Does the intensive care unit make you sick?
STAND 19.4.2021 , 8:16 am AUTHOR/IN Horst Gross ONLINE REVIEW Anja Braun
Modern intensive care saves the lives of hundreds of thousands of patients. Today, even in old age, acute health crises can be overcome. But new studies make it clear: Treatment in intensive care units often leaves patients with chronic conditions – patients who can no longer move properly and are dependent on equipment. This does not have to be. Consequential damage can be reduced with consistent follow-up treatment.
So far, however, the prevention of such sequelae has hardly played a role. In this context, critically ill patients would have to undergo weeks and often months of physiotherapy and continuous respiratory training after an extended period of time in the intensive care unit. This is the only way for severely ill patients to return to a normal life.
Staying in an intensive care unit has consequences. But even these are treatable. picture-alliance / dpa picture-alliance / dpa – Susann Prautsch
Former intensive care patients need more support
There is even a separate clinical picture characterizing the possible consequences of intensive medical treatment. It's called "Post Intensive Care Syndrome". The most common symptoms are muscle disorders. In addition, the central nervous system is often affected, and after treatment in the intensive care unit, mental health disorders also often occur. As a rule, these are depression, anxiety disorders and post-traumatic stress disorder.
Intensive care physician Bjorn Weib from Charite Berlin explains that bedridden people rapidly lose muscle mass. They lack the strength to move their arms and legs and stabilize their trunk. But the diaphragm is also affected. Patients get difficulties with breathing. They then lack the strength to breathe on their own. One way to counteract this is through targeted physiotherapy in the intensive care unit. However, to date, the loss of strength cannot really be stopped.
Weaning from the ventilator is too seldom successful
Too many patients remain permanently dependent on ventilation, says Simone Rosseau. She runs a special unit for patients freshly discharged from the ICU:
Every year in Germany, we have about 400.000 ventilated cases in intensive care units. Some patients, however, cannot be weaned off the ventilator at a later stage. That is estimated to be up to 8000 patients per year. They have to go into so-called out-of-hospital intensive care with artificial respiration.
Rosseau regrets that few medical centers offer weaning from the ventilator The term "to wean" comes from English and means "to wean off".Estimated around 60.000 places for weaning from the ventilator are needed per year. So far, there are not enough places. This is how tens of thousands of intensive care patients miss out on the chance for a better quality of life.
Weaning stations and centers help patients to live again without a ventilator. The artificial coma should help the brain through the critical phase, so to speak. Also shield those affected from the stress of the intensive care unit. For many years, this seemed to intensive care physicians to be the best solution to protect patients. Finally, about a quarter of ICU patients have measurable nervous system disorders after treatment. The typical symptom of this brain damage is acute confusion, delirium.
Deep sedation is now known to cause a variety of problems, including increased mortality in ICUs. The hoped-for protective effect against psychological consequences of the treatment could not be proven either.
Today, the ideal intensive care patient is awake and alert
In addition, patients in intensive care units should also be mobilized on a daily basis. This means they should at least leave the bed. There are studies that prove that patients who were awake and were thus able to consciously participate in their recovery are significantly better able to cope with psychological consequences.
Daily mobilization of intensive care patients is important. Those who can, should also get out of bed in the process. Nursing staff have to. Physiotherapists to be especially careful. imago images Imago/Photographer XY – epd
However, in order to largely spare intensive care patients long-term damage, it is not only mobilization and physiotherapy that are important, but also the right diet and optimal adjustment of the ventilator. In the daily routine of a turbulent intensive care unit – where nursing staff is chronically scarce – one or two things are sometimes overlooked.
Staying in an intensive care unit often leads to psychological problems
The psyche also suffers in an intensive care unit. Intensive care units are noisy and hectic. Constantly disturbing their night's rest. In addition, many patients are in constant fear for their own lives. This leaves traces. The Dacapo study by German physicians from the Regensburg University Hospital examined nearly 1,000 patients after maximum intensive care therapy.
All had recovered physically to a large extent. But the state of her psyche was worrisome. Every second person complains about sleep disturbances, anxiety and concentration problems. One in four suffered from severe depression. Many of those affected are permanently unable to work. What exactly leads to this disastrous finding is unclear. But one thing is certain: psychological support after treatment is important. Because depression is treatable. And the sooner you catch it, the better the prognosis.
Psychological treatment after a stay in intensive care is useful in many cases. Getty Images Thinkstock –
Keeping a diary during treatment helps
Kiel-based nursing scientist Peter Nydahl promotes the idea of keeping an individual diary for each intensive care patient. This helps patients who usually cannot remember their time in the intensive care unit. Many experience nightmares during this time and then confuse dream and reality in their memories.
The idea for the intensive diary comes from Scandinavia. Peter Nydahl has taken up the concept and is now trying to convince German intensive care units of it. Because the diary has also been shown to help against later depression and anxiety.