The Hardships That Remain After an ICU Stay
Picture this: A 29 year old male with multiple gunshot wounds is rushed to the intensive care unit (ICU) where he will be placed on mechanical ventilation for 48 hours and undergo multiple surgeries. He is partially paralyzed from the traumatic incident. Now fast forward three months, the devastating effects still remain, for him and his family. The path to living a normal life is disrupted by continuous pain, depression, and post-traumatic stress disorder, which may lead to further disabilities.
Unfortunately, this story is not fictional. It is a reality for many patients who face the complex challenges of recovery after being discharged from the ICU. To combat these devastating effects, clinical researchers have focused their attention on understanding the factors that complicate the long-term recovery of patients and their family.
As a SUMR scholar, I am working with Dr. Meghan Lane-Fall on a project to improve post-intensive care syndrome (PICS) and understand the extreme difficulties behind a trauma injury. When you grow up in an urban area, you become accustomed to the sound of sirens late at night. This provides me with a personal connection to my research project, where I am able to interview some of the patients behind those sirens I hear at night. Connecting with patients who are only 15 minutes from my home at Penn Presbyterian Medical Center provides me with a sense of urgency to one day be the difference they are looking for in their health care experience.
Post ICU experiences frequently consist of physical/functional impairments, cognitive impairment, and even psychosocial problems. The difficulties extend to family members as they are heavily involved and invested in the recovery of a loved one’s traumatic injury. The emotional and physical toll of efforts to regain normal abilities is often overlooked by physicians and their colleagues. While some patients are fortunate enough to face none or minimal effects from post ICU experiences, many others face months, years, or even a lifetime of consequences after suffering from a critical trauma injury and ICU stay.
Physical/Functional Impairments: One year after discharge, 50% of patients in the ICU and 75% of those who were mechanically ventilated continue to face rigorous challenges with activities of daily living (ADLs) and instrumental ADLs. Long term immobility in combination with neuromuscular damage after an ICU stay can pose an uphill battle for patients trying to regain full physical function.
Cognitive Impairment: At least one-third of patients suffer from cognitive impairments after being discharged from the ICU. While some improve significantly over the first year, others may never return to their normal cognitive abilities and way of thinking.
Psychosocial Problems: Between 10% and 50% of patients who survive an ICU stay have new symptoms of depression, post traumatic stress disorder (PTSD), anxiety, and difficulties with sleeping. Half of post ICU patients may not return to their normal work life within the first year of recovery, and one-third will never return.
Family Effects: Close family members suffer from psychosocial problems more than any other consequence of an ICU experience. About 1/3 of ICU family members show signs of depression, and 70% show signs of anxiety after dealing with the care of an ICU patient. Furthermore, nearly half of family members dealing with the death of an ICU patient reveal symptoms of depression.
The following model shows the various problems associated with post-intensive care syndrome and how they can lead to a lower quality of life in the patient and family.
Researchers have suggested that physicians schedule post ICU planning as a standard part of care. This will allow physicians to meet with patients and their families to discuss problems as the discharge date approaches, and to educate the families about some of the hardships they may face in the recovery process. Making them aware of PICS could potentially mitigate any consequences by providing them with appropriate resources beforehand. In addition, a team-based approached that includes specialists in psychiatry and rehabilitation could present an effective method to address the cognitive, physical, and emotional impairments that become a risk for post ICU patients and families. Lastly, it is vital to address the needs of both the patient and family after an ICU stay because their experiences are very different throughout the recovery process.