than the general population, at between 24% and 45% at six weeks [7], three months [8] and one year [9]after ICU admission. Anxiety and depression conditions often co-exist with posttraumatic stress disorder (PTSD) [10].…”

Section: Recovery From Critical Illnessmentioning

confidence: 99%

“…In addition to anxiety, depression and PTSD, ICU survivors have often reported the absence of factual memory and the occurrence of delusional memories, including hallucinations or nightmares, throughout their recovery period [7]. ICU-related delusional memories are estimated to be present in around 30% to 70% of patients [10,12,13], are often persecutory in nature, and tend to be recalled with high vividness and in substantial detail [2].The direct cause of these delusional memories is unknown but is thought to be related to a combination of medication (including adrenaline, corticosteroids, opiates and sedative drugs such as propofol and benzodiazepine), sleep deprivation, and critical illness [12].…”

Section: Recovery From Critical Illnessmentioning

confidence: 99%

“…ICU-related delusional memories are estimated to be present in around 30% to 70% of patients [10,12,13], are often persecutory in nature, and tend to be recalled with high vividness and in substantial detail [2].The direct cause of these delusional memories is unknown but is thought to be related to a combination of medication (including adrenaline, corticosteroids, opiates and sedative drugs such as propofol and benzodiazepine), sleep deprivation, and critical illness [12]. The literature surrounding the relationship between recall of absent, traumatic or delusional memories and psychological disorders is mixed, with different authors finding positive [10,12,14,15] and negative associations [7,16]. The association between delusional memories and the psychological distress of ICU survivors has been mainly attributed to the strong vividness with long duration and high emotional content of these memories when compared with memories of real events [13].…”

Section: Recovery From Critical Illnessmentioning

confidence: 99%

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Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review

Ullman

Aitken

Rattray

et al. 2015

International Journal of Nursing Studies

112

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Review methods: Studies evaluated the effectiveness of patient diaries, when compared to no ICU diary, for patients or family members to promote recovery after admission to ICU were included. Outcome measures for describing recovery from ICU included the risk of post-traumatic stress disorder (PTSD), anxiety, depression and post-traumatic stress symptomatology, health-related quality of life and costs. We used standard methodological approaches as expected by The Cochrane Collaboration. Two review authors independently reviewed titles for inclusion, extracted data and undertook risk of bias according to pre-specified criteria. Permanent repository link Results:We identified three eligible studies; two describing ICU patients (N = 358), and one describing relatives of ICU patients (N = 30). No study adequately reported on risk of PTSD as described using a clinical interview, family or caregiver anxiety or depression, health-related quality of life or costs. Within a single study there was no clear evidence of a difference in risk for developing anxiety (RR 0.29, 95% CI 0.07 to 1.19) or depression (RR 0.38, 95% CI 0.12 to 1.19) in participants who received ICU diaries, in comparison to those that did not receive a patient diary. Within a single study there was no evidence of difference in median post-traumatic stress symptomatology scores (diaries 24, SD 11.6; no diary 24, SD 11.6) and delusional ICU memory recall (RR 1.04, 95% CI 0.84 to 1.28) between the patients recovering from ICU admission who received patient diaries, and those who did not. One study reported reduced post-traumatic stress symptomatology in family members of patients recovering from admission to ICU who received patient diaries (median 19; range 14 to 28), in comparison to no diary (median 28; range 14 to 38). Conclusions:Currently there is minimal evidence from RCTs of the benefits or harms of patient diaries for patients and their caregivers or family members. A small study has described their potential to reduce post-traumatic stress symptomatology in family members. However, there is currently inadequate evidence to support their effectiveness in improving psychological recovery after critical illness for patients and their family members.

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“…Esta tendencia general de la familia a sobreestimar el malestar del paciente también se ha reflejado en otros estudios como por ejemplo el llevado a cabo por Myhren et al (2009) en Noruega con una muestra considerable de pacientes y de familiares tras el alta de UCI.…”

Section: Comparación Entre Pacientes Y Familiaresunclassified

Afectación emocional asociada al ingreso en una Unidad de Cuidados Intensivos

Juliá¹

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Patients’ memory and psychological distress after ICU stay compared with expectations of the relatives

Cited by 88 publications

References 37 publications

Sedation and Its Association With Posttraumatic Stress Disorder After Intensive Care

Sedation and Its Association With Posttraumatic Stress Disorder After Intensive Care

Intensive care diaries to promote recovery for patients and families after critical illness: A Cochrane Systematic Review

Afectación emocional asociada al ingreso en una Unidad de Cuidados Intensivos

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