Improving patients’ wellbeing after a traumatic stay in intensive care 

13/02/2014 00:00 
More than £2 million have been allocated to a pioneering project investigating ways of reducing the rate of post-traumatic stress disorder in intensive care patients.

The project could help thousands of patients in the UK who suffer from anxiety, panic attacks and terrifying hallucinations and delusions during their stay in an intensive care unit (ICU). The serious distress caused by the ICU experience leaves many former patients so psychologically scarred, that both their physical recovery and quality of life are severely impaired.

Part of the money will be used to develop a psychological and educational programme at University College Hospital. Intensive care nurses will be trained to carry out psychological support sessions to help patients cope with the extreme stress of being in the ICU. All staff will learn new skills in caring for distressed and hallucinating patients.

If the pilot shows that the programme is practical and acceptable to nurses and patients alike, the study will be extended to 24 hospitals across the country and tested among nearly 3,000 patients in a randomised controlled trial.

“We hope that patients in the trial whose nurses are specially trained to give them extra psychological support in a calm, low-stress environment, will be much less likely to develop post-traumatic stress disorder or depression in the months after leaving intensive care,” said UCLH psychologist Dorothy Wade.

The study, “Psychological outcomes following a nurse-led Preventative Psychological Intervention for critically ill patients” (known as POPPI for short), a collaboration between the Intensive Care National Audit & Research Centre (ICNARC), UCLH and the London School of Hygiene & Tropical Medicine, is to be carried out by Dr Wade in partnership with ICNARC director Professor Kathy Rowan.

Dr Wade said: “The POPPI trial is an exciting milestone for us, as no large-scale studies of psychological treatments started in the ICU to prevent future PTSD have ever been carried out.”

UCLH director for critical care David Howell, who is also a study co-investigator, said: “As would be expected, our multidisciplinary team on the ICU focuses on saving lives and ensuring that patients recover physically. However, we are also passionate about patients making a full psychological recovery so that they can look forward to a good quality of life after their stay in intensive care.”

The research grant has been awarded by the National Institute of Health Research, as part of its Health Services and Delivery Research (HSDR) programme, to ICNARC with extra funding from the NIHR University College London Hospitals Biomedical Research Centre to the team of researchers from UCLH.

The POPPI study is the culmination of recent work by Dr Wade and colleagues which looked at the excessively high rates of post-traumatic stress disorder and depression suffered by former intensive care patients. A 2012 study showed that more than 50% of surviving patients suffered from clinical levels of PTSD, depression or anxiety symptoms.

The 2012 study was followed by a systematic review in 2013 which showed that clinical factors including the use of benzodiazepine drugs to sedate patients on breathing machines, and the number of highly invasive treatments patients received, increased the risk of suffering PTSD after Intensive care.

However the strongest risk factors of all were high stress and disturbed mood during the patient’s intensive care stay. A further study (under review) showed how patients with post-ICU PTSD suffered from flashbacks of disturbing hallucinations and delusions they had while in intensive care.

Building on this, Dr Wade and colleagues then created the intensive care psychological assessment tool (IPAT) to detect patients who were most distressed in ICU, (including having terrifying hallucinations), and who were most at risk of developing PTSD. The IPAT will be used to identify the patients who need most psychological support from nurses in the POPPI trial.

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