Psychological morbidity: life after the ICU

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Despite numerous clinical advances in the field of emergency medicine, patients that survive the intensive care unit (ICU) may experience prolonged psychological distress and a decreased quality of life.

Although risk factors for adverse psychological outcomes such as depression, anxiety, and posttraumatic stress disorder (PTSD) have been classified, it is not known which factor poses the greatest risk in the development of psychological morbidity after intensive care.

New research by Dorothy Wade and colleagues from University College London (UCL) identifies acute stress reactions within the ICU as the most important risk factor in the development of mental illness after discharge. Shockingly, this prospective study reveals a high incidence of depression (46%), anxiety (44%) and PTSD (27%) in patients 3 months after release from the ICU. Pharmacological treatment was also found to influence psychological outcome, with correlations revealed between the use of benzodiazepines and depression, length of sedation and PTSD, as well as inotrope/vasopressor treatment and post-ICU anxiety.

Interestingly, previous research published in Critical Care suggests that female intensive care survivors have a higher incidence of depression and PTSD compared to their male counterparts. Together, these findings suggest that intensive care treatment could be modified to aid the prevention of cognitive disturbances. Such intervention could include the use of ear plugs within admitted patients, which has recently been found to decrease the incidence of delirium in the ICU setting (see Van Rompaey et al, Critical Care). These studies collectively highlight the need for psychological and clinical treatment interventions, in the hope that the prevalence of psychological morbidity can be reduced amongst ICU survivors.