Colleen Farrell, MD+ Your Authors @colleenmfarrell Internal medicine resident in New York City. Soon-to-be pulmonary and critical care fellow. Writer. Creator of @MedHumChat. Views mine. Jul. 11, 2019 2 min read + Your Authors

Yesterday I gave a talk to my #primarycare residency on PTSD in ICU Survivors. It's a topic I've learned a lot about here on Twitter (special thx to @Potato_Chip and @brookevitti), so feels appropriate to share as my first #Tweetorial. #PCCM #MedHumChat #TraumaInformedCare

Modern medicine has developed the tools to bring people back from the brink of death. What is life like for patients after surviving the previously unsurvivable? How can we provide better care for them?

~10% of ICU patients die during their hospitalization. 90% survive. ( https://www.ncbi.nlm.nih.gov/pubmed/28800866 )

~20% of ICU survivors will develop symptoms of PTSD by 12 months ( https://www.ncbi.nlm.nih.gov/pubmed/31186070 )

What about the ICU may be traumatizing for patients?
🔹Not being able to breath on their own; feeling like they can't breath
🔹Unable to communicate
🔹Pain
🔹Hallucinations caused by delirium & meds (esp benzos)
🔹Uncertainty
🔹Total loss of control

To understand how difficult this experience can be, it's so important to listen to those who have experienced critical illness first hand. @RanaAwdish on her experience:

Many patients describe truly frightful, horrific hallucinations while in the ICU. These hallucinations may later return as nightmares of PTSD. Adrien Stoutenburg's poetry describes this

"I keep living there.
Foolish. I am home. Half safe."

 https://www.poetryfoundation.org/poems/54780/intensive-care-unit 

PTSD is just one of many challenges ICU survivors often face. Here's a video of a patient describing many features of Post Intensive Care syndrome: nightmares, anxiety, cognitive difficulties, weakness  https://www.youtube.com/watch?v=30sbefBcjEU&feature=youtu.be 

I'd argue that any ICU stay is inherently traumatic. But there are things we can do to limit the trauma and help patients cope. Some of its medical (try to avoid benzos, only do truly necessary procedures). Lots has to do with communication:

🔹Assume your sedated patients can hear what you're saying. Speak gently. Discuss sensitive topics outside the room
🔹Explain what's going on to patients and families. Think of yourself as interpreter of a foreign environment
🔹Validate feelings, acknowledge tough journey ahead

ICU diaries are a fascinating approach to reducing ICU PTSD. They provide pts an account of what happened during ICU stay to fill in the gaps left by sedation and amensia. A 35 center RCT on ICU diaries is underway in France  https://www.ncbi.nlm.nih.gov/pubmed/29141694 

ICU diaries have been used by ICU nurses in Scandanavia for >30 years. They're now being piloted at @HopkinsMedicine which put together a hlepful video:  https://www.youtube.com/watch?v=abMPULXpUVw 

Working in the ICU & seeing what patients go through can be so upsetting. It can be overwhelming to realize how much patients struggle afterward. I ended my talk with a reminder that trauma is universal, but it's not destiny. Some form of healing is always possible.

Related books I love:
🔹In Shock by @RanaAwdish
🔹You Can Stop Humming Now by @danielalamasmd
🔹The Body Keeps the Score by Bessel van der Kolk
🔹The Trauma of Everyday Life by @MarkEpstein108

I'd love to learn more about this topic so please feel free to share personal experiences, useful studies, tips on best sedation practices, etc. Thank you🙏


You can follow @colleenmfarrell.



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