Jamie Pinkas MSN, AGACNP-BC, CCRN, is a nurse practitioner, Columbia University Irving Medical Center's Medical ICU and graduated at the University of Pennsylvania Adult Gerontology Acute Care Nurse Practitioner Program. Abigail Horowitz MSN, AGACNP-BC, CCRN, practices as a registered nurse at Penn Presbyterian Medical Center's Heart and Vascular ICU and graduated at the University of Pennsylvania Adult Gerontology Acute Care Nurse Practitioner Program.
Dimens Crit Care Nurs. 2020 Nov/Dec;39(6):298-304. doi: 10.1097/DCC.0000000000000439.
When patients are in the intensive care unit (ICU), they are in their most vulnerable and fragile state. These critically ill patients are often unable to make their needs known, which can produce an overwhelming feeling of helplessness and fear. The environment can seem threatening and foreign, and patients are often subjected to a multitude of disturbances that can be detrimental to their physical and psychological recovery. Loud noises, diagnostic tests performed at all hours, and poor natural lighting contribute to debilitating delirium and disturbed diurnal rhythms. Loss of privacy and basic human dignity, as well as painful procedures, has been associated with traumatic memories and distress in the post-ICU survivor population. All of these factors have contributed to patients developing ICU-related posttraumatic stress disorder after they leave the hospital. Recently, there has been an increase in awareness regarding this phenomenon within the medical community, which has generated more literature on the topic. Evidence suggests that ICU-related posttraumatic stress disorder can be mitigated. This article proposes the implementation of interventions by critical care health care providers that focus on reducing sleep disturbances, delirium, and benzodiazepine use in ICU patients, thereby improving patient comfort and reducing the severity of posttraumatic stress disorder in ICU survivors.
当患者在重症监护病房(ICU)时,他们处于最脆弱和脆弱的状态。这些重病患者常常无法表达自己的需求,这会产生一种无助和恐惧的压倒性感觉。环境可能看起来具有威胁性和陌生,患者经常会受到许多可能对其身体和心理康复有害的干扰。嘈杂的噪音、不分昼夜进行的诊断测试以及较差的自然光会导致衰弱性谵妄和昼夜节律紊乱。隐私和基本人类尊严的丧失,以及痛苦的程序,与创伤后记忆和 ICU 幸存者的困扰有关。所有这些因素都导致患者在离开医院后患上 ICU 相关创伤后应激障碍。最近,医疗界对这种现象的认识有所提高,这也增加了关于该主题的文献。有证据表明,ICU 相关创伤后应激障碍是可以减轻的。本文提出了由重症监护医疗保健提供者实施的干预措施,重点是减少 ICU 患者的睡眠障碍、谵妄和苯二氮䓬类药物的使用,从而提高患者的舒适度并减轻 ICU 幸存者创伤后应激障碍的严重程度。