Sedation and its psychological effects following intensive care

Abstract

Significant psychological impacts, including post-traumatic stress disorder (PTSD), have been associated with a patients' under sedation in Intensive Care Units (ICU). It however remains undefined if and how sedation is related to post-ICU psychological outcomes. This literature review explores the relationships between sedation, the depth of sedation and psychological disorders. A review of existing literature was undertaken systematically using key terms and included peer reviewed primary research and randomised controlled trials (RCT). To ensure subject relevance pre-2006, non-English and paediatric based research were excluded. Findings highlighted that reduced sedation levels did not significantly reduce the outcome of PTSD yet reduced ICU length of stay and length of mechanical ventilation (MV) were both associated with lighter sedation. Further research is recommended in terms of more specific factual and delusional memories post-ICU in comparison to the level of sedation administration and the relationship to psychological distress.

Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory

“…Factors such as delirium, confusion, sleep disorders and sedatives potentially contribute to delusional memories and symptoms related to post‐traumatic stress syndrome (PTSD) (Croxall et al . ). Delirium is a confusional and often fluctuating state experienced by patients in the ICU, whereas intrusive memories are memories that persist in the ICU survivors.…”

Implementing augmentative and alternative communication in critical care settings: Perspectives of healthcare professionals

“…For many patients being admitted to an intensive care unit (ICU) can be a traumatic, frightening and unfamiliar experience (Holm & Dreyer, ; Svenningsen et al., ; 2807–2815). Critically ill patients subjected to endotracheal intubation and therefore not able to speak often suffer from anxiety, stress, delirium, confusion, delusional memories and symptoms related to the post‐traumatic stress syndrome (Croxall, Tyas, & Garside, ; 800–804; Holm & Dreyer, ). Patients' lack of the ability to speak may lead to anger, anxiety and frustration among other things because many patients in the ICU are unaware of what has happened prior to admission and will have many questions and a compelling wish to communicate (Croxall et al., ; 800–804; Holm & Dreyer, ).…”

“…Critically ill patients subjected to endotracheal intubation and therefore not able to speak often suffer from anxiety, stress, delirium, confusion, delusional memories and symptoms related to the post‐traumatic stress syndrome (Croxall, Tyas, & Garside, ; 800–804; Holm & Dreyer, ). Patients' lack of the ability to speak may lead to anger, anxiety and frustration among other things because many patients in the ICU are unaware of what has happened prior to admission and will have many questions and a compelling wish to communicate (Croxall et al., ; 800–804; Holm & Dreyer, ). Exposure to high levels of stimuli in the ICU may entail sensory overload known to cause further problems for the patients such as irritability, headache, severe anxiety, hallucinations and confusion (Uzar Ozcetin & Hicdurmaz, ; 3186–3196).…”

“…2 | BACKGROUND 2.1 | Being awake and unable to speak For many patients being admitted to an intensive care unit (ICU) can be a traumatic, frightening and unfamiliar experience (Holm & Dreyer, 2015;Svenningsen et al, 2016;2807-2815. Critically ill patients subjected to endotracheal intubation and therefore not able to speak often suffer from anxiety, stress, delirium, confusion, delusional memories and symptoms related to the post-traumatic stress syndrome (Croxall, Tyas, & Garside, 2014;800-804;Holm & Dreyer, 2015).…”

“…Patients' lack of the ability to speak may lead to anger, anxiety and frustration among other things because many patients in the ICU are unaware of what has happened prior to admission and will have many questions and a compelling wish to communicate (Croxall et al, 2014;800-804;Holm & Dreyer, 2015). Exposure to high levels of stimuli in the ICU may entail sensory overload known to cause further problems for the patients such as irritability, headache, severe anxiety, hallucinations and confusion (Uzar Ozcetin & Hicdurmaz, 2015;3186-3196).…”