The PTSD-ICU connection is real. What can be done?

By Jules Murtha | Medically reviewed by Amanda Zeglis, DO, MBA
Published May 31, 2022

Key Takeaways

  • Among the more than 270,000 patients admitted annually to the ICU, as many as 27% leave with post-ICU PTSD.

  • ICU patients may face the fear of dying, struggle with the inability to communicate or think clearly, and undergo invasive treatments and sensory deprivation, among the experiences that could play a part in development of post-ICU PTSD.

  • To prevent and treat PTSD in patients recently discharged from the ICU, GPs can schedule appointments to talk about their experiences and assess for PTSD symptoms, as well as provide diary or journal entry prompts to patients.

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.[]

It’s no surprise that 27% of people annually admitted to the ICU survive with a PTSD diagnosis to show for it.

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.

Walls tinged with blood and children whose faces went missing are just two examples of what patients have seen.

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

If you have a patient who was recently discharged from the ICU, there are a number of symptoms to watch for.

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.[]

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.”

Give your patients writing prompts that encourage them to explore their experience, what they recall, and if intrusive or distressing memories surface as a result.

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.

What this means for you

Close to 73,000 patients exit the ICU with PTSD each year. Take care of them by scheduling a check-up to talk about their experience. Scan them for PTSD symptoms such as intrusive memories, hyperarousal, fear and panic, flashbacks, emotional numbing, and trembling or dizziness. Minimize such symptoms by giving patients the opportunity to own their narrative through journaling, in addition to providing mental health resources. While these practices may increase work in the short-term, preventing worsening of symptoms may decrease long-term management.

Related: Exploring the link between schizophrenia and COVID-19

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