Unpleasant memories from intensive care

"Being cared for in an intensive care unit (ICU) can never be an especially positive experience. But at any rate it should not mean that the care improves the patient's physical condition only to leave him or her with severe mental problems!"

This is what Karin Samuelson feels. She is a nurse and researcher at Lund University in Sweden. She has studied patients' memories, experiences, and psychological problems after their care period.

Intensivecare often involves treatment in a respirator, with the air being supplied either via a tube in the nose or mouth or via a cannula through the throat.To alleviate the discomfort of the treatment, patients are given sedatives or drugs to induce sleep.

In the past powerful sedatives were used, rendering the patient more or less unconscious. But this can lead to complications in the form of mucus accumulation, pneumonia, muscle atrophy, and prolonged respirator dependency.What's more such treatment is expensive. Therefore most wards have switched to lighter sedation, which is easier on the body.

However, the effects on the mental well-being of the patient have never been studied. This is what Karin Samuelson has now done in her doctoral dissertation, which she will defend September 22. She interviewed 250 patients five days after their release from the ICU and again two months later.

The results were hardly encouraging. Most of the patients had memories of their time in intensive care, despite the sedation, and more than half of them remembered at least one event that was extremely stressful. These stressful experiences included discomfort from the breathing tube and not being able to speak. One third of the patients also had delusional memories such as nightmares and hallucinations.

Two months after their discharge there was still a high degree of symptoms of anxiety in 5 percent of the patients, of depression in 8 percent, and of post-traumatic stress in 8 percent.

"The risk of remembering nightmares and hallucinations was more closely related to the length of the stay in intensive care than to the depth of sedation. On the other hand, the risk of remembering the experiences as bothering were associated with the depth of sedation: patients more awake experienced memories as more stressful. We must therefore focus on patients' subjective perceptions and get better at dealing with the psychological problems that critical illness and intensive care can lead to," says Karin Samuelson.

Among other things, this requires better following up of ICU patients. The Lund University Hospital staff has started to visit patients at the general wards a few days after ICU discharge and also to invite them back for a visit after two months. In this way it is hoped that they will be able to single out patients who have been the most seriously affected by their critical illness and their stay in the ICU and see to it that their experience there does not led to persistent mental disorders such as depression and post-traumatic stress.

Her dissertation is titled Sedation During Mechanical Ventilation in Intensive Care – sedation practices and patients' memory, stressful experiences and psychological distress.