Intensive Crit Care Nurs. 2006 Dec;22(6):346-54. Epub 2006 Aug 9. Links
Delusional memories from the intensive care unit--experienced by patients with physical trauma.
Ringdal M, Johansson L, Lundberg D, Bergbom I.
Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, SE40530 Göteborg, Sweden. mona.ringdal@fhs.gu.se
During and after intensive care unit (ICU) stays some patients report unreal experiences or so called
delusional memories, which can be a source of distress. The aims of this study were: to describe trauma
patients' memories of their stay in the ICU, factors that may influence delusional memories, problems
experienced after discharge from the ICU and the patients' return to work. In this multi-centre study, 239
trauma patients filled in a self-administered questionnaire (ICUM tool) 6-18 months after their ICU stay.
Clinical data were obtained from patient records. Fifteen percent of the respondents had no memory
whatsoever of the ICU. Factual memories such as visits by family members were recalled by 83%.
Delusional memories were reported by 26%, nightmares being the most common. These patients' also had
more memories of pain, fear and panic. Significant factors associated with delusional memories were
age <50 year, ICU stay >or=3 days, temperature >or=38 degrees C, S-Haemaglobin <or=100g/l, renal
failure, surgery, ventilator support, sedative drugs, and opioids. A logistic regression analysis of all
significant factors revealed that age was the best predictor of delusional memories. Significantly more
patients with delusional memories reported unexplained feelings of panic after discharge from the ICU and
had still not returned to work 1 year after the trauma. In conclusion, patients with delusional memories are
younger and these memories affect them even after discharge from the ICU.
PMID: 16901701 [PubMed - indexed for MEDLINE]
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Aust Crit Care. 1999 Jun;12(2):47-53.Links
The cardiac surgical patient's expectations and experiences of nursing care in the intensive care
unit.
Hunt JM.
St Vincent's Private Hospital, Darlinghurst, New South Wales.
There is an abundance of research investigating patient satisfaction. However, few studies have addressed
patient satisfaction by comparing patients' expectations of nursing care with the care they actually received.
This qualitative study explores both cardiac surgical patients' preconceptions and expectations of nursing
care in the intensive care unit (ICU) and their actual experience of nursing care while in the unit. Data were
collected using a semi-structured interview technique. Interviews took place prior to admission and following
discharge from ICU, and were taped and transcribed. Using thematic analysis, major and minor themes
emerged from the data. The preoperative interviews revealed that participants had clear expectations of the
nurse's role in ICU. They expected the nurse who cared for them to be capable, intelligent, experienced and
technically adept. Further, they wanted a nurse who would be vigilant and provide them with personalised
care. Participants understood they would be vulnerable and looked to the nurse to help them through this
period. Post-operative interviews revealed that when participants perceived vigilance or experienced
personalised care from the nurses they felt reassured and secure. However, patients also described
feelings of anxiety, apprehension, fear and other unexpected experiences, notably confusion and
hallucinations. Recommendations suggest that modification to pre-operative patient education programs
could lead to a reduction in anxiety in the post-operative period. They also highlight the importance, to the
patients, of nurse caring activities. In addition, the findings suggest a need for staff education that
addresses patient anxiety and post-operative psychological disturbances.
PMID: 10624186 [PubMed - indexed for MEDLINE]
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Intensive Crit Care Nurs. 1999 Feb;15(1):19-33.Links
Acute confusion and unreal experiences in intensive care patients in relation to the ICU syndrome.
Part II.Granberg A, Engberg IB, Lundberg D.
Intensive Care Unit, Helsingborg Hospital, Sweden. anetthgranberg@anest.lu.se
The intensive care unit syndrome (ICU syndrome) is defined as an altered emotional state occurring in a
highly stressful environment, which may manifest itself in various forms such as delirium, confusion,
crazy dreams or unreal experiences. The purpose of this part of a study of patients' experiences is to
describe and illuminate patients' experiences of acute confusion, disorientation, wakefulness, dreams and
nightmares during and after their stay in the ICU. The data were obtained from 19 ventilated patients, who
were interviewed twice and had stayed at least 36 hours in the ICU, the first interview being about one week
after discharge from the ICU, and the second 4-8 weeks later. The hermeneutic approach used when
interpreting and analysing the text from the interviews revealed that patients' experiences of unreal
experiences were often associated with intense fear. Intense or continuous unbearable fear seems to result
in frightening unreal experiences, which further increase the level of fear. Care actions or caring relationships
with relatives or nurses can reduce this fear, which can help to prevent the occurrence and/or duration and
intensity of the unreal experiences. Trust and confidence in nurses or significant others and feelings of selfcontrol or trust in self-control seemed to reduce the risk of unreal experiences so that adverse stimuli might
only trigger a mild confusion.
PMID: 10401338 [PubMed - indexed for MEDLINE]
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Memory. 2000 Mar;8(2):79-94.Links
Comment in: Curr Surg. 2003 Jul-Aug;60(4):356-60.
Disturbed memory and amnesia related to intensive care.
Jones C, Griffiths RD, Humphris G.
Department of Medicine, University of Liverpool, UK.
Patients, when admitted to an intensive care unit (ICU), have one thing in common: their illness is lifethreatening. Patients may remain on ICU in a critical condition, needing support with their breathing,
circulation, and/or kidneys for varying lengths of time, from days to weeks. During that time the patients will
receive sedative and analgesic drugs to ensure compliance with artificial ventilation. Patients recovering
from critical illness frequently have little or no recall of their period in ICU, or remember nightmare,
hallucinations, or paranoid delusions. The nature, extent and reason for these difficulties, have been
under-reported and consequently our purpose was to conduct a review of memory problems experienced by
ICU patients. A systematic literature review of computer databases (Medline, PsycLit, and CINAHL) identified
25 relevant papers. In addition, other relevant articles were obtained, citation lists and associated articles
retrieved. Due to lack of research on processes underlying memory problems in ICU patients all articles
that introduced an insight into possible mechanisms were included in the review. There seem to be two
possible processes contributing to memory problems in ICU patients. First the illness and treatment may
have a general dampening effect on memory. Delirium and sleep disturbance are both common in ICU
patients. Delirium can result in a profound amnesia for the period of confusion. Sleep deprivation
exacerbates the confusional state. Slow wave sleep is important for the consolidation of episodic
memories. Treatment administered to patients in ICU can have effects on memory. Opiates,
benzodiazepines, sedative drugs such as propofol, adrenaline, and corticosteroids can all influence
memory. In addition, the withdrawal of drugs, such as benzodiazepines, can cause profound withdrawal
reactions, which may contribute to delirium. Second, we hypothesise that there is a process that affects
memory negatively for external events but enhances memory for internal events. The physical constraints
and social isolation experienced by ICU patients and the life-threatening nature of the illness may increase
the experience of hypnagogic hallucinations. Attentional shift during hypnagogic images from external stimuli
to internally generated images would explain why ICU patients have such poor recall of external ICU events,
but can clearly remember hallucinations and nightmares. Patients describe these memories as being very
vivid and this is explored in terms of flashbulb memory formation. The absence of memories for real
events on ICU can result in ICU patients remembering paranoid delusions of staff trying to kill them,
with little information to reject these vivid memories as unreal. This has implications for patients'
future psychological health.
PMID: 10829125 [PubMed - indexed for MEDLINE]
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J Clin Nurs. 1999 May;8(3):284-90.
Intensive care unit psychosis, the therapeutic nurse-patient relationship and the influence of the
intensive care setting: analyses of interrelating factors.
Dyson M.
Intensive Care Unit, Wythenshawe Hospital, Manchester, UK.
It has been estimated that between 12.5% and 38% of conscious patients admitted to critical care
settings experience Intensive Care Unit psychosis, a condition which seems to resolve upon transfer to
the ward. This phenomenon was traditionally recognized when the patient outwardly exhibited
abnormal behaviours and signs in the form of confusion, delirium, anxiety, depression, delusions
and audiovisual hallucinations, yet it has been argued that due to the illness of the patient and their
suppressed ability to communicate, such overt displays of unusual behaviour are the tip of the
iceberg. In recognizing this phenomenon, it is felt that a relationship exists between Intensive Care
Unit Psychosis, the therapeutic nurse-patient relationship, and the environment in which nurses'
interactions with their clients occur. This paper will explore the interaction between these three elements
while considering the implications for contemporary nursing practice.
PMID: 10578751 [PubMed - indexed for MEDLINE]
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The importance of diagnosing and managing ICU delirium.
N, MSN, Center for Health Services Research, Vanderbilt Medical Center, Nashville, TN 37232-8300, USA.
Brenda.Pun@vanderbilt.edu
ICU delirium represents a form of brain dysfunction that in many cohorts has been diagnosed in 60
to 85% of patients receiving mechanical ventilation. This organ dysfunction is grossly
underrecognized because a majority of patients have hypoactive or "quiet" delirium characterized by
"negative" symptoms (eg, inattention and a flat affect) not alarming the treating team. Hyperactive
delirium, formerly called ICU psychosis, stands out because of symptoms such as agitation that may
cause harm to self or staff, but is actually rare relative to hypoactive delirium and associated with a better
prognosis. Delirium is often incorrectly thought to be transient and of little consequence. After adjusting for
numerous covariates, delirium is a strong, independent predictor of prolonged length of stay, reintubation,
higher mortality, and cost of care. Expanded work on patient safety and recommendations by professional
societies have established the importance of delirium monitoring and recommended it as standard practice in
ICUs all over the world. This evidence-based review for physicians, nurses, respiratory therapists, and
pharmacists will outline why it is imperative that patients be routinely monitored for delirium. This
review will discuss modifiable risk factors for delirium, such as metabolic disturbances or potent sedative and
analgesic medications. Attention to mitigating risk factors, along with recommended pharmacologic
approaches such as antipsychotic medications, may provide resolution of delirium in some patients, while
others will persist with refractory brain dysfunction and long-term cognitive impairment following
critical illness.
PMID: 17699134 [PubMed - indexed for MEDLINE]