Prospective Evaluation of Psychological Consequences and Impact on Long-term Quality of Life

A stay in intensive care can be seen as a stressful ordeal for a patient's body, both physically and morally. Among patients alive following a stay in intensive care, half have a disabling psychiatric disorder. The main psychiatric disorders described in post-resuscitation are anxiety, depression and post-traumatic stress disorder (PTSD). When one of these disorders is present, there is a 64% chance that it will coexist with one of the other two disorders. These psychological disorders will have an impact on the quality of life and mortality of patients leaving intensive care. Depression is independently associated with an increased risk of further hospitalisation. These different psychological and somatic disorders can be found in the same entity: post-resuscitation syndrome (PRS).

In a context where the proportion of awake patients is growing in our intensive care units, the impact of subjective factors is becoming increasingly important. A stay in intensive care is marked by a stressful environment for the patient at several levels, as well as by care procedures that are often experienced as traumatic (mechanical ventilation, dialysis and invasive procedures). For example, memories of terrifying experiences, often the source of nightmares or hallucinations that persist beyond the hospital stay, encourage the development of PTSD. Similarly, certain environmental factors such as lighting conditions and noise levels can have an impact on patient comfort during their stay in intensive care, confirming the importance of better controlling all external factors that can contribute to stress. Targeted measures centred on an isolated objective, such as reducing thirst, have shown real clinical benefit in terms of patient outcome. Recognition of these sources of discomfort in intensive care and resuscitation units is a first step towards optimising patient comfort. A research team have developed a standardised and validated discomfort score (Discomforts of Patients in Intensive Care, IPREA) that enables several discomforts perceived throughout the intensive care stay to be identified and quantified.

In addition to the psychiatric consequences, the investigators know that patients who survive a stay in intensive care face physical and cognitive consequences for their state of health. PRS is a concept that includes these three dimensions, defined as cognitive dysfunction, acquired physical weakness and altered mental health. It is thought to affect at least 50% of patients. The growing interest in this syndrome is explained by its multi-dimensional aspect, which is representative of patients' long-term quality of life. The potential impact between discomfort in intensive care and long-term psychiatric consequences, or more broadly the occurrence of an PRS, is a central question with an impact on our daily practice. In addition, a bedside assessment using simple tools as part of a psychological follow-up could help to prevent or at least recognise early the factors favouring an PRS.