Researchers are considering how best to support patients who have posttraumatic stress disorder (PTSD) after spending time in the intensive care unit (ICU), after a trial of a nurse-led psychological support initiative in the ICU was not found to significantly reduce rates of PTSD, depression or anxiety in these patients.
While disappointed with the trial outcome, lead clinical investigator for the POPPI - Psychological outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients – study, Dr Dorothy Wade, ICU psychologist at UCLH, said it provides clues about what may work to reduce levels of PTSD among ICU patients, including changing the timing of the intervention.
Other POPPI co-investigators from the UCLH critical care department include senior nurses Debbie Smyth and John Welch, and Intensive Care Medicine consultants Dr David Howell and Professor Monty Mythen.
25% of ICU patients later report clinically significant PTSD symptoms, which can result from the stress of being in the ICU, the use of sedative drugs which disorient patients and can lead to hallucinations and delusions, and the number of highly intensive treatments patients receive.
For the study, involving 1,458 patients across 24 ICUs in the UK, nurses promoted a therapeutic environment in the ICU – which included reducing noise levels and optimising patients’ sleep – and offered three one-to-one stress support sessions to patients experiencing high levels of anxiety while they were still in the ICU.
The trial did not meaningfully reduce rates of PTSD reported by patients 6 months after leaving the ICU, but researchers said changes to the intervention such as altering when it is given and improving nurses’ training may improve its effectiveness.
Dr Wade said: “Providing psychological support to patients while they are still in the ICU may be too early – patients may need time to process the trauma experienced in intensive care before they receive support, so we could develop an approach where we offer patients support sessions once they have left the ICU. In addition, we may need more intensive training for nurses who lead the intervention.”
The researchers also added that in many cases patients didn’t have all three one-to-one stress support sessions. “Where patients did have all three sessions, we saw a reduction in patients’ immediate anxiety scores, so there is reason to believe these sessions can be effective at reducing psychological distress,” Dr Wade said.
“An alternative approach, that we are looking to develop further, might involve reducing the triggers for delirium, hallucinations and delusions in the ICU, such as stress, sedative drugs and sleep deprivation, with the aim of preventing the psychological repercussions of these disturbing phenomena.”
The POPPI trial was run by the Intensive Care National Audit and Research Centre, with further academic support from the London School of Hygiene and Tropical Medicine, Professor John Weinman of Kings College London and Professor Chris Brewin of UCL.
