The Trauma of Intensive Care Units
It is not often we hear about PTSD in those patients in Intensive Care Units (ICUs), however this category of PTSD patients does exist.
In a study of ICU patients in the UK, 85 percent of eligible patients participated in the study and found that all patients had variations of PTSD symptoms: 23 percent high symptom levels, 25 percent medium symptom levels, 52 percent low symptoms levels (Twigg et. al., 2008).
When considering this level of healthcare, it is important to recognize the types of invasive and high acuity diagnoses patients encounter as well as this as a baseline for their environment.
According to (Sutter Health, 2005), patients may enter the ICU following a complex surgery, for a head injury, after their heart stopped beating, difficulty breathing and life threatening chemical imbalances and infections.
It is difficult to adjust with everything from the aggressive treatments and the mechanical function of the bodies of patients in these settings to the lack of control and agency in their care. The longer the patients remain in this setting, the higher their PTSD symptom levels increase, especially for those patients who have respiratory issues as a reason to be in the ICU.
Patients with respiratory problems seem to face an increased rate of PTSD symptoms during acute care in the ICU and up to 12 months following discharge to a post-acute care location.
Sixty-six percent of patients in a study of 700 respiratory ICU patients who survived their ICU stay reported symptoms of up to three psychiatric symptoms and comorbidities of PTSD: Thirty-six percent of patients expressed feelings of depression, 42 percent presented with active anxiety and twenty-four percent showed signs of PTSD (Parker et al., 2015).
Chronic Obstructive Pulmonary Disease (COPD) is one of the main diagnoses we consider when measuring outcomes in relation to PTSD. Given that the disease trajectory of COPD includes aggressive coughing, tightness in the chest, shortness of breath with or without physical activity and excessive wheezing, these symptoms often make patients stop in their tracks to ensure they can breathe before making another step.
According to Abrams, Blevins & Vander Weg (2015), PTSD symptoms and assessments on patients w/ COPD is significant when identifying PTSD as a co morbiditiy to COPD.
Knowing that PTSD symptoms can exacerbate COPD symptoms, more evidence is needed to confirm its impact. However, data implies that the etiology of PTSD can be derived from living with COPD and that PTSD can also exacerbate COPD.
Being mindful of the experiences of our patients isn’t enough when we are not changing our treatment interventions. As clinicians, we need to utilize tools for patients to use during their ICU stay to help manage the PTSD symptoms outside of the conventional psychiatric protocol for patients experiencing such symptoms, as these symptoms are much more unique and formed as a result of their current environment and experiences.
Many times, patients have a foggy memory of their day-to-day experiences in the ICU. One innovative intervention to use with these high risk PTSD ICU patients is an ICU diary that collects the events of the day experienced by these patients. The goal of the diary is to give the power and autonomy of directing care back to them and give them meaning and understanding of what their days look like to help combat some of the other co morbidities of PTSD symptoms including depression and anxiety (Amoss, 2003).
The DSM does not recognize being in the ICU as a criteria for PTSD at this time. However, with continued research on the topic, more emphasis on this population will help practitioners better understand their patients’ experiences and provide them with more personalized care options to fit their unique patient needs.
Abrams T.D., Bevins A., Vander Weg M.V. (2015). Chronic obstructive lung disease and posttraumatic stress disorder: current perspectives. International Journal of Chronic Obscturctive Pulmonary Disease, 10, 2219-2233. link
Amoss, M. (2003). Treating the Trauma of Intensive Care
Parker, Ann M. MD, Sricharoenchai, Thiti MD, Raparla, Sandeep MD, Schneck, Kyle W. BA, Bienvenu, O. Joseph MD, PhD, & Needham, Dale M. FCA, MD, PhD. (2015). Posttraumatic Stress Disorder in Critical Illness Survivors: A Metaanalysis. Critical Care Medicine, (43)5.
Sutter Health (2005). What is the ICU? Retrieved from http://www.cpmc.org/learning/documents/icu- ws.html
Twigg,E., Humphris G., Jones C., Bramwell R., & Griffiths, R.D. (2008) Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients.
Silvi Saxena is a licensed social worker, certified oncology social worker and clinical trauma professional. She works with the chronically and terminally ill population in Philadelphia, PA and has a special focus on employee health and wellness.
Saxena,, S. (2018). The Trauma of Intensive Care Units. Psych Central. Retrieved on March 19, 2018, from https://pro.psychcentral.com/the-trauma-of-intensive-care-units/