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Why a stay in the ICU can leave patients worse off

June 16, 2017 at 6:30 PM EDT
Almost 6 million patients land in an intensive care unit every year, and for many, it marks a turning point in their lives. A substantial number of patients leave the ICU with newly acquired problems, from dementia to nerve disease. Medical leaders have developed new standards to reduce the use of drugs and get patients moving, but adoption has been slow. Special correspondent Jackie Judd reports.
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JUDY WOODRUFF: More than six million Americans are admitted into hospital intensive care units, or ICUs, each year. Undoubtedly, they are a crucial component of the health care system for treating seriously ill patients and preventing deaths.

But some patients also eventually leave the ICU with new complications and problems.

Special correspondent Jackie Judd looks at those concerns and an effort to make sure patients are getting the right interventions.

WOMAN: Well, as soon as we get this ultrasound done, we are going to get your lights on and your windows open, OK?

JACKIE JUDD: Every year, almost six million patients land in an intensive care unit, and, through often heroic efforts, lives are saved.

For many of those survivors, that period of time becomes a bright line in their lives of before and after.

PAUL TURPIN, Was Admitted to ICU: I am very aware that I am not the same person who went into the hospital with sepsis. I am just not.

JACKIE JUDD: In what ways?

PAUL TURPIN: Well, my personality. I’m shorter-tempered, mood change, mild depression.

JACKIE JUDD: Paul Turpin, an endocrinologist who lives outside of Nashville with his wife, Mary Lou, spent a month in an ICU. That was two-and-a-half years ago.

Richard Langford’s first ICU stay was a decade ago, and he has not lived on his own since.

RICHARD LANGFORD: Mom is the one who takes care of me. Now, my mother is 88 years old.

JACKIE JUDD: Psychologist Jim Jackson leads this support group, and is part of a team at Vanderbilt University Medical Center that helped identify a constellation of symptoms mimicking PTSD, post-traumatic stress disorder. They call it post-intensive care syndrome, or PICS.

JIM JACKSON, Vanderbilt University Medical Center: They don’t have a traumatic experience in the way that a combat veteran or a rape survivor would, so they’re not referred to a mental health professional. They really fall through the cracks. With all of these gaps, there just is a lack of awareness.

How do you feel?

JACKIE JUDD: Dr. Wes Ely has studied this phenomenon for almost 20 years. He says the risk factors are clear: powerful sedatives and prolonged use of ventilators, which can trigger delirium. Some ICU patients need those interventions, but not all of them do.

DR. WES ELY, Vanderbilt University Medical Center: We had to tie people down, so they wouldn’t pull lines and tubes out, but we also chemically restrained them with these deep sedatives. So we got comfortable pummeling people’s brains with gargantuan amounts of benzodiazepines, propofol, and other types of sedation.

We put them in this cocoon, but it wasn’t a safe one. And when we started measuring delirium, and then started measuring physical immobility, it unveiled this issue of PICS.

WOMAN: Hi, sweetie. Can you open your eyes?

JACKIE JUDD: A substantial number of patients leave the ICU with newly-acquired problems, ranging from dementia, to depression, to muscle and nerve disease.

Dr. Ely has been following some of them for six years, and will soon release a study. Preliminary data show one-third of patients improve and get back to normal cognitive and functioning levels. One-third remain the same as the day they left the hospital. And one-third decline even further.

WOMAN: We should talk about whether we should move the tube to the neck, OK, because that will allow us to decrease the amount of sedation that you’re on.

JACKIE JUDD: So, leaders in acute care developed a different ICU treatment. When possible, they keep patients out of the cocoon by reducing the use of drugs and ventilators, and by getting patients moving.

WES ELY: Turning off of sedation every day and turning off the ventilator every day gets people out of the hospital sooner, it decreases cost of care and it helps improve survival.

JACKIE JUDD: Hospitals across the country have been slow to adopt the practices in use here at Vanderbilt. It’s been more than four years since the Society of Critical Care Medicine issued new treatment guidelines for controlling pain and delirium in the ICU, and, yet today, the organization describes compliance as mediocre.

MAN: We’re going to get you every day up as much as we can, OK?

JACKIE JUDD: Coaxing patients out of bed to exercise takes a lot more staff time than sedating them. And getting doctors to change what has long been done is hard.

WES ELY: A lot of it has to do with people in long white coats, the doctors. The doctors are used to how they do things. They don’t want to be told to do it a different way, and they’re late adopters.

We have early adopters in life, and we have late adopters, and the doctors think, well, this is an invisible problem. I don’t see it. I don’t see it as an issue anyway. They can’t even necessarily envision what it is that could happen so much better.

JACKIE JUDD: Vanderbilt used to release patients from the ICU with no follow-up. Now it is one of a handful of hospitals with post-ICU clinics. It’s a way station for patients at risk.

The goal is to be a bridge to a medical world with little awareness of the syndrome.

Dr. Carla Sevin is one of the founders.

DR. CARLA SEVIN, Vanderbilt University Medical Center: The main purpose of the clinic is to sort of bridge this million-dollar intensive care time to this outpatient status, which is not set up to take care of the multipronged problems that people experience after the ICU.

RICHARD LANGFORD: That might be permanent.

JACKIE JUDD: The clinic also organizes the support group where Richard Langford is a regular.

RICHARD LANGFORD: It helps give me a structure for why I’m feeling the way I do, and that I’m not going crazy. This anxiety, it is — is not something that will kill me. It’s not something that I have to worry about, and keep worrying about worrying about worrying.

PAUL TURPIN: Thank you, lord, for this nice day.

JACKIE JUDD: As for Paul Turpin, he is happily back practicing medicine, and still managing emotional ups and downs, including a lingering sense of terror, which is common among ICU patients.

PAUL TURPIN: Fear of ever being in an ICU.

JACKIE JUDD: What is that fear rooted in?

PAUL TURPIN: Being back in those circumstances, being out of control, being wrapped up in that cocoon.

JACKIE JUDD: Is it what you fear the most in your life at the moment?

PAUL TURPIN: Probably.

WES ELY: You know, you’re an inspiration to us.

JACKIE JUDD: Dr. Ely, who travels worldwide to spread the word about PICS, says he senses a momentum to shift ICU care in order to reduce the harm it can cause.

WES ELY: People were built to be vertical and moving around, not lying in a bed 24/7. So we’re trying to get back to the humanness of critical care.

JACKIE JUDD: Even so, he predicts it will be at least five years before what happens in this ICU becomes the norm for patients being treated at the most vulnerable and frightening time of their lives.

For the PBS NewsHour, I’m Jackie Judd in Nashville, Tennessee.

Editor’s Note: The number of Americans admitted into hospital intensive care units each year is six million, not five million as was previously reported.

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