Discomfort, awareness and recall of patients in the intensive care: still a problem?

Introduction

During surgery, anaesthetists take extra care to prevent awareness of any patient who is having any kind of operation done, mainly under general anaesthesia either by using inhalational or intravenous medications, but patients in the ICU, mainly those on ventilatory support, with intubation and sedation, pass through a lot of psychological stress and frustration, which most of the times is not documented in the genera intensive care, and has never been done in our unit.

Aim of this study

In this study at our general ICU, we tried to have a proper assessment of this problem in order to avoid it in the future, and to get a proper consensus regarding its existence and solution.

Methods

Seventy patients between the ages 20–60 years, were interviewed 1 day after discharge from the ICU, about their memory of events during their stay. Patients with head injury, CNS infection or those who were disoriented at the time of interview were excluded from the study. The remaining 55 patients were oriented to place and time.

Intravenous opiates (morphine, pethidine) were used for analgesia as required, while sedation was achieved using midazolam and morphine infusions in appropriate doses as decided by the attending doctors and nurses.

Questions asked were generally about patients' memory of events and about their distressing experiences regarding pain, anxiety, dreams, fear, noises, causes of discomfort and others which will be displayed in the results section.

The same questions were repeated 5 days later.

Results

The sample of patients were representative of our regular ICU admissions in their age group, APACHE II score and duration of stay.

The most distressing and commonest experiences recalled were: anxiety (68%), discomfort from endo-tube (60%), fear (54%), pain (52%), discomfort from N/G tube (48%), difficulty in communicating (33%), dreams and hallucinations (31%), discomfort from physiotherapy (24%), noise (15%), insomnia (13%), thirst (10%), some of these like anxiety, fear, dreams, hallucinations and insomnia had continued since discharge in 6% of patients. None of the studied experiences correlated with age, sex, or with the APACHE II score. On interviewing the patients 5 days later, there were no significant changes in their responses.

Conclusion

Our sedation and analgesia in the ICU is not enough to prevent unpleasant experiences, mainly those related to patient awareness.

More work is still needed, i.e. using sedation scores to improve our sedation and analgesia in the ICU.