Beware the ICU

[Red]

Wow, saw this in my news feed this morn.

This is scary, since one never knows when one could experience a medical emergency that could land one in a hospital ICU. At any age.

https://www.npr.org/sections/health...leads-to-symptoms-of-dementia-after-discharge

Doctors have gradually come to realize that people who survive a serious brush with death in the intensive care unit are likely to develop potentially serious problems with their memory and thinking processes.

This dementia, a side effect of intensive medical care, can be permanent. And it affects as many as half of all people who are rushed to the ICU after a medical emergency. Considering that 5.7 million Americans end up in intensive care every year, this is a major problem that until recently, has been poorly appreciated by medical caregivers...

...."This is a huge problem," says Dr. E. Wesley Ely, an intensive care specialist who heads that effort. He says post-ICU syndrome — a cluster of cognitive symptoms that can include anxiety, depression and post-traumatic stress disorder, as well as delirium — affects 30 to 50 percent of all patients who are rushed to the ICU because of a medical emergency. That's including younger patients who had no prior mental challenges. And in some of those patients, dementia soon follows.

"You have somebody coming into the ICU with a previously very well-working brain, and they leave critical care not being able to have a good conversation," Ely says. "They can't balance their checkbook, they can't find the names of people at a party and they get very embarrassed, so they start socially secluding themselves. Our patients tell us what a misery this form of dementia is."

Ely has been tracking his patients for more than a decade through scientific studies such as the BRAIN-ICU study. He says about one-third of patients who have cognitive problems following their ICU stay fully recover; another third stay about the same after their dementia sets in — and a third continue to go downhill.

For many, the damage to mental processing is akin to what's seen with a traumatic brain injury, in a condition called mild cognitive impairment — or even with Alzheimer's disease.

 

[LogGrad98]

This is one of the contributing factors for my deoression/PTSD after my cancer treatment and I can say positively that this is an effect I have dealt with my entire life afterward. I have had memory problems, difficulty concentrating, depression and anxiety, and as I have written on here before I had a near-death experience and spent 10 days or so in the ICU due to the effects of heavy chemo. I'm lucky to be alive, but my life is definitely not the same as it was before.

 

[str8line]

This is one of the contributing factors for my deoression/PTSD after my cancer treatment and I can say positively that this is an effect I have dealt with my entire life afterward. I have had memory problems, difficulty concentrating, depression and anxiety, and as I have written on here before I had a near-death experience and spent 10 days or so in the ICU due to the effects of heavy chemo. I'm lucky to be alive, but my life is definitely not the same as it was before.

Is it because of ICU or because of the generally traumatic experience of facing your mortality?

 

[str8line]

I would think that any near death experience, especially a prolonged one like having cancer, would be traumatic, ICU or not.

 

[infection]

The ICU really isn't the independent variable in this equation and is more correlated with the underlying severity of illness. Delirium is simply the mental manifestations of underlying medical instability. If you're older or in poorer health, you will be more susceptible to deliriogenic effects due to your body being not being as able to handle physiologic insult relative to younger or healthier people, plus possessing less cognitive reserve. If you're young and healthy and end up delirious, it's a reflection of the severity of the underlying medical instability. While there can be some iatrogenic variable, such as infections or unnecessary intervention, you've got to remember that people don't end up in an ICU because they're healthy. Being in the ICU is simply a marker for having serious underlying medical problems. If the thought is that this can be avoided by simply not going to the ICU, then we're missing the same mark as if we were to say that the majority die who receive CPR, so be cautious about getting CPR.

 

[RandyForRubio]

Correlation does not equal causation.

 

[LogGrad98]

Is it because of ICU or because of the generally traumatic experience of facing your mortality?

I would think that any near death experience, especially a prolonged one like having cancer, would be traumatic, ICU or not.

I have been to numerous doctors over the years, and I have documented my struggles with depression here before. I was diagnosed with PTSD, partially due to the total affect of chemo and other drugs over a year of treatment, partly due to the sheer trauma and duration of the event. And due to my experiences in ICU. infection is right, though, it isn't just simply being in the ICU but why you are there. I was in a coma for 4 or 5 days, and I died twice in that time frame. The doctors were surprised I made it. They told my wife 3 different times that she should go spend some time with me because they doubted I would make it through the night. One NDE I had lasted 3 minutes or so. I actually had an out of body experience that I cannot explain during that time. After my experiences I have dealt with the same cognitive issues they mention in the article.

One telling thing was that before I had cancer I had tested into Mensa (about 26 years old at the time), getting the requisite scores on the requisite tests and hitting the scores needed pretty easily. About 2 years after my cancer treatments ended (about 30 years old), I took essentially one of the same tests again, because I felt like my head was fuzzy a lot, and I did not score high enough to pass the bar for Mensa that time.

I believe everything this article puts forth because I have experienced many of those symptoms, luckily not in the same severity as many do, but I was affected similarly all the same. It forever changed me and shaped the rest of my life dramatically. It is hard to explain how that makes me feel. I spent a lot of time, until I worked through it in therapy, grieving for the person I was and lamenting the fact that my kids would only know this moody, quick-tempered, distracted father and would never know the father I could have been. I won't go into heavy detail because I have done that before, but suffice it to say that I am actually happy to read this, because it helps to reinforce what my doctors have told me, and it ties me to other people who have experience the same thing.

 

[JazzGal]

I have been to numerous doctors over the years, and I have documented my struggles with depression here before. I was diagnosed with PTSD, partially due to the total affect of chemo and other drugs over a year of treatment, partly due to the sheer trauma and duration of the event. And due to my experiences in ICU. infection is right, though, it isn't just simply being in the ICU but why you are there. I was in a coma for 4 or 5 days, and I died twice in that time frame. The doctors were surprised I made it. They told my wife 3 different times that she should go spend some time with me because they doubted I would make it through the night. One NDE I had lasted 3 minutes or so. I actually had an out of body experience that I cannot explain during that time. After my experiences I have dealt with the same cognitive issues they mention in the article.

One telling thing was that before I had cancer I had tested into Mensa (about 26 years old at the time), getting the requisite scores on the requisite tests and hitting the scores needed pretty easily. About 2 years after my cancer treatments ended (about 30 years old), I took essentially one of the same tests again, because I felt like my head was fuzzy a lot, and I did not score high enough to pass the bar for Mensa that time.

I believe everything this article puts forth because I have experienced many of those symptoms, luckily not in the same severity as many do, but I was affected similarly all the same. It forever changed me and shaped the rest of my life dramatically. It is hard to explain how that makes me feel. I spent a lot of time, until I worked through it in therapy, grieving for the person I was and lamenting the fact that my kids would only know this moody, quick-tempered, distracted father and would never know the father I could have been. I won't go into heavy detail because I have done that before, but suffice it to say that I am actually happy to read this, because it helps to reinforce what my doctors have told me, and it ties me to other people who have experience the same thing.

Sounds like you've gone through quite an ordeal. I'm sorry you've had to experience all of this. I know how hard illness can be, and it is so difficult to figure out how to cope. I'm glad you've found ways to work through it and hope you continue to improve.

 

[Keefe]

Correlation does not equal causation.

That doesn’t seem to apply in this case.

 

[infection]

That doesn’t seem to apply in this case.

In the OP’s mind or in reality?

 

[Rubashov]

The ICU really isn't the independent variable in this equation and is more correlated with the underlying severity of illness. Delirium is simply the mental manifestations of underlying medical instability. If you're older or in poorer health, you will be more susceptible to deliriogenic effects due to your body being not being as able to handle physiologic insult relative to younger or healthier people, plus possessing less cognitive reserve. If you're young and healthy and end up delirious, it's a reflection of the severity of the underlying medical instability. While there can be some iatrogenic variable, such as infections or unnecessary intervention, you've got to remember that people don't end up in an ICU because they're healthy. Being in the ICU is simply a marker for having serious underlying medical problems. If the thought is that this can be avoided by simply not going to the ICU, then we're missing the same mark as if we were to say that the majority die who receive CPR, so be cautious about getting CPR.

Hey infection isn't there an increased risk of dementia like symptoms, (a permanent cognitive deficit) to the elderly from anesthesia? Especially if they are already showing signs of the illness?

 

[infection]

Hey infection isn't there an increased risk of dementia like symptoms, (a permanent cognitive deficit) to the elderly from anesthesia? Especially if they are already showing signs of the illness?

As far as anything permanent, that I don’t know. Having not read any literature specifically addressing that, I’d be a bit skeptical about it being a significant (clinically meaningful) difference. But it would also be hard to separate the effects of the anesthesia from the effects of whatever led to the necessity of being anesthetized. One thing, though, is that elderly who get delirious typically don’t fully return to baseline, but again a lot of times that may not be clinically significant.

 

[Red]

In the OP’s mind or in reality?

I'm just a layman and there's no way I can have an informed or educated opinion on the study described in the article. You, on the other hand, sound like you have an educated and informed opinion. For me, it was just something I was not aware of, and I thought it would be of general interest. But, I do admit, reading it did make me think I would likely feel nervous about being put in an ICU. That did happen several years ago, when I developed an infection from a hospital procedure, and just waited way too long before going back to the hospital. At the time, they told me if I had waited still another day, I would have been in more trouble then I was already. Some doctor working for the CDC had to interview me, because whatever the bug was, it was regarded as very rare. Or maybe it was standard procedure, I just remember he had to interview me. I did hallucinate some that first night, so maybe I'm lucky....

 

[infection]

I'm just a layman and there's no way I can have an informed or educated opinion on the study described in the article. You, on the other hand, sound like you have an educated and informed opinion. For me, it was just something I was not aware of, and I thought it would be of general interest. But, I do admit, reading it did make me think I would likely feel nervous about being put in an ICU. That did happen several years ago, when I developed an infection from a hospital procedure, and just waited way too long before going back to the hospital. At the time, they told me if I had waited still another day, I would have been in more trouble then I was already. Some doctor working for the CDC had to interview me, because whatever the bug was, it was regarded as very rare. Or maybe it was standard procedure, I just remember he had to interview me. I did hallucinate some that first night, so maybe I'm lucky....

I was more asking Wes to clarify. Regarding being nervous about being in an ICU, it's perfectly normal to feel nervous about being in an ICU, but perhaps not for the reasons this article suggests. Not too dissimilar from feeling nervous about having to ever receive CPR... you should feel nervous about ever having to receive CPR in the future, but it shouldn't be the CPR you'd have to fear.

I think there's a good lesson in this, though. An article puts forward some facts, presents things that are true, and leads to anxiety. But the overall premise is misguided, despite having lots of facts. Especially in arenas where other biases can creep in, it's easy to see how people could come to any conclusion given any data set.

 

[Harambe]

I'm not sure using ICU attendance as PR maneuver is my favorite way to study long term delirium related trauma, but if it gets them some revenue to look into it, and open support centers, run studies, then by the hand of Cthulu let's get on board.

Also, let's all remember that you're going to an ICU for a reason. As a general rule, if your physician(or the ED staff) thought you didn't need to to go the ICU, they wouldn't send you there. Any good physician wants you there only as much as you want to be there.

 

[bigb]

I'm just a layman and there's no way I can have an informed or educated opinion on the study described in the article. You, on the other hand, sound like you have an educated and informed opinion. For me, it was just something I was not aware of, and I thought it would be of general interest. But, I do admit, reading it did make me think I would likely feel nervous about being put in an ICU. That did happen several years ago, when I developed an infection from a hospital procedure, and just waited way too long before going back to the hospital. At the time, they told me if I had waited still another day, I would have been in more trouble then I was already. Some doctor working for the CDC had to interview me, because whatever the bug was, it was regarded as very rare. Or maybe it was standard procedure, I just remember he had to interview me. I did hallucinate some that first night, so maybe I'm lucky....

Or maybe you’re dumb now and you just don’t remember how smart you were before.