1. Article Review By: Jenna Faiella
Posttraumatic Stress Symptoms in ICU patients: An Exploration of Associated Factors1 Rosalind Elliot, Doug Elliot, Mary Fien, Sharon McKinley
Article Review
By: Jenna Faiella

2. Purpose
To explore demographic, clinical, and psychological factors in the ICU, including self-reported sleep quality and experiences that were associated with posttraumatic stress (PTS) symptoms 6 months after discharge from the hospital
 Effects of sleep in ICU during critical illness on subsequent PTS symptoms has not been previously studied

3. PTS Symptoms
“Feelings of anxiety, avoidance, intrusive thoughts, and alterations in reaction to those attributes as a result of exposure to a traumatic event.”

4. Setting & Inclusion Criteria
Adult ICU at a University-affiliated hospital in New South Wales, Australia
18 years or older
Treated in ICU for 48 hours or more
Assessed as sufficiently recovered by the treating physician to transfer out of the ICU
Able to provide informed consent

5. Exclusion Criteria Known or suspected preexisting sleep disorder
Uncorrected vision or hearing impairments
Inability to complete the study instruments in English

6. Method
While in the ICU: Completed self-report questionnaires on their sleep prior to admission and during their stay in the ICU
2 months after DC: Reported on sleep over the past month + experiences in the ICU
6 months after DC: Reported on PTS symptoms + depression, anxiety, stress levels + quality of sleep over past month

7. Measures Age Sex BMI Severity of illness Operative admission or not
Clinical & demographic characteristics were collected from healthcare records including:
Age
Sex
BMI
Severity of illness
Operative admission or not
Trauma or not
Length of mechanical ventilation
LOS in ICU & hospital

8. Measures Cont’d Sedation level Pain level (Visual Analog Pain Scale)
State anxiety (Faces Anxiety Scale)
Experience of treatment in ICU (ICEQ)
Psychological well-being (DASS-21 & PCL-S)
Self-reported quality of sleep (ISI, RCSQ, PSQI)
Sedation level (Richmond Sedation-Agitation Scale)
Pain level (Visual Analog Pain Scale)
State anxiety (Faces Anxiety Scale)
Experience of treatment in ICU (Intensive Care Experience Questionnaire)
Psychological well-being (DASS-21: Depression, Anxiety, and Stress Scales-21 and PCL-S: Posttraumatic Stress Disorder Checklight-Specific)
Self-reported quality of sleep (Insomnia Severity Index, Richards-Campbell Sleep Quesitonnaire, The Pittsburgh Sleep Quality Index)

9. Patient Demographics & Clinical Characteristics
Out of 222 patients:
65% male (mean age: 57 y.o.)
Severity of illness: Low
Median duration of mechanical ventilation: 0.5 days
Median ICU LOS: 3 days
Pain intensity: Low (Mean: 2.5)
Anxiety Level: Moderately High

10. Experience of Treatment in ICU
82.7% of the sample remembered their ICU stay
63.8% answered never to “I knew where I was”
High frequency of memories evident for “bad dreams” (47% all of the time) and “seeing strange things” (53% all of the time)
Only 10.8% felt in control all of the time

11. Results Symptoms of PTS reported by 1 in 7 (14%)
 (Previous studies 13-27%)
Depression and anxiety symptoms were demonstrated by 1 in 5 (20%)
Note: *Demonstrated in a cohort with a relatively low severity of illness, short durations of mechanical ventilation and ICU length of stay  low level of exposure to critical illness process and treatments that may affect psychological well-being

12. Factors associated with PTS symptoms at 6 months after DC
1. Higher pain-intensity scores at enrollment 2. Poorer sleep quality at 6 months 3. Lower awareness of ICU 4. More recall of frightening experiences 5. Higher levels of depression, anxiety, & stress

13. Impact & Implications
Continued attempts to maximize sleep quality and comfort are required & appear to be more important during recovery
Patients should be provided with access to specialist follow-up and rehab services for psychological screening and treatment

14. Implications Cont’d Further pain management practices in ICU
Assess anxiety regularly using the Faces Anxiety Scale

15. Implications Cont’d
Need to assess, prevent, and treat delirium to reduce the likelihood of patients recalling frightening experiences in ICU*
Intensive efforts to provide reassurance and repeating explanations about treatment*
Enabling patients to communicate their fears when possible

16. Conclusion
Continuing symptoms of PTS were evident in 14% of the cohort
Clinically significant depression and anxiety were demonstrated in 20% of patients
Sleep quality proved to be affected at 6 months after DC
Screening for delirium is essential
Psychological screening and follow-up during recovery would also be beneficial for many patients

17. References
1. Elliott, Rosalind, Sharon Mckinley, Mary Fien, and Doug Elliott. "Posttraumatic Stress Symptoms in Intensive Care Patients: An Exploration of Associated Factors." Rehabilitation Psychology 61.2 (2016): Web.