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Delirium and PTSD are Two Common Symptoms of ICU Stays. Researchers are Working to Change That - ABC

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Delirium and PTSD are two common symptoms of ICU stays. Researchers are working to change that - ABC News [abc.net.au]:

"There were multiple times ... when I would wake up screaming because I couldn't deal with it anymore. It was like this evil darkness that didn't even have a face."

Rebecca Craven is describing the nightmares she experienced as a patient in intensive care.

In her early 20s, she found herself in ICU after suffering heart failure from a virus she caught in Bali.

While in there she experienced delirium, a common condition among ICU patients that can involve frightening hallucinations.

"If you survive ICU and you've had delirium, your mortality is three times higher in six months," says John Fraser, a professor of intensive care medicine and Director of the Critical Care Research Group at the Prince Charles Hospital in Brisbane.

"Your ability to go back to work and hold down a job is dramatically diminished.

"Your risk of relationship breakdown is massively upregulated."

Intensive care units are a 24-hour operation and the constant noise and light make it very difficult for patients to sleep — one of the biggest risk factors for delirium.

"Often we see patients who are trying to climb out of the bed, maybe they are pulling at their lines or calling out for someone or being aggressive to staff," says Steven Forest, who has been an intensive care nurse for over 25 years.

"We also see delirious patients who are quiet, but when you talk to them, it's clear they are very confused and frightened."

That's why the Critical Care Research Group were keen to get input from people like Ms Craven into creating better intensive care units, to reduce the risk of developing delirium.

"We've developed intensive care units for the doctors, for physios for nurses — but we never asked the patient," Professor Fraser said.

A holiday in paradise led to a potentially fatal illness

For Ms Craven, it all started in 2012 when she was in Bali for a holiday.

"Halfway through the trip I got really sick, but didn't think much of it at the time," she says.

Doctors thought Ms Craven, then 23, had pneumonia, and began treatment that lasted for around four months.

"I was getting progressively worse, I was really lethargic, out of breath and could barely walk 50 metres without wanting to sit down," she said.

Ms Craven was taken to emergency, where doctors discovered it wasn't her lungs that were in trouble, but her heart — it was being attacked by a virus she contracted in Bali, and she was experiencing heart failure.

Ms Craven was given medication, but it soon stopped working.

Her only hope was a heart transplant.

Hallucinations and nightmares

Ms Craven was treated in ICU multiple times before the transplant, and she often experienced hallucinations.

"The first time in intensive care I didn't have too many bad thoughts, they were just weird," she says.

"There was one time I asked mum to do a cancan dance and told her she was wearing a pretty dress when she wasn't.

But it was the long stay in ICU after her heart transplant where things got very scary.

"The lights are on most of the time and you have a lot of weird thoughts going on in your mind," she says.

"I had nightmares every night. I would hear voices, I would think people were beside me but when I opened my eyes, no-one was there.

"You get very distressed because you don't really know what's real."

Post-intensive care syndrome after leaving hospital

Ms Craven spent months in the ICU, and after leaving hospital she continued to struggle with delirium.

"For the first few months after leaving hospital I still heard beeping," she says.

"I would cringe when I heard ambulance sirens, and any type of beeping sound or coughing could make me panic.

"Visiting the hospital for my check-ups was very distressing."

She was diagnosed with a condition called post-intensive care syndrome, which refers to a collection of physical, mental and emotional symptoms that persist after a patient leaves intensive care.

Associate Professor Dylan Flaws, a psychiatrist at the Mental Health Short Stay Unit at the Caboolture Hospital in Queensland, has been conducting research into recovery after critical care.

"When I started to get to know these patients and hear their story, there was this common history that they had been treated in an ICU at some point in their lives," he says.

"I found out that their health anxiety was actually PTSD, and nobody had asked the questions around nightmares and flashbacks.

Darryl also experienced hallucinations

Darryl O'Callaghan also spent time in ICU after being involved in a very serious motorbike accident.

Doctors didn't think he would survive and when he got to hospital, he had multiple complex surgeries and was put into an induced coma.

Three weeks later he woke up in an ICU.

"The lights are always on, there's always noise, it's a 24-hour operation. If I got four hours sleep in a night, that was good," he recalls.

Like Ms Craven, Mr O'Callaghan also experienced "bizarre" hallucinations.

"I used to think that my work colleagues were in the room, but their heads were on the bodies of the nurses.

"I remember thinking, 'what are you all doing here?' It was all so vivid.

"I used to think, 'why would someone give up the will to live?' But I get it now — you have to fight every day to survive and it's not just in ICU, it's an ongoing journey once you leave."

Indeed, once Mr O'Callaghan left hospital, he transitioned into a rehab facility before his wife Julie took over his care.

"My brain was so deconditioned that I couldn't even remember how I got from the bedroom to the bathroom," he says.

"Julie became my nurse — we didn't have a husband-wife relationship, we had a carer-patient relationship.

"[She] also had to care for our baby daughter and go to work to bring some money in."

Ms O'Callaghan remembers one doctor giving her a warning early on about what it would be like when Darryl got home.

Improving the physical environment of intensive care

Disrupted sleep, bright lights and the endless beeping of alarms all are thought to play a role in bringing on delirium.

That's why researchers are keen to look into how redesigning our hospital system might reduce the chance of developing it.

The Critical Care Research Group is in the process of designing a new kind of intensive care bed, which will make the physical environment the best it can be for the patient by reducing noise and light so it's easier to sleep.

"We have a patient at the moment who has been in ICU for half a year. Imagine six months of sleeping five hours a night — it's not going to be good for healing," says group physiotherapist Oystein Tronstad.

The bed is in a cocoon style and uses video screens and noise-cancelling technology to eliminate the sounds of "unnecessary" alarms, hopefully providing a calmer and more secluded stay in hospital.

"A lot of the noises are due to alarms, but the vast majority are not actioned or false alarms," Mr Tronstad says.

"Staff members quickly realise an alarm is not urgent but patients don't know that.

"They often assume something is seriously wrong and it can create a lot of anxiety.

"Many of these alarms are unnecessary, so firstly, we can try eliminate some, and secondly, do they all need to be auditory alarms?

"And do they all need to go off right near the patient's head?"

The group's next step will be an environment trial, comparing the hormone and stress response of a patient in a standard ICU bed to one using an ICU bed of the future.

It's been more than five years since Ms Craven received her donor heart, and she's one of 25 patients who've had input into the ICU bed's design.

"I have learnt a lot about myself and how resilient I am," she says.

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Your information is being handled in accordance with the ABC Privacy Collection Statement [abc.net.au].Email addressSubscribePosted , updated Wed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amShare

'Patients get absolutely freaked out': World-first 'cocoon' hospital bed aims to relieve ICU delirium [abc.net.au] Organ transplant recipient keeps donor close to her heart [abc.net.au] 'Patients get absolutely freaked out': World-first 'cocoon' hospital bed aims to relieve ICU delirium [abc.net.au] Organ transplant recipient keeps donor close to her heart [abc.net.au] More on:

"There were multiple times ... when I would wake up screaming because I couldn't deal with it anymore. It was like this evil darkness that didn't even have a face."

Rebecca Craven is describing the nightmares she experienced as a patient in intensive care.

In her early 20s, she found herself in ICU after suffering heart failure from a virus she caught in Bali.

While in there she experienced delirium, a common condition among ICU patients that can involve frightening hallucinations.

"If you survive ICU and you've had delirium, your mortality is three times higher in six months," says John Fraser, a professor of intensive care medicine and Director of the Critical Care Research Group at the Prince Charles Hospital in Brisbane.

"Your ability to go back to work and hold down a job is dramatically diminished.

"Your risk of relationship breakdown is massively upregulated."

Intensive care units are a 24-hour operation and the constant noise and light make it very difficult for patients to sleep — one of the biggest risk factors for delirium.

"Often we see patients who are trying to climb out of the bed, maybe they are pulling at their lines or calling out for someone or being aggressive to staff," says Steven Forest, who has been an intensive care nurse for over 25 years.

"We also see delirious patients who are quiet, but when you talk to them, it's clear they are very confused and frightened."

That's why the Critical Care Research Group were keen to get input from people like Ms Craven into creating better intensive care units, to reduce the risk of developing delirium.

"We've developed intensive care units for the doctors, for physios for nurses — but we never asked the patient," Professor Fraser said.

A holiday in paradise led to a potentially fatal illness

For Ms Craven, it all started in 2012 when she was in Bali for a holiday.

"Halfway through the trip I got really sick, but didn't think much of it at the time," she says.

Doctors thought Ms Craven, then 23, had pneumonia, and began treatment that lasted for around four months.

"I was getting progressively worse, I was really lethargic, out of breath and could barely walk 50 metres without wanting to sit down," she said.

Ms Craven was taken to emergency, where doctors discovered it wasn't her lungs that were in trouble, but her heart — it was being attacked by a virus she contracted in Bali, and she was experiencing heart failure.

Ms Craven was given medication, but it soon stopped working.

Her only hope was a heart transplant.

Hallucinations and nightmares

Ms Craven was treated in ICU multiple times before the transplant, and she often experienced hallucinations.

"The first time in intensive care I didn't have too many bad thoughts, they were just weird," she says.

"There was one time I asked mum to do a cancan dance and told her she was wearing a pretty dress when she wasn't.

But it was the long stay in ICU after her heart transplant where things got very scary.

"The lights are on most of the time and you have a lot of weird thoughts going on in your mind," she says.

"I had nightmares every night. I would hear voices, I would think people were beside me but when I opened my eyes, no-one was there.

"You get very distressed because you don't really know what's real."

Post-intensive care syndrome after leaving hospital

Ms Craven spent months in the ICU, and after leaving hospital she continued to struggle with delirium.

"For the first few months after leaving hospital I still heard beeping," she says.

"I would cringe when I heard ambulance sirens, and any type of beeping sound or coughing could make me panic.

"Visiting the hospital for my check-ups was very distressing."

She was diagnosed with a condition called post-intensive care syndrome, which refers to a collection of physical, mental and emotional symptoms that persist after a patient leaves intensive care.

Associate Professor Dylan Flaws, a psychiatrist at the Mental Health Short Stay Unit at the Caboolture Hospital in Queensland, has been conducting research into recovery after critical care.

"When I started to get to know these patients and hear their story, there was this common history that they had been treated in an ICU at some point in their lives," he says.

"I found out that their health anxiety was actually PTSD, and nobody had asked the questions around nightmares and flashbacks.

Darryl also experienced hallucinations

Darryl O'Callaghan also spent time in ICU after being involved in a very serious motorbike accident.

Doctors didn't think he would survive and when he got to hospital, he had multiple complex surgeries and was put into an induced coma.

Three weeks later he woke up in an ICU.

"The lights are always on, there's always noise, it's a 24-hour operation. If I got four hours sleep in a night, that was good," he recalls.

Like Ms Craven, Mr O'Callaghan also experienced "bizarre" hallucinations.

"I used to think that my work colleagues were in the room, but their heads were on the bodies of the nurses.

"I remember thinking, 'what are you all doing here?' It was all so vivid.

"I used to think, 'why would someone give up the will to live?' But I get it now — you have to fight every day to survive and it's not just in ICU, it's an ongoing journey once you leave."

Indeed, once Mr O'Callaghan left hospital, he transitioned into a rehab facility before his wife Julie took over his care.

"My brain was so deconditioned that I couldn't even remember how I got from the bedroom to the bathroom," he says.

"Julie became my nurse — we didn't have a husband-wife relationship, we had a carer-patient relationship.

"[She] also had to care for our baby daughter and go to work to bring some money in."

Ms O'Callaghan remembers one doctor giving her a warning early on about what it would be like when Darryl got home.

Improving the physical environment of intensive care

Disrupted sleep, bright lights and the endless beeping of alarms all are thought to play a role in bringing on delirium.

That's why researchers are keen to look into how redesigning our hospital system might reduce the chance of developing it.

The Critical Care Research Group is in the process of designing a new kind of intensive care bed, which will make the physical environment the best it can be for the patient by reducing noise and light so it's easier to sleep.

"We have a patient at the moment who has been in ICU for half a year. Imagine six months of sleeping five hours a night — it's not going to be good for healing," says group physiotherapist Oystein Tronstad.

The bed is in a cocoon style and uses video screens and noise-cancelling technology to eliminate the sounds of "unnecessary" alarms, hopefully providing a calmer and more secluded stay in hospital.

"A lot of the noises are due to alarms, but the vast majority are not actioned or false alarms," Mr Tronstad says.

"Staff members quickly realise an alarm is not urgent but patients don't know that.

"They often assume something is seriously wrong and it can create a lot of anxiety.

"Many of these alarms are unnecessary, so firstly, we can try eliminate some, and secondly, do they all need to be auditory alarms?

"And do they all need to go off right near the patient's head?"

The group's next step will be an environment trial, comparing the hormone and stress response of a patient in a standard ICU bed to one using an ICU bed of the future.

It's been more than five years since Ms Craven received her donor heart, and she's one of 25 patients who've had input into the ICU bed's design.

"I have learnt a lot about myself and how resilient I am," she says.

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Your information is being handled in accordance with the ABC Privacy Collection Statement [abc.net.au].Email addressSubscribePosted , updated Wed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amWed 1 Sep 2021 at 1:00amShare

'Patients get absolutely freaked out': World-first 'cocoon' hospital bed aims to relieve ICU delirium [abc.net.au] Organ transplant recipient keeps donor close to her heart [abc.net.au] 'Patients get absolutely freaked out': World-first 'cocoon' hospital bed aims to relieve ICU delirium [abc.net.au] Organ transplant recipient keeps donor close to her heart [abc.net.au] More on:

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