Cuckoo, “Swine Flu”, and the ICU

2009-07-27 | |
Last updated: 2009-07-27

Admission to the Intensive Care Unit or ICU of a hospital usually means that a patient is in very rough shape; frequently as a result of an unexpected life threatening condition. The patient is there because they need round the clock surveillance of their heart function, blood-oxygen levels, kidney function and brain operation as well as management of the highly specialized medications that are helping to keep them alive. In the event that anything suddenly goes awry with the patient, the highly trained staff of any typical ICU use the many specialized drugs and pieces of technically advanced equipment to re-stabilize the patient. Nowhere else in a hospital is the environment more ideal for ensuring patient survival.

Though ideal for the work of saving lives, the ICU environment can sometimes be very negative to the mental and emotional states of patients as a result of what is clinically called “ICU Psychosis” or “ICU Delirium”. As a result of being a very work-focused environment, the ICU is often very noisy and very bright. Combine these physical factors with drugs including sedatives that can cause confusion and disorientation, even psychotic experiences, and the distress caused to patients can be quite severe. Finally, add the fears from any recent trauma, concerns for one’s life and long periods of isolation from the familiar faces of loved ones and the experience could be considered something of a nightmare.

With regard to the physical factors causing psychosis, the constantly varying noise and high noise levels of conversations, beeping and buzzing equipment and alarms limit the ability of patients to sleep for long durations or to get deep sleep and this results in them becoming stressed. The lack of artificial light and lack of day and night cycles in the constantly lit work environment disrupts the circadian rhythms and sleep regulating melatonin levels so that even if sleep is possible the patient is unable to fall asleep.

Were you to envision this sort of treatment of a person anywhere else, you would likely come to the conclusion that the person was being interrogated in some foreign military compound, but the reality is that in many cases, the experience in intensive care can be traumatic. This outcome results despite ongoing efforts to make ICUs a more comfortable place for the patient.

In fact, according to studies including one published in the journal General Hospital Psychiatry, 1 in 5 patients who spend time in intensive care will experience the anger, numbness, sleeping problems, flashbacks and general irritability that is associated with Post Traumatic Stress Disorder (PTSD). These patients are experiencing the same symptoms as many soldiers and prisoners of war and the effects can last for quite some time. The results of another study from Portugal showed that, even without full blown PTSD, roughly 40% of former ICU patients will have problems sleeping and problems with day to day activities requiring concentration.  To make a bad situation worse, the development of the delirium of ICU Psychosis increases the risks of dying by a factor of 3.

Those who experience the worst effects of their ICU stay seem to be those with breathing tubes inserted in their throats and nose. The feelings of contending with breathing issues related to pneumonia and awakening in a confused state while on a ventilator easily explain why many former ICU patients remember suffering feelings of suffocation. It is no wonder that mental stresses are felt as badly as they are.  

Now, the reason that the spectre of this mental health condition has been raised without any accompanying good news or new science is because of the far too familiar H1N1. With the growing concern that a stronger strain may overwhelm many world nations this fall, there will be a large number of patients with both the “regular flu” and “swine flu” in the limited ICU beds of the many hospitals around the world. These patients will have assisted breathing in many cases because of their weak lung function caused by the flu. Just remember, for yourself and your loved ones, the value of visiting your loved ones where possible and asking for earplugs to help get a little shut eye and preserve both health and sanity.

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