Stressors and Open ICU

The memory of the clinical course in the ICU holds often –for critically ill patients at high risk- a great importance long after healing; it often changes radically the world’s view, values and expectations. The presence of annoying or even disquieting memories, tied to specific stressing factors of the ICU, has been widely described in international literature.

Pain, sleep deprivation, thirst, the presence of tubes in the mouth or nose, the inability to move freely, the inability to speak and to communicate needs adequately, the absence of loved ones are often reported among the most important memories. Some of these stressing factors are potentially preventable and treatable. Therefore – as ICU’s operators - we have the duty to know these problems and to avoide them to become an intolerable burden for our patients, both during the course of critical once and the discharged from ICU.

In order to investigate – and then correct - the possible causes of patients' stress, family members can give us significant help . They know the patient’s experience and can bring valuable informations about his medical history; in addition, if properly motivated and driven, they can be valuable intermediaries in the communication between patients and operators. The “opennes” of ICU has a solid foundation in improving neurologic outcome for both patient and family members, and it presents no additional risks (i.e. infection’s risk) as long as they respect the elementary rules such as washing hands.

The presence of family during critically phases can be as important as psychological support, reassurance of the patient, “preventive therapy” to the possible development of psychiatric profiles after discharge form the ICU. The resolution of organizational (opening time and ways) and logistic (flow of relatives, other patients’ privacy observance) problems must necessarily be actuated locally at each hospital. It is important to consider the presence of relative as a kind of resource and not as an additional workload for operators; it is sufficient to do an experiment in two weeks, leaving the door a little more open, to verify the relatives do not come to watch and judge the work of doctors and nurses. On the contrary, they are more often impressed by the cares provided, and reassured by the attention sourrounding their loved ones, in some cases up to become a resource also for patient’s treatment.

CCM 2001 Nelson - ICU experiences oncology patients

CCM 2002 Rotondi - ICU patients stressfull experiences

ICM 1997 Novaes - Stressors in ICU patients evaluation

ICM 1999 Novaes - Stressors preceived by patients, relatives, and health care team

ICM 2008 Giannini - Policies Italian ICU nationwide survey

MA 2007 Giannini - Review on the Open ICU

MA 2010 Giannini - Editorial on the Open ICU