Physical, psychological and cognitive problems during and after critical illness and intensive care
Many intensive care unit patients leave the Intensive Care Unit (ICU) with significant physical weakness and with memories of pain, stress and delusions. A significant proportion of these patients will suffer from physical disability, psychological distress and cognitive problems several weeks-months after the ICU stay.
The main focus of the research group is to study the extent of these morbidities in a mixed ICU population, to link ongoing in-ICU problems and comorbidities with later morbidity, and to find methods to prevent early and late post-ICU problems in ICU survivors.
Ongoing research projects include inhaled sedation studies, acute stress detection with skin conductance variability, prediction of physical and psychological problems after ICU stay and cognitive function after sepsis and delirium.
ICU survivors have a significant burden of illness remaining after ICU discharge. Understanding the epidemiology and spectrum of problems and how to predict and treat them is important. In the future, this knowledge can aid clinicians to better identify risk patients and reduce late sequelae as well as improve clinically important functions and well-being in ICU survivors.
| Group members | |
|---|---|
| Peter Sackey | MD, PhD |
| Matteo Bottai | Professor of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet |
| Anders Öwall | Associate Professor of Anesthesiology and Intensive Care Medicine. Senior Consultant in Anesthesiology and Intensive Care Medicine. Department of Cardiothoracic Surgery, Karolinska University Hospital |
| Claes-Roland Martling | Associate Professor of Anesthesiology and Intensive Care Medicine. Department of Physiology and Pharmacology, Karolinska Institutet |
| Jan Hellström | MD, PhD. Specialist in Anesthesiology and Intensive Care Medicine. Department of Cardiothoracic Surgery, Karolinska University Hospital |
| Anna Schand | lRN, PhD. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital. Department of Physiology and Pharmacology, Karolinska Institutet |
| Anders Günther | MD, doctoral student. Specialist in Anesthesiology and Intensive Care Medicine, Department of Cardiothoracic Surgery, Karolinska University Hospital |
| Emily Brück | MD, doctoral student. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital |
| Anna Milton | MD, doctoral student. Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital |
| Elisabeth Hellgren | RN, Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital |
| Örjan Sundin | Professor of Clinical Psychology, Mid University Östersund |
Projects
Inhaled anesthetic agents in cardiac patients (PhD project, Jan Hellström)
The project aims at investigating inhaled anesthetic agents (sevoflurane and isoflurane) as sedatives in mechanically ventilated cardiothoracic patients. The main questions posed in the project are:
- Does sevoflurane after coronary artery bypass grafting (CABG) provide better cardiac protection than propofol?
- Is sevoflurane after coronary artery bypass grafting (CABG) a feasible and potentially better sedative option than propofol?
- Is isoflurane sedation feasible and suitable during therapeutic hypothermia in patients resuscitated after cardiac arrest?
- Is sevoflurane administration via the AnaConDa for ICU sedation environmentally safe?
Follow-up after intensive care (PhD project Anna Schandl)
The project aims at understanding the trajectory of recovery after critical illness and prolonged intensive care, and to evaluate multidisciplinary follow-up. The main questions posed in the project are:
- How common are psychological and physical problems in general ICU patients with prolonged ICU stay?
- Does multidisciplinary ICU follow-up help ICU survivors to better long-term psychological outcome?
- How well can psychological problems at 3 months after ICU discharge be predicted before ICU discharge?
- How well can physical disability at 3 months after ICU discharge be predicted before ICU discharge?
Stress during intensive care unit stay (PhD project Anders Günther)
The project aims at understanding stressful processes in ICU patients and how they affect stress responses. The main questions posed in the project are:
- Does room type and design affect sound levels in a multidisciplinary ICU?
- Does skin conductance variability reflect pain and distress in critically ill ICU patients?
- How does noise and unpleasant visual stimulation impact pain perception?
- Does skin conductance variability correlate well with pain reporting in healthy volunteers?
Cognitive function after critical illness (PhD project Emily Brück)
The project aims at understanding links between delirium, sepsis and cognitive dysfunction and potentially sustained inflammation following critical illness and intensive care. The main questions posed in the project are:
- Does delirium and sepsis interact and affect self-reported cognitive function 3 months after ICU discharge?
- Does sepsis and delirium affect assessed cognitive function 3 and 6 months after critical illness?
- Are levels of the proinflammatory marker High Mobility Group Box 1 (HMGB-1) elevated 3 or 6 months after severe sepsis/septic shock?
- Are HMGB-1 levels and cognitive dysfunction after severe sepsis/septic shock linked?
Financial support
- ALF Medicin (the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet)
- KI/SLL Committee for Strategic Research
- Karolinska Institutet
- VINNOVA
- Lena och Per Sjöberg Foundation
- Byggmästare Olle Engkvist Foundation
Publications
Body image and psychological outcome after severe skin and soft tissue infection requiring intensive care.
Hellgren E, Lagergren P, Larsson A, Schandl A, Sackey P
Acta Anaesthesiol Scand 2013 Feb;57(2):220-8
Gender differences in psychological morbidity and treatment in intensive care survivors--a cohort study.
Schandl A, Bottai M, Hellgren E, Sundin �, Sackey P
Crit Care 2012 May;16(3):R80
Wake-up times following sedation with sevoflurane versus propofol after cardiac surgery.
Hellström J, Öwall A, Sackey P
Scand. Cardiovasc. J. 2012 Oct;46(5):262-8
Cardiac outcome after sevoflurane versus propofol sedation following coronary bypass surgery: a pilot study.
Hellström J, Öwall A, Bergström J, Sackey P
Acta Anaesthesiol Scand 2011 Apr;55(4):460-7
Screening and treatment of problems after intensive care: a descriptive study of multidisciplinary follow-up.
Schandl A, Brattström O, Svensson-Raskh A, Hellgren E, Falkenhav M, Sackey P
Intensive Crit Care Nurs 2011 Apr;27(2):94-101
A preliminary validation of the Swedish version of the Critical-Care Pain Observation Tool in adults.
Nürnberg Damström D, Saboonchi F, Sackey P, Björling G
Acta Anaesthesiol Scand 2011 Apr;55(4):379-86
Case scenario: tailored sedation to the individual needs of the intensive care unit patient.
Sackey P, Eriksson L, Martling C, Radell P
Anesthesiology 2010 Dec;113(6):1439-46
Three cases of PICU sedation with isoflurane delivered by the 'AnaConDa'.
Sackey P, Martling C, Radell P
Paediatr Anaesth 2005 Oct;15(10):879-85
Short- and long-term follow-up of intensive care unit patients after sedation with isoflurane and midazolam--a pilot study.
Sackey P, Martling C, Carlswärd C, Sundin O, Radell P
Crit. Care Med. 2008 Mar;36(3):801-6
Bispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients.
Sackey P, Radell P, Granath F, Martling C
Anaesth Intensive Care 2007 Jun;35(3):348-56
Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device.
Sackey P, Martling C, Nise G, Radell P
Crit. Care Med. 2005 Mar;33(3):585-90