December 27, 2011

Depression and Physical Impairment Often Follow ICU Stays

(Ivanhoe Newswire) — Critically ill patients who recover from a fatal syndrome known as acute lung injury commonly emerge with new, long-lasting depressive symptoms and new physical impairments that make daily living difficult, according to this study.

In addition, the study suggests that the depressive symptoms frequently precede the new physical impairments, not the other way around. The research team also said the findings may be applicable to patients with other types of disease or injury who spend time in hospital intensive care units hooked up to ventilators that breathe for them.

"When people are discharged from the ICU, we tend, understandably, to focus on their physical health, but our data tell us we need to focus on their mental health, too," study leader O. Joseph Bienvenu, M.D., Ph.D., an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, was quoted as saying. "Depression can make recovery much more difficult. Identifying depressive symptoms early – and treating them – could make a real difference in how patients fare physically in the long term."

Bienvenu and his colleagues assessed 186 survivors of acute lung injury from four Baltimore hospitals at three, six, 12 and 24 months after they became ill, and surveyed their levels of depression as well as their ability to independently perform important tasks of daily life, such as using the telephone, shopping and preparing food.

The Hopkins team found that 40 percent of the patients developed depressive symptoms in the first two years after discharge even though they had not previously experienced them, and that 66 percent experienced new physical impairments. The average age of patients in the study was 49 years – people who should be in the prime of their lives but became disabled and unable to return to work, the researchers say. The researchers are continuing to follow these patients to see if the problems persist for an even longer period of time.

"Patients are burdened for a very long time after their hospital stays," principal investigator Dale M. Needham, M.D., Ph.D., an associate professor of pulmonary and critical care medicine and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine, was quoted as saying. "We need to figure out what we can do to help these previously productive people get back their lives."

Needham says it is unclear whether it is the acute lung injury syndrome itself causing the new problems or whether the cause is to be found in how patients are routinely cared for in ICUs. Standard ICU care for patients with acute lung injury often includes deep sedation and bed rest. Long stretches of inactivity are known to cause physical impairment, and the use of high-dose benzodiazepines to sedate ICU patients has been associated with depressive symptoms. Needham suspects that both critical illnesses themselves and typical ICU practices contribute to negative outcomes.

Needham says it is important that intensivists like himself, and psychiatrists like Bienvenu work together to ensure the best outcomes for patients, a collaboration that is frequently missing in the care of ICU patients.

SOURCE: American Journal of Respiratory and Critical Care Medicine, published online December 2011