Patients in the ICU go through a lot. Often rolled in on stretchers and hooked up to life-saving machinery, they come face-to-face with their own mortality. Fluctuating consciousness due to the use of sedatives and/or the onset of delirium can give way to terrifying hallucinations during their stay, according to The Lancet.

Burki TK. Post-traumatic stress in the intensive care unit. Lancet Respir Med. 2019;7(10):843–844.

 

Doctors can address post-ICU post-traumatic stress disorder (PTSD) in patients by taking proactive measures: Schedule a check-up, assess for PTSD symptoms, assign journaling prompts, and have a list of mental health resources ready to go.

This has never been more important than in the era of COVID-19.

 

How a visit to the ICU could lead to PTSD

While an ICU stay can already be an intense event, the trauma of the experience itself can be something else altogether.

The Lancet article stated that patients in the ICU are often ventilated or catheterized. Floating between states of consciousness, they may see different people caring for them every time their eyes open.

Inability to communicate may arise due to sedation, delirium, or intubation. Patients are also subject to hallucinations in the ICU.

What’s more unsettling is how some patients perceive their ICU experiences as a result of medications or delirium. Those who have been catheterized, for example, may recall that process as a sexual assault rather than a medical procedure. Others may perceive doctors with surgical instruments as violent attackers, as noted by The Lancet.

It’s safe to say that for some patients—especially those with a pre-existing anxiety diagnosis—an ICU visit can be traumatic. To prevent and treat post-ICU PTSD, doctors first need to know how to identify it.

 

Symptoms to note

According to an article published by the British Journal of General Practice, classic PTSD symptoms include hyperarousal, fearfulness or panic, and intrusive memories among patients. Other noted symptoms are trauma flashbacks, avoidance of triggers, and emotional numbing.

Taylor AK, Fothergill C, Chew-Graham CA, et al. Identification of post-traumatic stress disorder following ICU. Br J Gen Pract. 2019;69(680):154–155.

 

Physical PTSD symptoms include trembling, dizziness, pain, headaches, and sweating. These symptoms, (along with emotional ones) can persist for months after patients are discharged.

Evidence shows that the psychological toll PTSD takes on those who live with it can impair their ability to function day-to-day. Therefore, it’s crucial that doctors intervene when possible to address any symptoms that surface post-ICU.

 

How to prevent and treat ICU-related PTSD

Let’s say you have a patient who survived COVID-19, but with an extended ICU stay. Given the possibility they endured trauma there, what can you do?

First, schedule an appointment with the patient. Give them space to talk about their experiences, and note any PTSD symptoms. If possible, obtain their ICU discharge summary to get a fuller picture.

Next, encourage your patient to journal. The British Journal of General Practice stated that ICU diaries “have been shown to be beneficial in reducing the incidence of PTSD, possibly through enabling patients to fill in the narrative of what has happened to them.”

Then review their entries and help them flesh out what actually occurred, should the patient be open to this practice.

Finally, give your patient the opportunity to talk about their traumatic ICU experiences with a mental health professional. Gather a list of resources, including helplines, mental health services, and ICU support groups, and make it available to patients to help address their PTSD symptoms.