Article

Incidence of recall, nightmares, and hallucinations during analgosedation in intensive care.

University Hospital Charité, Department of Anaesthesiology, Campus Mitte, Schumannstrasse 20/21, 10117 Berlin, Germany.
Intensive Care Medicine (Impact Factor: 5.54). 02/2002; 28(1):38-43. DOI: 10.1007/s00134-001-1168-3
Source: PubMed

ABSTRACT To define the incidence of recall and dreams during analgosedation in critically ill patients.
Prospective clinical study.
Anaesthesiological intensive care unit (ICU) in a university hospital. Patients and participants: Two hundred and eighty-nine critically ill patients, who either arrived intubated and sedated at the ICU or required intubation, mechanical ventilation, and sedation during their ICU stay.
none.
The patients were interviewed 48-72 h after discharge from the ICU. By a structured interview they were asked whether they recalled any event before they had regained consciousness at the ICU. Moreover they were asked for dreams. Descriptive statistics: 64.7% of all patients did not recall any event, before they regained consciousness. However, 17% ( n=49) of all patients indicated that they remembered the tracheal tube or being on the ventilator, before they woke up. Some patients (21.1%) reported dreams or dreamlike sensations. Some patients (9.3%) recalled nightmares, while 6.6% reported hallucinations.
Critically ill patients reported a high incidence of recall for unpleasant events, which they thought to have taken place before they regained consciousness. The patients, who stayed longer than 24 h at the ICU, indicated vivid memory for nightmares and hallucinations. Further studies are suggested to evaluate: 1) whether there is an impact of the present findings on outcome; and 2) whether clinical scores for sedation or neurophysiological monitoring help to define the exact time, when recall happens, in order to guide therapeutic intervention.

2 Followers
 · 
309 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Traumatic events connected with a critical condition and treatment in the intensive care unit (ICU) may result in subsequent posttraumatic stress-reactions. The aim of this phenomenological study was to describe the meaning of posttraumatic stress-reactions as experienced by individuals following a critical illness or injury and intensive care. Fourteen informants, testing positive for posttraumatic stress-reactions as a clinical concern, were interviewed. The data was analysed following the principles indicated by Giorgi [Giorgi A. The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure. J Phenomenol Psychol 1997;28:235-61]. The essence of the phenomenon of posttraumatic stress-reactions was understood as a transition to a life-situation beyond control, where the traumatic experiences have a profound impact and are ever-present. The variations of the phenomenon presented themselves as a need to make sense of the traumatic memories, which live on; being haunted by the trauma; a need to escape; distress and strain in the life-situation; transformation of self and, finally, interactions with others affected. The need for caring strategies and support is emphasised, both in the ICU and afterwards, thus preventing or alleviating some of the suffering.
    Intensive and Critical Care Nursing 09/2007; 23(4):206-15. DOI:10.1016/j.iccn.2007.01.004
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Delirium is an acute, reversible disorder of attention and cognition and may be viewed as cerebral dysfunction similar to the failure of any other organ. The development of delirium is associated with increased morbidity and mortality, extended length-of-stay in the intensive care unit and longer time spent sedated and ventilated. Nearly every clinical, pharmacological and environmental factor present and necessary in the ICU setting has the potential to cause delirium. Since all of these factors cannot be removed, it is paramount to increase the awareness amongst health care professionals so as to minimise under-recognition and encourage future research into factors that may improve the long-term outcome for ICU patients. There is a need for user-friendly, validated assessment tools for the intubated and ventilated ICU patient, which can be applied at the time of ICU admission without the need for lengthy psychiatric assessment. Nursing professionals are at the forefront of those who are able to provide holistic care through meaningful conversation and empathetic touch. A 6-month Quality Improvement (QI) project screening patients for signs of delirium provided a foundation for discussion. All patients admitted to ICU for more than 72 h, with a hospital length-of-stay less than 96 h prior to ICU admission were screened. Patients admitted following neurological insults or with pre-existing altered mental state were excluded. The QI project showed the incidence of delirium to be 40% of the total sample (n = 73) in a mixed medical/surgical and elective/emergency patient population.
    Intensive and Critical Care Nursing 09/2004; 20(4):206-13. DOI:10.1016/j.iccn.2004.04.003
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients' experiences of hallucinations and nightmares during an intensive care unit stay (ICU) are well- known, but it is less known how these delusional memories (DM) affect patients after discharge from hospital following trauma. The overall aim of this thesis was therefore to acquire a comprehensive understanding of patient memories from the ICU-stay and their putative effects on outcome after physical trauma from a long and short-term perspective. Both quantitative and qualitative methods have been used. In a multicenter study including five hospitals in the western part of Sweden, patients with the diagnosis of trauma admitted to the ICU during one year were included. In the first quantitative study, 239 adult patients answered a questionnaire about memories from the ICU and self-estimated health 0.5-1.5 years after the trauma. Patients of the same cohort (n=153) participated in a follow-up study after four years. Clinical data were obtained from medical records. Eighteen participants from the first study were included in a qualitative study and interviewed 2- 3 years after the trauma. Questions about memories from the injury, hospital and ICU-stay and life after discharge from hospital were asked and analyzed by means of phenomenological hermeneutical analysis. The results of the studies indicate that memories from the trauma and ICU-stay often were fragmentary and one out of four patients had DM. These patients were younger, more seriously injured, had more complications, were more often mechanically ventilated and sedated. They also remembered more feelings of pain, panic and fear and described more unexplained feelings of panic after discharge from the ICU. These patients also experienced lower health related quality of life (HRQoL) both from a long and short-term perspective after the trauma and ICU care compared to those of a reference sample. Patients who reported DM experienced lower HRQoL and also higher levels of anxiety and depression 0.5-1.5 years after trauma compared to patients without such memories. Four years after the first measurement, patients with DM still experienced anxiety and depression to a greater extent than patients without such memories. When comparing HRQoL over time, all patients had improved in half of the eight health domains. Patients with DM still differed from the other patients in all HRQoL domains, except for general health. About five years after injury, 75% of all patients had returned to work (RTW). Despite a poorer HRQoL, patients with DM had a comparable level of RTW. From the interviews emerged both good memories of care and gratitude for life and bad memories from a surrealistic word and an injured body. When these memories balance out, there are more possibilities to move on despite an uncertain future following the injury. Memories of being cared for and a gratitude for life seemed to make it easier to go on with life and meet this uncertain future. The findings provide new insights regarding the impact of patients' memories after a physical trauma and ICU care on HRQoL, including the psychological well-being from both a long and a short-term perspective.

Preview

Download
1 Download
Available from