Incidence of recall, nightmare, and hallucination during analgosedation in intensive care

University of Hamburg, Hamburg, Hamburg, Germany
Intensive Care Medicine (Impact Factor: 7.21). 02/2002; 28(1):38-43. DOI: 10.1007/s00134-001-1168-3
Source: PubMed


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.
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.

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    • "Most of the participants who were subjected to sedation recalled illusory memories, whereas few of those who were not subjected to sedation reported this type of recollection. Illusory memories are recollections of delirious and oniric formations enveloped by emotional content that are recorded upon recovery of consciousness following discontinuance of sedation.(5,6,14) "
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    ABSTRACT: Objective: To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods: This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the participants' memories were collected using a specific validated instrument. Assessment was performed three months after discharge from the intensive care unit. Results: A total of 128 individuals were assessed, most of whom (84.4%) reported recollections from their stay in the intensive care unit as predominantly a combination of real and illusory events. The participants subjected to sedation (67.2%) at deep levels (Richmond Agitation-Sedation Scale [RASS] -4 and -5) for more than two days and those with psychomotor agitation (33.6%) exhibited greater susceptibility to occurrence of illusory memories (p>0.001). Conclusion: The probability of the occurrence of illusory memories was greater among the participants who were subjected to deep sedation. Sedation seems to be an additional factor that contributed to the occurrence of illusory memories in severely ill individuals subjected to mechanical ventilation.
    Full-text · Article · Apr 2014 · Revista Brasileira de Terapia Intensiva
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    • "Thus, the traumatic experience can remain etched in the mind well into the future (Van der Kolk, 1996b; Van der Kolk and McFarlane, 1996). In the long-term, factual memories may persist as well as memories of unreal experiences, hallucinations and nightmares (Löf et al., 2006; Rundshagen et al., 2002; Van de Leur et al., 2004), which are referred to as delusional memories (Jones et al., 2001; Skirrow, 2002). "
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    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.
    Full-text · Article · Sep 2007 · Intensive and Critical Care Nursing
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    • "Patients' perceptions of the intensive care experience itself are associated with subsequent distress, and patients' subjective reports frequently include the presence of 'odd perceptual experiences' [18], or 'nightmares' and 'hallucinations' [19] which seem real and distressing for them at the time. The reported frequency of these experiences ranges from 7% to 73% [20,21]. These continuing problems have implications not just for patients, but impose a continuing financial burden for the National Health Service (NHS) in terms of primary and secondary health care costs. "
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    ABSTRACT: Background: A number of intensive care (ICU) patients experience significant problems with physical, psychological, and social functioning for some time after discharge from ICU. These problems have implications not just for patients, but impose a continuing financial burden for the National Health Service. To support recovery, a number of hospitals across the UK have developed Intensive Care follow-up clinics. However, there is a lack of evidence base to support these, and this study aims to test the hypothesis that intensive care follow up programmes are effective and cost-effective at improving physical and psychological quality of life in the year after intensive care discharge. Methods/Design: This is a multi-centre, pragmatic, randomised controlled trial. Patients (n = 270) will be recruited prior to hospital discharge from three intensive care units in the UK, and randomised to one of two groups. The control group will receive standard in-hospital follow-up and the intervention group will participate in an ICU follow-up programme with clinic appointments 2–3 and 9 months after ICU discharge. The primary outcome measure is Health-related Quality of Life (HRQoL) 12 months after ICU discharge as measured by the Short Form-36. Secondary measures include: HRQoL at six months; Quality-adjusted life years using EQ-5D; posttraumatic psychopathology as measured by Davidson Trauma Scale; and anxiety and depression using the Hospital Anxiety and Depression Scale at both six and twelve months after ICU discharge. Contacts with health services in the twelve months after ICU discharge will be measured as part of the economic analysis. Discussion: The provision of intensive care follow-up clinics within the UK has developed in an ad hoc manner, is inconsistent in both the number of hospitals offering such a service or in the type of service offered. This study provides the opportunity to evaluate such services both in terms of patient benefit and cost-effectiveness. The results of this study therefore will inform clinical practice and policy with regard to the appropriate development of such services aimed at improving outcomes after intensive care. This project is funded by the Chief Scientist Office of the Scottish Executive Health Department (project number CZH/4/351). Peer reviewed Publisher PDF
    Full-text · Article · Feb 2007 · BMC Health Services Research
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