Medical Events and Traumatic Stress

Question 1

Severe injuries and critical illnesses highly stressful

Answer 1

ICU & critical care interventions are sources of extreme physiological & psychological stress

Significant mental health consequences for patients and their families

Significant functional limitations

Clinical implications for PTs/ rehab providers (think long term)

Question 2

Burns

Answer 2

> 1 million /year in US

> result in over 45,000 acute care admissions

Question 3

Injuries

Answer 3

2.5 million/year have injuries requiring acute care admissions

half a million/ year need ICU admissions

> 200,000 children / year require ICU admissions

Question 4

Illness/disease/injuries

Answer 4

Millions of people / year require and are discharged from ICUs

Question 5

Psychiatric morbidity adult patients : Burns

Answer 5

PTSD 20-45%

Major depression 2-28%

Question 6

Psychiatric morbidity adult patients : Traumatic Injury

Answer 6

PTSD 10-42%

Depression 4-19%

Question 7

Psychiatric morbidity adult patients : Critical Illness and ICU

Answer 7

PTSD 22% survivors 10 years later

Major depression 28%
> some diagnoses up to 43%

Question 8

Prevention and Treatment

Answer 8

Recognition first….gaps in knowledge on prevention and treatment

Minimization of delirium

Reduction of sedation strategies

Treatment for PTSD (including a care manager for tracking, symptom management)

Treatment of parents can improve mental health outcomes in children

Question 9

What is PICS?

Answer 9

Post-intensive care syndrome (PICS)

new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization

Question 10

How common is PICS?

Answer 10

Of the millions admitted to ICUs in US per year, 33% need a ventilator

Physical Impairments (ICU acquired weakness)

Cognitive Impairments

Mental Health problems

Question 11

PICS - Physical Impairments (ICU acquired weakness)

Answer 11

35% of patients on vents

50% of patients with sepsis

between 15%-50% of all pts. who have a 1 week stay

~50 % of ICU pts. and 75% of pts. on vents have trouble with ADLs 1 year post d/c

Question 12

PICS - Cognitive Impairments

Answer 12

Executive function, memory, attention, processing speed, visual spatial, language, etc.

100% of survivors at d/c

56% several years post d/c

Question 13

PICS - Mental Health problems

Answer 13

Anxiety/ ASR

Depression

PTSS/ PTSD

Question 14

What causes PICS?

Answer 14

Inflammation
Hypoxia
Glucose dysregulation

Question 15

Risk factors for cognitive impairments

Answer 15

Delirium
Sedative use

Question 16

Can PICS be prevented?

Answer 16

ABCDE bundle

A =Awakening
B = breathing trials (spontaneous)
C = coordination of care
D = delirium assessment & prevention
E = early mobility and exercise

Question 17

Benefits of ABCDE Protocol

Answer 17

increase:
- liberation from ventilator

• earlier ICU and hospital discharge
• return to normal brain function
• independent functional status
• survival

Question 18

Early Exercise in the ICU

Answer 18

Early exercise = progressive mobility

Question 19

Early Exercise & Mobility Levels of Therapy*

Answer 19

Active range of motion in bed and sitting position in bed

Dangling

Transfer to chair (active), includes standing without marching in place

Ambulation (marching in place, walking in room or hall)

*All may be done with assistance.