Shock and Awe ! Going back to "Normal'
00:02
[Ken] Being in the ICU, the things that are very vivid to me, is, one, being stuck in the bed, you just couldn't move, you couldn't get comfortable. And you’re not really there, because of the drugs you're on, and you can't sleep. But the noise, the noise is constant. And you think, well, okay, you get used to the beep beep. No, that beep beep just literally starts drilling into your head. My name is Ken Foltz, I'm from Pittsburgh, Pennsylvania.
00:33
I’m 52 years old. I'm an attorney. Or at least I used to be an attorney. Haven't been for a couple of years due to my disability. Yeah, that's that's who I am. [Narrator] In 2020, Ken developed sepsis from necrotizing pancreatitis, which put him in the ICU for three months. Unfortunately, Ken had multiple ICU admissions after this. Each stay eroded his physical and mental health.
00:59
Even when he was finally well enough to go home, Ken felt far from recovering his old life. [Melissa] Whenever he first got home, he he was very, very skinny. He didn't. He lost a lot of his muscle mass. Pretty much had to learn how to walk again. And we did stairs at home. And then he has all these wires and cords going everywhere. Sometimes he would get paralyzed to move, in fear of moving and causing himself harm.
01:26
It's how many years after the fact now. And I think he just started to be able to try to sleep on his side, because he just got in such a habit of not moving. Being afraid to move to sleep is, is a pretty, not a good place to be. [Narrator] Being afraid to move when sleeping is just one example of how the ICU stays affected Ken long-term. Lasting impairments after ICU discharge are not uncommon among survivors. These impairments are collectively known as post-intensive care syndrome, or PICS.
01:58
The three classic domains of PICS are physical, cognitive, and mental health. Physical symptoms among ICU survivors could be fatigue or impaired strength. Cognitive symptoms could be difficulties with executive function, memory, or attention. Common mental health impairments might include depression, anxiety, or PTSD. But PICS can really affect every part of a person's life. People with PICS may struggle with activities of daily living like bathing or walking. They may have trouble going back to work or maintaining social relationships.
02:27
And PICS can affect caregivers too, especially in terms of psychological symptoms. This is known as PICS-F or PICS-Family. Dr Brad Butcher sees a lot of patients with PICS. He's a critical care doctor and also leads a post-ICU clinic at the University of Pittsburgh, commonly known as CIRC, where he met and worked with Ken. [Dr Butcher] One thing that I think is important to point out is that the people who coined the term PICS never meant for it to be considered a medical diagnosis, per se.
02:54
It was really meant to be a tool to raise awareness. And since the term was coined, you can look at the number of papers that use the term post-intensive care syndrome. And it's rising exponentially. [Narrator] To patients, even though PICS is not a diagnosis, many people still find it helpful to have a name for their post-ICU experiences. [Ken] One of the things working with the folks at CIRC early on, that was so incredibly helpful for me, was literally them explaining to me what PICS was. Because before I had no idea.
03:23
Like, is this normal? Is this not normal? Then I understood, well, no, this is what happens. That would have been extremely helpful to know, the, like, that I wasn't failing. I wasn't the one that was being weak or why, you know, suck it up. It's like, no no no, that's, that's the wrong. This is, I'm not going to go back to being the person I was. That's just not reality. [Dr Butcher] So I think many people will leave the intensive care unit and leave the hospital thinking, within a couple of weeks I'm going to be back to my old self.
03:56
And, unfortunately, for many patients, that's just not the reality of the situation. And, sadly, the literature would tell us that most intensivists never spend time talking about what life might look like once the patient leaves the hospital. [Narrator] This is surprising, since PICS is not a rare experience. Estimates vary, but the prevalence of PICS was 54% in a recent meta-analysis. Given how high this prevalence is, what causes PICS? [Dr Butcher] To be honest, we're still working out the pathophysiology of post-intensive care syndrome.
04:27
But it almost certainly has to do with a combination of the disease process that led the person to intensive care in the first place and what I like to call the hazards of hospitalization. [Dr McPeake] We’re much more conscious of what we're doing in intensive care now. And we're trying to be more person-centered. But there's some things we're never going to get away from. [Narrator] This is Dr Jo McPeake. In addition to being a researcher, she also spent almost 20 years as an ICU nurse.
04:51
[Dr McPeake] Some of the medicines that we use in intensive care, for example, can cause some of the longer-term problems. But this environment of intensive care as well you know, lots of lights, lots of noise, poor sleep patterns. And it’s the shock often of what's happened to a person. So, for a lot patients it’s completely unexpected. And it disrupts their entire world. [Ken] You don't really know what's happening to you.
05:18
Because you're sedated, you're drugged. But you do know the physical things that are there, all the stuff stuck in my body that I could feel every time I would move. So it was like, okay, I'm going to try to lay here as still as possible, but then you're laying there still and you're stuck, and you're getting hit with the sounds, the noise, and the smells, which I don't even probably want to even delve into. [Melissa] The hardest thing, like, being there in the ICU, being there and witnessing the stuff his body had to endure.
05:51
I've been in therapy for quite a few years now, before I was on my own, for my own issues, but getting involved with therapy to help him deal with his new reality, because the person that went into the hospital has never come home. Yeah. It's been a journey. [Narrator] Most often, ICU survivors receive care in the primary care setting after discharge. Ken was able to receive specialized care in a post-ICU clinic. These clinics started in the UK around 30 to 40 years ago and are growing in numbers worldwide.
06:26
Dr McPeake has helped to start many post-ICU clinics throughout Scotland. [Dr McPeake] We worked with patients and family members and clinicians for about a year. We spent a lot of time really understanding the problems that patients faced, why they faced them, what would be acceptable in terms of an intervention. We piloted a program integrating health care, so all the traditional things like physiotherapy, medical staff, and we also integrated social support from local organizations, a pharmacist, and peer support.
07:03
[Narrator] At CIRC, where Doctor Butcher worked with Ken, patients are seen for roughly a year, although this varies. [Clinician] So this clinic is for anybody who has spent time in the ICU. [Narrator] This is Ida. She's at CIRC for her first appointment, which at this clinic is about 2 to 3 hours long. [Dr Butcher] And you're warned that this is probably the longest doctor's appointment that you will have ever had and will likely ever have in your life. And you're going to see a whole lot of people. [Narrator] The clinicians that patients see could include respiratory therapists and speech therapists, especially if the patient has been intubated, physical therapists to work on strength, occupational therapists, cognitive therapists, pharmacists, dieticians, and social workers.
07:42
Patients might also meet with critical care physicians to help understand what happened to them in the ICU. Many ICU survivors report feeling that post-ICU clinics greatly benefit their recovery. But despite this, there's very little medical literature to support these benefits. [Dr McPeake] I think there's a number of reasons for that. I think it's, you know, sometimes perhaps the outcomes that we're using aren't maybe the right outcomes.
08:05
But I also think it's about the timing of the intervention, the dose of the intervention. We we still have a lot of learning to do round about that. We need to do much more about which patients will benefit most from services and at what point that they will benefit in their journey. [Melissa] She’s been a good girl, get her over to the park so she can run. [Ken] Want some tea? [Melissa] Yes, please. [Narrator] Ken started going to CIRC after his first ICU stay, and he has returned after each subsequent hospitalization.
08:40
His health is much recovered now, and he has officially graduated from needing more surgery. Ken and Melissa recently took a vacation to celebrate his good health. Doctors Butcher and McPeake say that seeing a patient recover after an ICU stay is also incredibly fulfilling for clinicians. [Dr McPeake] As an intensive care nurse for the best part of 20 years, that's a really tough job. And there is nothing that brings a smile to an ICU nurse's face when a patient walks back in months later, and they come back in with their family.
No comments:
Post a Comment