ICU Syndrome: Managing Anxiety After Surgery for Peritonitis

Gastric perforation leading to peritonitis?

Hello, Doctor: My father was hospitalized due to a gastric perforation that led to peritonitis and underwent surgery.
He has a history of heart disease and is quite elderly.
For the first three days after the surgery, his condition was relatively stable.
However, on the fourth day during our visit, he suddenly became agitated, and his heart rate spiked to 170.
It took the administration of a sedative by the medical staff to stabilize his emotions.
During this process, he repeatedly expressed a desire to transfer to another hospital and even attempted to remove his tubes.
I would like to ask if this is what is referred to as "ICU syndrome"? If we continue to administer low doses of sedatives, will it affect his wound healing or heart condition? What can we, as family members, do to help the patient? Thank you, Doctor!

Cai Xiaojie, 20~29 year old female. Ask Date: 2010/12/27

Dr. Huang Zhihui reply Surgery

It may still be necessary to assess clinical symptoms, and if needed, a consultation with a psychiatrist should be arranged.
If there is a suspicion of cardiac issues, a consultation with a cardiologist can be considered.

Reply Date: 2010/12/27

More Info

Understanding ICU Syndrome, often referred to as ICU psychosis or delirium, is crucial for managing patients who have undergone significant surgeries, such as those for peritonitis. Your father's situation, where he experienced sudden agitation and elevated heart rate after surgery, is not uncommon in ICU settings, especially for older patients or those with pre-existing health conditions like heart disease.

ICU Syndrome can manifest as confusion, agitation, hallucinations, or even a desire to remove medical devices, as you've described. This condition is often exacerbated by factors such as the stress of hospitalization, the effects of anesthesia, pain medications, sleep deprivation, and the unfamiliar environment of the ICU. The emotional and psychological toll of being in an intensive care unit can lead to heightened anxiety and distress, which may explain your father's behavior.

Regarding the use of sedatives, while they can be effective in managing acute agitation and anxiety, there are potential downsides. Continuous administration of sedatives can lead to prolonged sedation, which may interfere with recovery by delaying mobilization and rehabilitation efforts. Additionally, in patients with heart conditions, certain sedatives can affect cardiovascular stability, so careful monitoring is essential. It's crucial for the medical team to strike a balance between managing anxiety and ensuring that the patient remains alert enough to participate in their recovery process.

As family members, there are several ways you can support your father during this challenging time:
1. Communication: Speak to him in a calm and reassuring manner. Familiar voices can provide comfort and help ground him in reality. Explain what is happening in simple terms, as confusion can be heightened in ICU settings.

2. Familiarity: Bring personal items from home, such as photographs or a favorite blanket. Familiar objects can help reduce anxiety and create a sense of normalcy.

3. Encourage Rest: Help him maintain a regular sleep schedule as much as possible. Reducing noise and ensuring a comfortable environment can aid in better rest.

4. Advocate for Care: Stay in close communication with the healthcare team. If you notice any changes in his condition or behavior, bring them to the attention of the nurses and doctors. They can adjust medications or provide additional support as needed.

5. Involve in Care: If appropriate, encourage him to participate in his care. Simple tasks, like moving his limbs or taking deep breaths, can empower him and reduce feelings of helplessness.

6. Monitor for Changes: Keep an eye on his emotional and physical state. If you notice persistent agitation or other concerning symptoms, discuss these with the medical team. They may need to reassess his medications or consider alternative interventions.

7. Educate Yourself: Understanding ICU Syndrome and its implications can help you manage your expectations and provide better support. Knowledge about the condition can also help you communicate effectively with healthcare providers.

In conclusion, ICU Syndrome is a significant concern for patients recovering from major surgeries, particularly in older adults or those with pre-existing conditions. While sedatives can help manage acute symptoms, they must be used judiciously to avoid hindering recovery. Your role as a supportive family member is vital in helping your father navigate this challenging time, and open communication with the healthcare team will be essential in ensuring he receives the best possible care.

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