Intensive Care
http://thedianerehmshow.org/shows/2011-03-02/intensive-care
For doctors and nurses caring for patients in intensive care, the number one concern is the patient’s survival. Pain killers, sedatives, and bed rest are standard procedure, but in recent years, a second objective has been added: to improve the patient’s longer term quality of life. Recent studies have shown that prolonged sedation, for example, can lead to reduced brain function years later and immobilization is associated with slower recoveries overall. Join us to discuss how changes in intensive care procedures can improve patients lives later.
Guests
Dr Dale Needham
associate professor of medicine, Johns Hopkins University
Dr Tim Girard
assistant professor, of Medicine in the Division of Allergy, Pulmonary, and Critical Care Medicine and the Center for Health Services Research at the Vanderbilt University School of Medicine
Donna Stanczac
nurse, intensive care, Georgetown University Hospital
Dr. Jennifer Brandt
clinical pharmacist, Washington Hospital Center
Comments
Please familiarize yourself with our Code of Conduct and Terms of Use before posting your comments.
In view of the present conversation, why is it that many ICU's have such restrictive visiting hours for family?
My daughter (22 years old) was hospitalized with MRSA and ARDS more than a year ago. She has recovered very well after 2 months in the hospital.
I'm wondering if you could share some of your knowledge/experience with PTSD and depression after "recovery".
I am listening to the show, and I have a story to share. Several years ago my father was hospitilized, and given a sedative despite our warning that sedatives in the past caused delirium. It, of course, caused severe agitation and delirium again, and he was put to ICU and tied to the bed so as not to hurt himself. The neurologist suspected stroke, and kept him on those sedatives in order to perform a brain scan. For three days we tried to explain that it was reaction to medication, and for three days he was delirious and agitated and didn't sleep for a second. The personal kept accusing us of hiding his drinking problem. Finally another doctor listened to out pleas, changed his medication, and after 24 hours of sound sleep he woke up as good as new. He is fine now, but who knows what would've happen if we didn't intervene.
I have been listening to the show and heard the callers explain their problems with cognitive functioning after critical illness. I am a speech-language pathologist that formerly administered cognitive- linguistic therapy with people suffering from the same impairments in cognition and executive functioning skills as the callers. We have been able to provide improvement with these skills and reintegration in to the community. My suggestion would be to contact their primary physicians to order speech therapy for rehabilitation in those areas.
I am 10 year veteran ICU RN. I am a proponent of visitors in the ICU but tend to run into major resistance from seasoned nurses. There are occassions where the family is a hindrance to healing because the client can't rest due to constant interaction, phone calls, or talking in the room.
I also would like to point out that with decreased funding for medical care, a lot of the services that would benefit clients such as speech and physical therapy are unavailable because ICU patients are often considered to sick to begin the rehabilitation process and staff in those areas are overloaded and consider ICU clients a low priority.
What do you recommend for delirium in the ICU, when the client is at risk for injuring self and or care-givers?
Many more questions, no time, but thanks for having such an important topic on your show.
Marina: Medical obstinance also occurs in assisted living. My partner's mother has an acute oxygen uptake condition requiring careful medication management to optimize her lung function. This recipe was perfected in the hospital by one of the best pulmonologist-cardiologists in the nation. But, the attending physician crew at the retirement home can't seem to understand that medication changes and even over the counter products are not advisable. Every month they do something willful and this dear old lady winds up tethered to oxygen because her concentration reference drops below 90. Sometimes I think they do it on purpose to increase Medicare and deductible billing. Has anyone else had a similar experience? Redlair6@yahoo.com
Thank you, I thought it was only me.
Two years ago I had hip replacement surgery, 24 hrs. later I had a massive heart attack. I was in a Cardiac ICU for ten days and I knew there was something "else" wrong with me that drs. weren't addressing. Now I accept that something profound, at the core of my being, changed as a result of this.
Needless to say I was very grateful to hear that this portion of an ICU/critical illness experience is being addressed.
I am an ICU nurse and working with Dr Needam on the Post Intensive Care Syndrome (PICS) task force. We are trying to raise awareness of PICS and improve care of our ICU survivors and their families. (Families also suffer long term consequences.) There is a lot of work being done around the world to identify specific strategies. For now, there are a few things you can do that can help. Get some resources to show those providing care for the patient that describe possible problems resulting from an ICU stay. For example: Dr Dale Needham published a review of what is known in Critical Care Medicine (February 2011). The UK's National Institute for Health and Clinical Excellence has a guideline on rehabilitation after critical illness (No. 83 2009). It includes a self-directed rehab manual. While the patient is in the ICU advocate for less sedation, for early moblility and physical/occupational therapy, and for family involvement in care. We need to know what you know and observe about the patient. The patient benefits from your loving care, familiar calming voice, and tender touch. Also, keep a diary on what happens to the patient day to day in the ICU. It may help the patient fill lost memories of time in ICU and decrease symptomes of PTSD.
My daugther spent the first three months of her life in a NICU as a preemie. She has severe ADHD and many learning difficulties. A few years ago she had two stays in the hospital with a kidney stone and horrific pain. After this ordeal she suffered from some mental problems I did not understand including hallucinations and paranoia. She has never fully recovered.
Within a multi-disiplinary, post ICU care plan, why isn't massage therapy being considered as part of that plan? There was much to say regarding the symptoms associated with a traumatic illness/injury with emphasis being placed on pain management, PTSD, delerium, and the use of drug therapies. The Institute For Touch Research in Miami is a source of imperical evidence for the the efficacy of massage therapy in addressing nearly every symptom that was discussed. According to The American Massage Therapy Association's (AMTA) 2010 Massage Therapy Consumer Fact Sheet, 54 percent of Americans who had a massage in the past 5 years say they have had a massage to relieve pain and 40 percent of Americans are getting massages to relieve their stress. Touch is essential to our quality of life and the quality of the touch we receive is essential to our overall health. After the life threatening illness or injury has been twarted it is imperitive that the recovery process includes non-invasive, compassionate, therapuetic touch. Massage therapy is the avenue by which this can be acheived in addition to Speech, Physical, Occupational, Psvchological, and pain management drug therapies.
As someone who practices both Healing Touch and Somatic Experiencing, I can attest to the fact ICU stays often result in some level of trauma, and that touch is crucial to the recovery process of both patient and care-givers.
Clearly, any injury or illness requiring hospitalization is traumatizing to body, mind and soul. The way to release trauma is to allow the body to move, and shake the trauma off. If you have ever watched a bird on the ground after it hits a window, you have seen how it trembles for 30 minutes before flying off, good as new. As humans, we resist this kind of involuntary movement and we try to "hold it together," instead.
But this rigidity – whether we do it ourselves or whether it’s done to us through sedation or immobilization – is just the OPPOSITE of what our body needs. What we need is gentle support in expressing the trauma, and releasing it from the body. That is exactly what Somatic Experiencing is designed to do, and it is amazingly successful. Likewise, Healing Touch – which was developed by nurses and is practiced in many hospitals – is a very powerful energetic touch that calms the nervous system and stimulates the immune system, thus speeding up the healing process.
For information on both these techniques, as well as an extensive reading list, visit www.hands-to-heart.com. Also, feel free to contact me at daphne@daphnewhite.com with questions about releasing trauma after an ICU stay.
This from a book that I wrote about what happened to my wife at Johns Hopkins....
After three weeks, they’d been able to get the breathing tube out of her and she was slowly emerging from the coma. But the long stay in the ICU had taken its toll.
It seems that Pam had been making a ruckus...
She had lost her mind, which is not uncommon in intensive care units.
“Most critical care nurses are familiar with the term ICU psychosis,” writes Nurse Manager Brenda Hixon-Vermillion of the Ohio State University Medical Center’s ICU. She defines it as “a disorder in which patients in an ICU or similar setting experience anxiety, have visual and/or auditory hallucinations, become paranoid, agitated, and potentially violent, and may become disoriented to time and place.”
Patients who have extended stays in ICUs, which Hixon-Vermillion defines as anything longer than two or three weeks, are more prone to the development of serious psychological and cognitive problems. Most critical care nurses are familiar with the term ICU psychosis. Brown cites studies which show that approximately one in every three patients who spend more than five days in a critical care unit will experience some sort of psychotic reaction.
As in other instances, they recognize the same problems over and over again, but nothing seems to get done.
http://collateral-damage.net