The accident occurred on November 16 in Pittsburgh. Joseph Masterson, a lawyer who was about to retire at the age of 63, suffered a cardiac arrest while driving, crashed into a guardrail, and was knocked unconscious.
Other drivers stopped, broke the car window and pulled him out safely. A passing volunteer firefighter performed CPR until an ambulance arrived to take Masterson to UPMC Mercy Hospital.
He spent 18 days in the medical intensive care unit there, 14 of which were on a ventilator. He developed delirium, a common ICU condition, and required antipsychotic medications. Despite the feeding tube, he lost weight. His brother-in-law Ron Dedes said, “To be honest, we weren’t sure he was going to win.”
But he did it. Masterson was discharged on February 1 and returned home with almost constant family support. Working diligently with a variety of therapists, he has regained the ability to walk and manage his personal care despite long-standing weakness. There has been significant improvement in his once spoken speech. He can make himself a sandwich.
Now, “our biggest concern is his memory,” Dedes said. Masterson, who has recently handled complex legal cases, tends to forget conversations and events that occurred just hours earlier, said his sister, Patty Dedes. He can’t operate a microwave or make phone calls yet.
In an interview, he described himself, accurately, as “much, much better than me” – but misreported his age. Screening tests after his discharge indicated cognitive impairment and depression.
Among critical care doctors, long-lasting symptoms like his are known as “post-intensive care syndrome” or PICS. The consequences can be physical or psychological, as well as cognitive, and can last for months or years.
more than this 5 million people annually Nearly 5,000 Americans are admitted to intensive care in hospitals, and research shows More than half of people experience such side effects. The chances increase with increasing age.
Patients and families are often shocked by these continuing difficulties. “The belief is that he will be released from the hospital and in two or three weeks, he will be back to normal,” said Brad Butcher, who was Masterson’s doctor and Wrote about PICS recently In the medical journal JAMA. “It doesn’t match reality.”
In fact, with greater ICU utilization and better treatment – the Society of Critical Care Medicine estimates 70% to 90% of adults are now alive The population likely to face their migration syndrome is increasing.
“Everyone is grateful that the patient survived,” said Lauren Ferrante, a pulmonary critical-care doctor and researcher at Yale School of Medicine. “But this is just the beginning of a long road to recovery.” In a study of patients aged 70 and older, which he co-authored, only half the patients were cured within six months after discharge His pre-ICU functional abilities returned.
Intensive care patients face a long list of challenges. PICS symptoms from physical to – Weakness, pain, neuropathy (tingling in the hands and feet), and malnutrition – to mental health concernsMainly anxiety and depression. cognitive difficulties Problems like Masterson’s are common, including problems with memory, attention and concentration, and language.
“For many people, surviving a serious illness is a life-changing experience,” Butcher said. Also patients in intensive care after emergency or elective surgery have higher rates New physical, mental and cognitive problems after a year.
The same aggressive treatments that save lives contribute to the syndrome. Carla Sevin, a pulmonary critical-care doctor who directs the ICU Recovery Center at Vanderbilt University Medical Center, explained that intensive care patients have “some type of dramatic organ failure that requires immediate attention” and requires constant monitoring.
This may mean a breathing tube attached to a ventilator, which in turn often requires sedation. Sedation “can aggravate delirium, and delirium is a major factor in cognitive symptoms,” Butcher said.
It doesn’t help that the constant beeps and alarms from monitors and the 24-hour bright lights disrupt sleep, and the restrictive family visiting hours deprive patients of reassuring faces and voices.
Gregory Matthews, a retired accountant in St. Petersburg, Florida, spent nearly a month in the ICU after a lung transplant in 2014. He still remembers his hallucinations, including rats running on the wall and someone trying to trap him for drugs.
Matthews, now 80, said, “One day, I thought a doctor was a killer – I could see a rifle.” The staff restrained his arms for several days.
But immobilization has its effects as patients quickly lose muscle and strength. “Our bodies are not meant to lie in bed all day,” Ferrante said.
Psychologically, “PTSD is very common, as seen in war veterans or survivors of sexual assault,” Sevin said, referring to post-traumatic stress disorder. Patients as well as families may suffer from anxiety and depression.
Concerned by such discoveries, doctors and administrators from about 35 US hospitals have founded Post-ICU ClinicWhere teams of doctors, nurses, pharmacists, therapists (physical, occupational, cognitive, speech) and social workers examine a range of conditions and help guide patients through them.
Vanderbilt’s clinic saw its first patient in 2012. The Critical Illness Recovery Center at the University of Pittsburgh Medical Center, which Butcher founded in 2018, works with about 100 patients a year, including Masterson. Yale opens its clinic in 2022.
They rely on six practices recommended by the Society of Critical Care Medicine that have been shown Reduces post-ICU symptoms to a great extent. These measures include using lighter sedation, lifting and moving patients earlier, checking their breathing daily to wean them off the ventilator early, and removing restrictions on family visits.
Clinics often offer support groups for patients and families. There is evidence that keeping an ICU diary, in which patients and caregivers record their experiences, and engaging in exercise and physical rehabilitation improve mental health After discharge.
Also on the clinic’s agenda: a discussion of what other options patients might prefer if they faced another serious illness, as many do. Would they agree to undergo intensive care and risk its side effects again? Or choose palliative care, which emphasizes comfort rather than cure? Some ICU patients remain permanently disabled.
Butcher, although he said the use of new practices needs to be dramatically expanded, seemed optimistic about the future of critical care. “We’re going to find better diagnostic tools, better preventive strategies and better treatments,” he said.
However, for now, the ICU experience remains disorienting and sometimes painful. When Butcher asked follow-up questions to 117 patients in his post-ICU clinic, many wanted to place limits on further medical interventions.
About a third would like to reduce the level of invasive care. Of those, about a quarter would like “do not resuscitate” and “do not intubate” orders, and about 7% said they would never want to go back to the ICU.
Masterson is working hard to further his recovery. “I haven’t gone out much,” he said. “I’ve been kind of homebound.” He hopes to get strong enough to resume running — he used to run 3 to 4 miles several times a week.
The future of patients suffering post-ICU syndrome often depends on their physical, mental and cognitive health prior to their admission. Masterson’s previous fitness and cognitively demanding work bode well for his further progress, Butcher said.
His family is still hopeful and worried. “Down the road, what’s it going to be like?” Dedes, his brother-in-law, was surprised. “We take it day by day.”
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