“Surviving” the ICU: A Perspective from Both Sides of the Bed · “Surviving” the ICU: A...
Transcript of “Surviving” the ICU: A Perspective from Both Sides of the Bed · “Surviving” the ICU: A...
“Surviving” the ICU: A Perspective from Both Sides of the Bed
Alison S. Clay, MD, FCCP Assistant Dean for Clinical Education
Duke University of School of Medicine
Departments of Surgery and Medicine
https://www.recordnations.com/wp-content/uploads/2015/04/two-viewpoints.jpg (accessed 4/8/2017)
Disclosures
• I have no conflicts of interest to report • I speak as a patient with chronic illness, not as faculty from Duke • I have used, with citation, photographs or pictures from many
webpages, including photos from some medical company websites. • I do not endorse any of the products pictured in these photos.
http://genelu.com/2010/11/word-up-thesis-concept-no-2/ (Gene Lu, 12/18/2013)
Context: About Me
Curiosity
http://www.cannockchasedc.gov.uk/site/custom_scripts/HeritageTrail/images/museum_cannock/scott.jpg
Context: About Me
Patients with Chronic Illness
Detailed View of Oxidative Phosphorylation (reprinted with permission from Kanehisa Laboratories and the KEGG project: www.kegg.org ); http://employees.csbsju.edu/hjakubowski/classes/ch331/oxphos/olcouplingoxphos.html (12/18/2013)
Context: About Me
Biochemical Basis of my Illness
LACTATE
http://www.bioinfo.org.cn/book/biochemistry/chapt15/bio4.htm (12/18/2013)
Context: About Me
Biochemical Basis of my Illness
http://en.wikipedia.org/wiki/Tracheal_intubation (Philipp, N, accessed 12/18/2013)
Context: About Me
Consequences of Biochemistry
• >50 Intubations • A tracheostomy • CLABSI:
• Staph Epi • MRSA • Candida
• VAP with Septic Shock/ARDS
• DVT
https://miscetceteradotcom.files.wordpress.com/2014/04/invisible_disability_stickers-r449f8209b2e24f9e99cbbfda6d03ece2_v9i40_8byvr_324.jpg
Mistrust
Context: About Me
Consequences of Biochemistry
http://www.kstoolkit.org/file/view/storytelling.gif/33222395/363x262/storytelling.gif (accessed 4/1/17)
Problems with Care in the ICU
Storytelling
Problems with Care in the ICU
One ICU Admission: A Journey
http://www.aime.com/flashbpic/201401/201401200034252066.jpg(accessed 4/2/2017)
http://saplingstories.blogspot.com/2013/12/my-new-dragonfly-friend-aka-port-huber.html (accessed 4/2/2017)
http://commons.wikimedia.org/wiki/File:Bag_Valve_Mask_(AMBU_-_bag).jpg (Creative Commons Usage, accessed 12/18/2013)
Problems with Care in the ICU
Readmission with Intubation
http://www.tracheostomy.com/care/suction.htm (Bard Medical Division, accessed2/18/2013)
Problems with Care in the ICU
Mechanical Ventilation
Reprinted with Permission Cartoon Stock
Problems with Care in the ICU
Restraints
http://www.rehabmart.com/imagesfromrd/PO-2528%20Posey%20Double%20Strap%20Foam%20Limb%20Holder_Patient%20Restraints.jpg (accessed 4/1/2017)
http://www.vitalitymedical.com/media/extendware/ewimageopt/media/inline/1a/6/posey-double-padded-double-security-mitts-ce4.jpg (accessed 4/1/2017)
Problems with Care in the ICU
My Restraints
Intensive Care Medicine 2013; 39:31-37
0
20
40
60
80
100
% of Patients Duration of Use
>75%50-75%25-50%<25%
% of French ICUs Reporting Restraint Use
Problems with Care in the ICU
Restraint Prevalence
http://www.listerhospital.com.gh/images/visiting_hours.jpg (accessed 8/14/2014)
Problems with Care in the ICU
Isolation
0102030405060708090
Visiting Hours VisitationDuration
VisitorNumber
ImmediateFamily
Members
Age limitations
Critical Care 2013; 17: R71
Problems with Care in the ICU
Isolation: Visiting Hour Restrictions
http://www.atitesting.com/ati_next_gen/skillsmodules/content/nasogastric-intubation/images/NG_salem_sump.jpg (accessed 3/31/2015)
Problems with Care in the ICU
Painful Procedures
http://img15.deviantart.net/b83a/i/2004/145/9/e/bloody_nose.jpg (Accessed 3/31/2015)
Problems with Care in the ICU
Painful Procedures while Restrained
https://loretob1group2.files.wordpress.com/2012/09/paranoia1.png (accessed 9/2/2014)
Problems with Care in the ICU
Paranoia
http://www.faecdn.com/bex/manual/i/CAD_4I-fixed.gif (accessed 4/2/2017)
Problems with Care in the ICU
Paranoia
1Heart & Lung: The Journal of Acute and Critical Care, 2014; 43(5): 427-431 2Johns Hopkins Medicine, February 26, 2013 http://www.hopkinsmedicine.org/news/media/releases/ptsd_symptoms_common_among_icu_survivors
Held as a Prisoner1
“I’d wake up…well like somebody is holding your head underwater or strangulating [you]”
“I was locked up…and every time I tried to get out, that person would try and stick me with a pitchfork”
Being Drowned1
Rape/Assault2
Problems with Care in the ICU
Themes of Paranoia experience by Patients
50 dB 75 dB 104 dB
Critical Care 2009; 13 (2): 208
http://www.clker.com/cliparts/z/U/G/l/B/3/blow-dryer-hi.png (Creative Commons Usage, 12/18/2013)
http://www.clker.com/cliparts/5/b/b/7/11954217391761912368Machovka_Power-saw.svg.hi.png (Creative Commons Usage, 12/18/2013)
Problems with Care in the ICU
Noise
http://livelovefruit.com/wp-content/uploads/2014/11/AR-403130303.jpg (accessed 4/1/2017)
Problems with Care in the ICU
Sleep Deprivation: Delirium, Drugs
1. Common Complaints of Patients in ICU 2. Sleep fragmentation occurs, even when appear to
be sleeping 3. Sleep Deprivation and Delirium look similar in the
Brain (neurohormonal/chemical) 4. Sleep Deprivation and Delirium provoke each other
Critical Care 2009 13:234 http://www.ccforum.com/content/13/6/234
Problems with Care in the ICU
Consequences of Sleep Deprivation
http://www.thisoldhouse.com/toh/how-to/intro/0,,20562442,00.htm (Kolin Smith, This Old House Magazine, Accessed 12/18/2013)
Problems with Care in the ICU
Transitions to Home
http://well.blogs.nytimes.com/2009/12/01/why-loneliness-can-be-contagious/?_r=0 (Vetta Collection, New York Times Magazine, December 1, 2009, Accessed 12/18/2013)
Problems with Care in the ICU
Transitions to Home: Loneliness
http://blackburnnews.com/wp-content/uploads/2012/08/thunderstorm.jpg (Josh Boyce, Blackburn News, Accessed 12/18/2013)
Problems with Care in the ICU
Transitions to Home: PTSD
“ICU stays lead to Alzheimer’s like
problems in one-third of patients s”- CBS
News
“Extended ICU Stays cause brain damage”-
USA Today
“Delirium in the ICU was independently associated with a
longer post-ICU stay, fewer median days alive and without mechanical ventilation and a higher incidence
of cognitive impairment at hospital discharge.”-Ely et al, JAMA 2004
Problems with Care in the ICU
Transitions to Home: Cognitive Dysfunction