| Abstract |
Background: The implications of the technological advancements in clinical medicine have led to a steady increase of people surviving their hospitalization in an Intensive Care Unit (ICU) due to critical illness. However, the return of these people back to normal everyday lives is a demanding process as a high percentage of them suffers from a diverse set of symptoms that constitutes the Post-Intensive Care Syndrome (PICS). PICS is associated with physical symptoms and disabilities as well as psychiatric disorders and cognitive impairment. Post-Traumatic-Stress-Disorder (PTSD) belongs to the psychological disturbances that people suffering from PICS are experiencing.
Methods: We conducted a retrospective study of patients hospitalized in the ICU of the University Hospital of Heraklion for at least 48 hours from 2013 to 2015. The patients were evaluated at the outpatient ward. 100 patients were included in the final analysis. We retrospectively recorded demographic parameters (age, gender) and clinical parameters concerning their hospitalization in the ICU (APACHE II score, GSC score at their admission and their discharge from the ICU, cause of admission in the ICU, presence of delirium during their hospitalization in the ICU, administration of corticosteroids, sedatives, antipsychotics and antidepressants during their hospitalization in the ICU, duration of mechanical ventilation either in the form of NIPPV or endotracheal tube). The patients performed self-evaluation via the completion of the questionnaire PTSS-10 during the conduction of a personal interview. Moreover, they answered a complementary questionnaire regarding the presence or not of traumatic experiences during their hospitalization in the ICU that it composed questions that included the presence of nightmares, panic attacks, pain and difficulty in breathing. Statistical analysis was performed using SPSS 25.00 and used the methods Chi-square, Kruskal-Wallis, Mann-Whitney and Pearson-Correlation Co-Efficiency. Confidence intervals were set at the level of 95%.
Results: Out of the 416 individuals hospitalized in the ICU of the University Hospital of Heraklion between 2013-2015 100 patients fulfilled the eligibility criteria for inclusion in the final analysis. 75 (75%) patients were male and 25 (25%) were female. Median age of the patient population was 58 years old (range: 41-67 years) and their median duration of hospitalization in the ICU was 8 days (range: 5-17 days). 6 patients (6%) developed severe PTSD (>35 PTSS-10 score). The PTSS-10 score as a continuous variable was associated at a statistically significant level with the cause of ICU admission (medical reasons, trauma and neurosurgery reasons)(p=0.038, CI 95%) and the younger age of patients(p=0.032). The presence of PTSD as a qualitative variable was correlated with the presence of CNS disorders (p=0.022, CI 95%), delirium during the hospitalization in the ICU (p=0.031, CI 95%) and preexisting psychiatric illness (p=0.020, CI 95%). In addition, increased time duration of mechanical ventilation was associated with increased risk for PTSD development (p=0.036, CI 95%). Denial of remembering the ICU stay(p=0.045, CI 95%), the presence of memories of the nightmares they experienced during their hospitalization in the ICU (p=0.040, CI 95%), memories concerning the disturbances due to medical interventions during their stay in the ICU (p=0.004, CI 95%) were all associated with increased risk of PTSD development.
Conclusions: Our study showed that PTSD was positively associated with younger age, female gender, the cause of entry, the CNS-related morbid entity, the days of mechanical ventilation, and whether or not the appearance of delirium during hospitalization, pre-existing psychiatric illness and finally the existence of more than two traumatic memories in adult patients treated in the ICU for more than 48 hours.
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