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SAN DIEGO – Even a year after a stay in an intensive care unit (ICU) for nontraumatic illness, a high percentage of ICU patients exhibit signs of post-traumatic stress disorder (PTSD), researchers said here.

Between 34% and 36% of patients who survived an ICU experience exhibited PTSD symptoms 7-12 months later on the validated Impact of Events Scale, said Thiki Sricharoenchai, MD, an instructor in pulmonology at Thammasat University in Pathum Thani, Thailand.

“We found that the incidence of PTSD among ICU patients is similar to what has been seen among trauma victims,” Sricharoenchai told MedPage Today at his poster discussion presentation during the annual meeting of the American Thoracic Society.

He said that the younger people, those who had been on benzodiazepines, those who had been on mechanical ventilation, and those individuals who retained memories of frightening ICU experiences were those most likely to have long-term PTSD symptoms.

“That was a review of all the literature on the subject, so we have certainly known about this relationship between ICU and PTSD for a while,” said Hannah Wunsch, MD, assistant professor of epidemiology at Columbia University in New York City.

“At different institutions, PTSD appears to be a substantial issue for a number of ICU patients,” Wunsch, a co-moderator of the poster discussion session, told MedPage Today. “There are a lot of people looking at what we can do about this. There are questions about or sedation strategies, the role of families, things like the use of ICU-diaries, providing for appropriate follow-up so these patients can get help and their condition does not go unrecognized in the continuum of care both in and after ICU.”

Senior author of the study Dale Needham, MD, PhD, associate professor of medicine at Johns Hopkins University in Baltimore, told MedPageToday, “The studies showed that in the first 6 months after ICU discharge, a range of 23% to 42% of survivors had clinically important events symptoms of PTSD, When we looked at 6-12 months, we found that that these symptoms still persisted.”

Their meta-analysis of 28 published articles representing 3,437 patients. The search identified 3,243 titles/abstracts, with 28 articles on 25 unique cohorts including two from the U.S.

The Impact of Events Scale was the most common instrument used to determine whether the patients had PTSD. It was employed in 12 studies, said Sricharoenchai, who performed the study during a fellowship at Johns Hopkins.

In 429 patients who were followed for 1-6 months post ICU, the pooled prevalence of clinically important PTSD symptoms was 23% and 42% using an Impact of Events Scale threshold of greater than 35 and greater than 20, depending on the study.

In 698 patients who were followed for 7-12 months post ICU, the pooled prevalence of PTSD symptoms was 34% and 36%. In other studies, the point prevalence of PTSD symptoms ranged from 5% to 62%, the researchers reported.

Needham noted that the patients in the study did not have any of the classic PTSD-causing events: Battlefield experiences, automobile accidents or violent crime experiences. “In our meta-analysis, we specifically excluded patients who had a physical trauma prior to the ICU. These were patients who had undergone surgery or who had a life-threatening medical condition.

“These events are happening at a time that patients are unable to properly process these events. They are very sick and their brains are not working that well, or they are given sedation medications that causes confused thinking. While they are confused they are often having false beliefs that nurses are trying to harm them, [that] they are being sexually assaulted in the ICU, that blood is coming out of the walls and ceilings, and these things can produce long, disturbed memories for ICU survivors.”

Needham also noted that many of those who later develop PTSD symptoms have had psychological problems before their ICU experience, and since ICU patients often have had underlying psychological problems, there may be a high percentage that go on to have PTSD symptoms.

He said that intubation procedures, the placement of intravenous lines and other invasive ICU procedures can influence the development of PTSD down the road. “There also may be other traumatic events happening around them; they do not have the opportunity to express how they are feeling. They are quite powerless in the ICU to work through this.”

“At this point we don’t know if all ICU survivors should be seen by a mental health provider, but what we do know is that if the person is having repeated disturbing memories of the ICU experience, that is another red flag that they may have clinically important PTSD symptoms.”

In his report, Sricharoenchai said, “Given the high PTSD point prevalence in ICU survivors, additional studies are needed evaluating systematic screening, prevention and/or treatment interventions

via. https://www.medpagetoday.com/MeetingCoverage/ATS/45904