How to Handle the ICU RENO, NV (KUNR) - Dr. Rebecca Jankovich, PhD can be reached at 322-1839

Intensive Care Units, ICU's, are scarey places. You only get admitted there if you're in really bad shape, needing help to breathe on a ventilator forcing oxygen into your lungs, unable to eat requiring a feeding tube, or in terrible pain so you must be quieted by such heavy sedation or pain killers that you're not conscious much of the time. As our population ages, more and more people may need ICU care, and as medicine advances, more and more ICU patients survive.
Physicians are happy if their ICU patients do well enough to leave ICU and move to another level of care in the hospital; it was assumed they progressed, left the hospital, healed and life went on. Now, researchers are wondering whether the time a patient spends in ICU has long lasting, perhaps even permanent effects on the patient's mood, thinking and physical strength. What doctors are noticing is that patients who've spent even a few days laying immobile, sedated, and having a machine breathe for them, rapidly lose their strength, even when they're young athletes! A stay as brief as 5 days can result in profound loss of muscle strength so much that a patient may not be able to lift the plastic cover off the hospital lunch tray. Those who have been in ICU care longer, have more severe and longer lasting changes.
The most obvious change is loss of physical strength. The muscles rapidly lose their power when they're not used to even sit up over a few days. Patients lose a lot of weight, increasing their physical weakness. There are changes in thinking and concentration where the patient's thinking is fuzzier, memory of the ICU stay and recent events is impaired, attention span is shortened. There are many changes in mood and emotion. Some researchers liken the changes following ICU to those of post-traumatic stress where a patient has increased anxiety, trouble concentrating, increased irritability and anger, frightening flashbacks of the trauma, nightmares and difficulty sleeping, mood swings, depression. There may be upsetting memories of the hallucinations experienced as an effect from the pain killers and sedation.
At Johns Hopkins Hospital, researchers are trying something new. They're studying the changes in outcome following ICU stays when a patient is awakened from sedation every day and helped to sit up, or even walk, while still attached to the ventilator, the feeding tube, the IV's. This approach towards ICU care isn't available in all hospitals because special staff are required to keep the patient breathing and safe while alert, sitting up, and walking. The results are promising: those patients who are awakened and assisted to move each day get better faster, spend less time in ICU and suffer fewer long term effects from their ICU care. Along the same lines, researchers are experimenting with changing sedation levels so the ICU patients are brought to a level of alertness once a day; again, with promising results because those patients whose sedation levels are reduced enough once a day so they become alert, recover better with fewer cognitive or emotional side effects. The researchers don't know why this helps the long term outcome; they guess that the personality works better when the brain is allowed to be awake part of each day.
So, it's not over if the patient survives ICU and gets to go home. If you're the family to whom they return, remember they have the long term effects of ICU care to cope with as well as the medical fall out of the illness or accident that landed them in ICU, and they're making sense out of having almost died. Understand they're physically weak, their emotions are on a roller coaster ride, they may be quick to temper, they're not thinking clearly, they're having flashbacks of frightening experiences and bizarre hallucinations. It can take a year or more for your loved one to work through all these challenges that's a year of frustration for you who just wants them back the way they were. Talk with your medical team about these effects of ICU care so your expectations of recovery are realistic. Take care of yourself as well as your patient so you don't lose your own patience. You're all lucky they made it even if it's still a long recovery.

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