Psychological symptoms in difficult‐to‐sedate critical care survivors

Abstract

BackgroundCritical care survivors often experience symptoms of anxiety, depression, or post‐traumatic stress disorder (PTSD).AimsTo determine the prevalence and severity of psychological symptoms during the first 6 months after discharge from the intensive care unit (ICU) and to evaluate its association with patients who are difficult to sedate during admission.DesignDescriptive, prospective analysis of psychological symptoms in survivors from medicosurgical ICU over a 2‐year period.MethodsAll ICU survivors who required mechanical ventilation (MV) for more than 24 hours were followed for 6 months after their ICU discharge. ICU outcome and complications as well as the presence of psychological symptoms, 1 to 3 to 6 months after discharge were prospectively evaluated through phone interviews comparing the incidence and intensity of patients who were difficult to sedate during their ICU stay with those who were not. Descriptive analysis and multivariate logistic regression were performed.ResultsData were obtained for 195 patients, of whom 30% experienced difficult sedation (DS). Difficult‐to‐sedate patients were younger (P = .001), less critically ill (APACHE II score P = .002), and more likely to engage in harmful use of alcohol (P = .001) and psychoactive/psychotropic drug abuse. They also spent longer times on MV and in the ICU (P = .001). Anxiety incidence at 1 to 3 to 6 months post‐discharge was significantly higher in DS patients than in those who were not (87.7% vs 45.4%, 75.5% vs 29.0%, and 70.8% vs 23.7%; P < .01), respectively. Depression incidence was also significantly higher in the DS group (82.4% vs 43.1%, 66% vs 33.9%, and 60.4% vs 27.2%; [P = .001]) at 1 to 3 to 6 months, respectively. A higher percentage of patients in the DS group reported symptoms of PTSD at 1 month (28.1% vs 11.5%) (P = .007) when compared with non‐DS group.ConclusionsCritical care survivors who are difficult to sedate during their ICU stay are more likely to present psychological sequelae. Early identification of at‐risk patients is necessary to implement appropriate preventive strategies.Relevance to clinical practicePatients who are difficult to sedate in the ICU may develop psychological disorders upon discharge, which may negatively affect their recovery. The prevention of DS and the early detection of psychological disorders are essential to minimize its subsequent impact.

Spotlight on the upcoming British Association of Critical Care Nurses conference and other clinical issues

“…Consequently, this issue includes a collection of 11 papers on delirium and/or sedation assessment and management. Lee and Roh 4 investigated the knowledge, barriers and training of nurses caring for patients with delirium in the Republic of Korea; Xu et al 5 and Wu et al 6 examined the risk factors of delirium in paediatric and adult intensive care unit (ICU) patients respectively; whereas Mortensen et al 7 and Castillejos et al 8 explored the experiences and the psychological symptoms of ICU survivors who had experienced delirium or difficult sedation 1 year after being discharged. Other papers report on clinical trials, observational studies or reviews investigating the potential impact of preoperative cardiac care unit visits, 9 eye masks and ear plugs, 10 sensory stimulation, 11 early sedation with dexmedetomidine, 12 non‐pharmacological interventions 13 and improved sleep quality 14 on the prevention of delirium in critically ill patients.…”