ICU Diaries Help Patients Ward Off PTSD

Almost one quarter of patients who spend time in an intensive care unit (ICU) suffer from post traumatic stress disorder. The rate is comparable to that of survivors of war, major catastrophes, or violent crime.

Experts say there’s evidence that keeping a daily dairy might be one way to prevent it. Joe Bienvenu, associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, warns:

“PTSD can drastically impact a person’s ability to communicate and connect with others, truly interrupting their lives and preventing experiences of joy.

This is why our findings are important and why it’s so critical that we continue to research ways to prevent PTSD.”

Fear and Stress

In PTSD, survivors of terrifying experiences feel stressed or frightened even when they’re no longer in danger, according to the National Institutes of Health. Symptoms can include flashbacks, bad dreams, depression, emotional outbursts, sleep problems, and other behaviors.

The new study, published in the journal Critical Care Medicine, improves on past research on PTSD among former ICU patients because far more data is available.

“We now have a larger data set to review and learn from,” says Ann Parker, a fellow in pulmonary and critical care medicine. “These data could help us develop better prevention methods for ICU-induced PTSD.”

Researchers looked at 40 studies involving more than 3,000 patients who survived a critical illness and ICU stay, then conducted a meta-analysis of six of the 40 studies, with a total of about 450 patients.

Surviving Critical Illness

Each study used a PTSD measurement tool called the Impact of Event Scale between one and six months after patients’ ICU discharge. One in four patients had symptoms of PTSD. Researchers also did a meta-analysis of studies that looked at patients seven to 12 months after an ICU stay and found that one in five patients had PTSD.

Said Dale Needham, professor of medicine and of physical medicine and rehabilitation:

“These rates are as high as you might see in combat soldiers or rape victims. Our clinicians and patients should know that the high risk of PTSD exists among patients surviving critical illness.”

Dear Diary

The most effective solution appears to be an ICU diary, a notebook that allows a patient, when able, or clinicians and family members to write daily messages about what happens to the patient.

“Diaries seem to help patients process their experience and formulate more accurate memories of their time in the ICU. They provide patients with a tool to better understand their experience in the ICU through the words of their loved ones and caregivers,” Bienvenu says.

Relatively few institutions in the United States use ICU diaries, but they’re common in Europe. The Johns Hopkins Hospital plans to use them for patients entering its medical ICU and will further evaluate their effectiveness as a therapeutic tool.

One risk factor for PTSD was a psychological problem, such as anxiety or depression, before admission to the ICU. Another was heavy sedation while in the ICU.

Patients who reported frightening memories of the ICU also had a higher risk of PTSD.

With more than 5 million people annually requiring ICU-level care in the United States and more than 750,000 Americans needing mechanical ventilators, Parker says:

“it’s clear that those who care for ICU patients need to be aware that there could be long-term consequences of critical illness and lifesaving treatments, including PTSD, which can significantly limit a patient’s quality of life well after discharge.”

The field of critical care medicine is getting better at saving lives, but that leads to an ever-growing group of ICU survivors.

“To ensure that these patients have the best possible quality of life, we have to look at what their lives are like after they leave the ICU,” Needham says.

Reference:

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
Posttraumatic Stress Disorder in Critical Illness Survivors: A Meta-analysis
Critical Care Medicine: May 2015 – Volume 43 – Issue 5 – p 1121–1129 doi: 10.1097/CCM.0000000000000882

Photo: Benjamin Ellis/flickr