9202938 JA
The psychological and psychiatric consequences of the ICU stay
Discusses management of regression, delirium and paranoia in ICU patients. Although ICU patients may function as
adults intellectually, they may regress to a childlike emotional state in order to adapt to being taken care of. However, this
also makes them more vulnerable to stress, more resentful of difficult treatments, and more angry at hospital personnel.
1997 Eur J Anaesthesiol Suppl 15;45-7
Blacher, R. S.
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Drug Intelligence & Clinical Pharmacy: Vol. 19, No. 1, pp. 13-20.
The intensive care unit syndrome: causes, treatment, and prevention
RJ Weber, MA Oszko, BJ Bolender, and DL Grysiak
The psychological assessment and management of the critically ill patient is often overlooked as a part of the patient
care plan. The intensive care unit (ICU) syndrome is a type of organic brain syndrome manifested by a variety of
psychological reactions, including fear, anxiety, depression, hallucinations, and delirium. Causes, treatment modalities,
and a multidisciplinary approach to preventing the ICU syndrome are presented. Causative factors that should be
assessed in the psychological evaluation of ICU patients include: (1) preadmission history; (2) past ability to adapt to
stress; (3) past and current medications; (4) current clinical status; and (5) environmental factors. The treatment of the
ICU syndrome includes: (1) the correction or elimination of causative factors; (2) the appropriate choice, dose, and route
of administration of anxiolytic and antipsychotic agents; (3) reduction or elimination of sources of environmental stress;
and (4) frequent patient and family communication. Finally, the prevention of the ICU syndrome through the involvement
of physicians, nurses, and pharmacists is stressed
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http://www.wordspy.com/words/ICUpsychosis.asp
Earliest Citation:
"Ms. Fogle said DeVries told her Friday that Clark has completely recovered from periods of confusion and forgetfulness
suffered several weeks earlier while he was in the surgical intensive care unit. The condition, called ICU psychosis,
occurs in about 25 percent of intensive care patients, Ms. Fogle said. It is caused by the constant beeping of electronic
monitors, taking of blood samples and changing of intravenous tubes, she said." Donna Anderson, "Clark Said To Be
Over Periods Of Confusion," The Associated Press, February 25, 1983
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ICU Syndrome: Current Documentation Practices, Relationship Between Physiological Measures and Behaviors,
and Consistency Among Three Neurological Measures
Primary Investigator - Jeanne Widener
P.I. Institution Name - Ohio State University
Contact Address - College of Nursing, 1585 Neil Avenue, Columbus, OH, 43210, USA
Contact E-mail - widener.6@osu.edu
Contact Telephone - 614.292.9293
Secondary Investigators - Frazier, Susan K.
PROBLEM: Intensive care (ICU) syndrome occurs in an estimated one-third of patients. Physiological alterations that
occur in critically ill patients effect cognitive and psychological function. Management of behaviors associated with ICU
syndrome requires significant nursing attention. Nursing management of ICU syndrome most often includes physical
restraint and/or pharmacological therapy. Traditionally, health care professionals believe that correction of the underlying
physiological alterations will decrease the behaviors associated with ICU syndrome. However, research does not support
this belief. In fact, negative psychological effects attributed to ICU syndrome may require long-term intervention in some
patients. Critical care nurses currently use multiple measurement scales to evaluate the patient behavior and provide
support for nursing interventions used to treat ICU syndrome.
SPECIFIC AIMS: The specific aims of this study are to: 1) describe the documentation practices related to behaviors
associated with ICU syndrome during the first 48 hours of ICU admission; 2) compare the documented results of 3 scales
that evaluate cognitive function and overt behaviors (the Glascow Coma Scales, Modified Ramsey Sedation Score, and
general neurological assessment); and 3) evaluate whether physiological measures are different in those subjects with
and without ICU syndrome during the first 48 hours of ICU admission.
DESIGN: A descriptive, retrospective medical records review pilot study.
SAMPLE: A random sample of 52 intensive care patients in a mid-western academic medical center.
DATA ANALYSIS: Descriptive statistics will be used to describe the sample and report frequencies of documentation.
Bias and precision will be calculated to compare the documentation of cognitive state and behaviors among the 3 scales.
To evaluate differences in the physiological measures, t-test and chi square will be used as appropriate to the
measurement level 9of the variable. Differences will be considered significant with a p < 0.05.
NURSING IMPLICATIONS: Patients with behaviors associated with ICU syndrome require increased nursing
management and these individuals may experience long-term complications related to this experience. ICU syndrome
may also significantly increase health care costs. Scales used in current practice may not be sensitive indicators of
altered cognitive function and behavior changes. In addition, these scales may not be reliable indicators of ICU
syndrome.
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http://answers.google.com/answers/threadview?id=490587
Comments
Subject: Re: ICU Syndrome
From: drdeftly-ga on 10 Mar 2005 09:33 PST
ICU syndrome exists, and is often diagnosed, but the notion that there are long term (0r even short-term) health
consequences has NEVER been sustained in the medical literature.
ICU syndrome is a state of disorientation, altered mental status or near psychosis that occurs in ICU patients. This
happens in long term ICU patients especially.
The causes are not all that hard to understand. Most ICU patients are restrained. They have multiple IV tubes, central
lines, monitors, and many are intubated and on a ventilator. Many require large doses of pain medication and a few
require paralysis to kee them safe in the ICU. And, MOST ICU patients are either severely injured or VERY sick.
Thus, even a very HEALTHY person would get a bit "flaky" mentally if restrained and drugged under similar
circumstances. Defense Department studies concerning sensory deprivation alone have documented as much.
The mental status changes are unfortunate, but are often unavoidable in those requireing hospitalization in the ICU.
AND, for the VAST majority of ICU patients, ICU syndrome resolves on its own. As the patient improves physically, the
mental status improves as well. The stronger narcotics and other medications are withdrawn. And the patient generally
is transferred from the ICU to a standard medical bed on a patient floor. Altered mental status can often be cause for
keeping the patient in the I.C.U. ---- but if this happens, "I.C.U. syndrome" is NOT an acceptable diagnosis. A medical
cause for the mental status changes has to be found.
If you are trying to sue someone or a hospital for "ICU syndrome," don't waste your time. The diagnosis itself is not well
regarded in medical circles. And if the "syndrome" does not resolve on its own as the patient improves, some OTHER
cause must be medically investigated and diagnosed as being the underlying etiology.
Don't bother suing on this. ONE medical expert testifying for the defense will blow your entire case out of the water.
There HAS to be another diagnosis linked to specific, identifiable medical malpractice. There has to be a tort to get your
suit started. There has to be a medical wrong to sustain your case.
Suing over "ICU Syndrome" is like suing a hospital because you feel BADly after having been admitted to the hospital for
a heart attack. If you feel bad in the hospital, its because you are SICK!
The medical literature will support my assertions here. The legal case law will support this as well. That is, if you can
find any case law dealing with something so ridiculous.
Dr. Deftly
My professional advice: don't waste your money.
Dr. Deftly
Subject: Re: ICU Syndrome
From: expertlaw-ga on 12 Mar 2005 13:56 PST
While I agree that case law research can be quite time consuming, that tends not to be the case when looking for a
specific term in the available online databases. WestLaw and Lexis both offer databases comprised of all state and
federal case law, and a search for ("ICU Syndrome" or "intensive care unit syndrome") should bring up any case in the
database which includes those terms.
However, to the extent that there are any cases which might be of interest, they are most likely to exist at the trial court
level, or perhaps even exist only as dismissed lawsuits, and are thus unlikely to appear in the online databases. Unless
information shows up through a service like ATLA Exchange, or similar service by a lawyers or insurance company group
which collects such information for the benefit of members, finding such information amounts to looking for a needle in a
proverbial haystack, and in many courts the information could be found only through a manual review of records.
Intensive care unit syndrome/delirium is associated with anemia, drug
therapy and duration of ventilation treatment
Authors: Granberg Axèll, A. I. R.1; Malmros, C. W.2; Bergbom, I. L.3; Lundberg, D. B. A.1
Source: Acta Anaesthesiologica Scandinavica, Volume 46, Number 6, July 2002 , pp. 726-731(6)
Publisher: Blackwell Publishing
Abstract:
Background:
We have performed a prospective qualitative investigation of the ICU syndrome/delirium; the main parts of which have
recently been published. The aim of the present study was to explore the relationship between the ICU
syndrome/delirium and age, gender, length of ventilator treatment, length of stay and severity of disease, as well as
factors related to arterial oxygenation and the amount of drugs used for sedation/analgesia. Methods:
Nineteen mechanically ventilated patients who had stayed in the ICU for more than 36 h were closely observed during
their stay, and interviewed in depth twice after discharge. Demographic, administrative and medical data were collected
as a part of the observation study. Results:
Patients with severe delirium had significantly lower hemoglobin concentrations than those with moderate or no delirium
(P=0.033). Patients suffering from severe delirium spent significantly longer time on the ventilator and at the ICU, and
were treated with significantly higher daily doses of both fentanyl (P=0.011) and midazolam (P=0.011) in comparison with
those reporting only moderate or no symptoms of delirium. There were no significant differences in the Therapeutic
Intervention Scoring System scores, reflecting the degree of illness, between patients with and without delirium.
Conclusion:
The development of the ICU syndrome/delirium seems to be associated with decreased hemoglobin concentrations and
extended times on the ventilator. Prolonged ICU stays and treatment with higher doses of sedatives and opioids in
patients with delirium appear to be secondary phenomena rather than causes.
Keywords: arterial oxygenation; critical and intensive care; hemoglobin; ICU syndrome; delirium; length of stay; opioids;
sedatives
Document Type: Research article
DOI: 10.1034/j.1399-6576.2002.460616.x
Affiliations: 1: University Hospital, Lund, and 2: Helsingborg Hospital, Helsingborg, and 3: Department of Nursing,
Division of Health and Caring Science, Gothenburg University, Sweden
Intensive and Critical Care Nursing
Volume 21, Issue 6, December 2005, Pages 344-354
‘Fishing with the dead’—Recall of memories from the ICU
Judith M. Magarey, and Helen H. McCutcheon
The Department of Clinical Nursing, The University of Adelaide, Adelaide, South Australia
Accepted 15 February 2005. Available online 1 June 2005.
Summary
The purpose of this study was to explore the memories of patients who had a short-term admission to the ICU, with a
particular focus on dreams, nightmares and confusion.
Descriptive data were collected from a target sample of 50 participants, by means of a questionnaire. Following this,
eight patients who had completed and returned the questionnaire and had reported hallucinations, dreams or confusion
participated in open-ended, semi-structured interviews.
Analysis of the data generated by the questionnaire revealed that the most common memories of ICU were anxiety, pain,
thirst and nausea. Nightmares, hallucinations and confusion were also common and were reported to be highly
distressing. The transcribed interviews were subjected to a thematic analysis. The themes that emerged were, reality and
unreality, blackness and colour, powerlessness and purpose, and death. Participants described horrifying paranoid
delusions. It is proposed that constant reassurance and explaining every day ICU happenings may assist patients to
understand what they are experiencing and loved ones may provide an important link with reality.
Keywords: Sedation; Memories; Dreams; Nightmares; ICU