A new element of damages – post intensive care syndrome – is emerging in medical headlines. Aggressive critical care saves lives but does not end the patient’s problems.

The medical community has known since at least 1999 that patients who have been treated in ICUs may develop nightmares, panic and pain associated with post-traumatic stress disorder.

The ICU environment can be overwhelming to patients, resulting in delirium or “ICU psychosis”.

When Jane Heron and I read medical records to explain the patient’s care, we often see ICU psychosis symptoms, such as hallucinations, agitation, nightmares, restlessness, and anxiety.

Many patients who are in ICU are on ventilators and cannot communicate with the staff to express their needs, making the psychosis symptoms even worse.

Causes of ICU Psychosis

The factors that may lead to this state of delirium include:

• the constant stimuli (being touched, hearing alarms)
• loss of sleep wake cycles (being kept awake by examinations and nursing care
• losing touch with the outside world by not being able to see out windows.
• inadequate pain control
• inadequate symptom control (nausea, diarrhea, hiccups)
• profound disruptions caused by being critically ill.
• sepsis (a blood borne infection)

The nursing and medical challenge is to prevent the patient from injuring himself or herself while in this psychotic state.

Haldol is sometimes used to treat the psychosis, nicknamed “Vitamin H” by some nurses. However, new research failed to support the use of Haldol to shorten the length of delirium in critically ill patients. The researchers recommended Haldol be given on short term basis to manage agitation. *

But the problems may not stop when the patient leaves the ICU. As many as 80% of ICU survivors have some form of cognitive or brain dysfunction, according to the Society of Critical Care Medicine, and some never recover. Many experiences post-traumatic stress symptoms, depression, fatigue and prolonged muscle weakness.

As a result of findings like this, critical care providers are paying more attention to preventing critical care psychosis and delirium.

* Source: Page, VJ, Ely EW, Gates S et al Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU); a randomized, double blind, placebo-controlled trial, Lancet Resp Med 2013: 1(7): 515-523

Points for Attorneys

Attorneys should be aware of the medical consequences of ICU care and be sure to obtain medical records for the follow up care – occupational and physical therapy, psychological counseling for depression – that many of these survivors need.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.