New research suggests receiving care in an intensive care unit can inadvertently lead to risk of developing symptoms of post-traumatic stress disorder (PTSD).
The study, presented at the American Thoracic Society International Conference, provides a new appreciation for the physical and mental trauma associated with surviving a medical crisis.
“An ICU stay can be traumatic for both patients and their families,” said Ann M. Parker, M.D., a pulmonary and critical care medicine fellow at Johns Hopkins University in Baltimore, Md.
“In our analysis of more than 3,400 ICU patients, we found that one quarter of ICU survivors exhibited symptoms of PTSD.”
In the meta-analysis, researchers reviewed 28 studies, totaling 3,428 adult ICU survivors. ICU survivors were tested with validated PTSD instruments — most commonly the Impact of Events Scale (IES, score range 0-75) — administered one month or more after the ICU stay.
In a subset of 429 patients assessed one to six months after their stay in the ICU, meta-analysis demonstrated the pooled prevalence of PTSD symptoms was 23 percent.
In 698 patients assessed at seven to 12 months, corresponding pooled PTSD prevalence rates were 17 percent and 34 percent. Rates in other studies included in the analysis ranged from five percent to 62 percent.
PTSD subsequent to ICU stays was associated with a younger age, use of benzodiazepines and/or mechanical ventilation during the ICU stay, and post-ICU memories of frightening ICU experiences.
In some studies of European ICU patients, keeping an ICU diary significantly reduced the occurrence of PTSD symptoms.
Importantly, three of three studies demonstrated that more PTSD symptoms were associated with worse health-related quality of life.
A potential limitation of this systematic review is the variability of patient populations and PTSD survey instruments studied, which makes direct comparison between studies difficult.
“Our meta-analysis confirms that a large proportion of patients who survive an ICU stay will suffer PTSD symptoms, which are associated with worse health-related quality of life,” said Thiti Sricharoenchai, M.D., who conducted the study as a postdoctoral research fellow at Johns Hopkins.
“Further research should focus on PTSD screening, prevention, and treatment in this vulnerable patient population.”
Source: American Thoracic Society