The accident happened in Pittsburgh on Nov. 16. Joseph Masterson, a lawyer who was just days from retiring at age 63, suffered cardiac arrest while driving, plowed into a guardrail, and lost consciousness.<\/p>\n
Other drivers stopped, broke the car window, and pulled him to safety. A passing volunteer firefighter performed CPR until an ambulance arrived to take Masterson to UPMC Mercy hospital.<\/p>\n
He spent 18 days in the medical intensive care unit there, 14 of them on a ventilator. He developed delirium, a common ICU condition, and needed antipsychotic drugs. Despite a feeding tube, he lost weight. \u201cWe honestly weren\u2019t confident that he would pull through,\u201d said Ron Dedes, his brother-in-law.<\/p>\n
But he did. Masterson was discharged Feb. 1 and returned home with near-constant family support. Working diligently with several kinds of therapists, he has regained his ability to walk, despite lingering weakness, and to manage his personal care. His once-garbled speech has markedly improved. He can make himself a sandwich.<\/p>\n
Now, \u201cour biggest concern is his memory,\u201d Dedes said. Masterson, who so recently handled complex legal matters, forgets conversations and events that happened a few hours earlier, said Patti Dedes, his sister. He can\u2019t yet operate a microwave or place a phone call.<\/p>\n
In an interview, he described himself, accurately, as \u201cmuch, much better than I was\u201d \u2014 but misstated his age. Screening tests after his discharge indicated cognitive impairment and depression.<\/p>\n
Among critical-care doctors, prolonged symptoms like his are known as \u201cpost-intensive care syndrome,\u201d or PICS. The fallout can be physical or psychological, as well as cognitive, and can persist for months or years.<\/p>\n
More than 5 million people annually<\/a> are admitted to intensive care across about 5,000 American hospitals, and research shows that more than half experience such aftereffects<\/a>. Older age increases the odds.<\/p>\n Patients and families are often startled by these continuing difficulties. \u201cThe belief is that they\u2019ll be discharged from the hospital and in two or three weeks, they\u2019ll be back to normal,\u201d said Brad Butcher, who was Masterson\u2019s doctor and wrote about PICS recently<\/a> in the medical journal JAMA. \u201cThat doesn\u2019t comport with reality.\u201d<\/p>\n In fact, with greater ICU use and improved treatments \u2014 the Society of Critical Care Medicine estimates that 70% to 90% of adults now survive<\/a> their stays \u2014 the population likely to encounter the syndrome is growing.<\/p>\n \u201cEveryone is grateful that the patient has survived,\u201d said Lauren Ferrante, a pulmonary critical-care doctor and researcher at the Yale School of Medicine. \u201cBut that\u2019s just the start of a long road to recovery.\u201d In a study of patients 70 and older that she co-authored, within six months after discharge only about half had returned to their pre-ICU functional ability<\/a>.<\/p>\n Intensive care patients face a long list of challenges<\/a>. PICS symptoms range from the physical<\/a> \u2014 weakness, pain, neuropathy (tingling in arms and legs), and malnutrition \u2014 to mental health concerns<\/a>, primarily anxiety and depression. Cognitive difficulties<\/a> like Masterson\u2019s are commonplace, including problems with memory, attention and concentration, and language.<\/p>\n \u201cFor many people, surviving a critical illness is a life-altering experience,\u201d Butcher said. Patients in intensive care after emergency or elective surgery also have high rates<\/a> of new physical, mental, and cognitive problems a year later.<\/p>\n The same aggressive treatments that save lives contribute to the syndrome. Intensive care patients \u201chave some sort of dramatic organ failure that requires immediate attention\u201d and constant monitoring, explained Carla Sevin, a pulmonary critical-care doctor who directs the ICU Recovery Center at Vanderbilt University Medical Center.<\/p>\n That could mean a breathing tube attached to a ventilator, which in turn often requires sedating drugs. Sedation \u201ccan precipitate delirium, and delirium is the key factor in cognitive symptoms,\u201d Butcher said.<\/p>\n It doesn\u2019t help that constant beeps and alarms from monitors and round-the-clock bright lighting disrupt sleep, and that restrictive family visiting hours deprive patients of reassuring faces and voices.<\/p>\n Gregory Matthews, a retired accountant in St. Petersburg, Florida, spent nearly a month in an ICU after a lung transplant in 2014. He still vividly remembers his hallucinations, including mice running across the wall and someone trying to frame him for drug running.<\/p>\n \u201cOne day, I thought a doctor was an assassin \u2014 I could see the rifle,\u201d said Matthews, now 80. \u201cSo I jumped out of bed,\u201d he said, and yanked out his IVs. The staff put his arms in restraints for days.<\/p>\n But immobilization exacts its own toll as patients quickly lose muscle mass and strength. \u201cOur bodies were not meant to lie in bed all day,\u201d Ferrante said.<\/p>\n Psychologically, \u201cPTSD is pretty common, similar to what\u2019s seen in combat veterans or sexual assault survivors,\u201d Sevin said, referring to post-traumatic stress disorder. Families can suffer anxiety and depression along with the patients.<\/p>\n Alarmed by such discoveries, doctors and administrators at about 35 U.S. hospitals have established post-ICU clinics<\/a>, where teams of doctors, nurses, pharmacists, therapists (physical, occupational, cognitive, speech), and social workers screen for a host of conditions and help guide patients through them.<\/p>\n Vanderbilt\u2019s 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 opened its clinic in 2022.<\/p>\n They rely on six practices recommended by the Society of Critical Care Medicine that are shown to significantly reduce post-ICU symptoms<\/a>. The measures call for changes such as using lighter sedation, getting patients up and moving earlier, testing their breathing daily to wean them from ventilators sooner, and removing restrictions on family visiting.<\/p>\n Clinics often offer support groups for patients and families. There\u2019s evidence that keeping an ICU diary, in which patients and caregivers record their experiences, and engaging in exercise and physical rehabilitation improve mental health<\/a> after discharge.<\/p>\n Also on the clinics\u2019 agenda: discussions of what other options patients might prefer if they face another critical illness, as many do. Would they agree to undergo intensive care and risk its aftereffects again? Or choose palliative care, which emphasizes comfort rather than cure? Some post-ICU patients remain permanently impaired.<\/p>\n Butcher, although he said that the use of the new practices needed to expand dramatically, sounded optimistic about the future of critical care. \u201cWe\u2019re going to find better diagnostic tools, better preventive strategies, and better therapies,\u201d he said.<\/p>\n For now, though, the ICU experience remains disorienting and sometimes traumatic. When Butcher asked 117 patients in his post-ICU clinic those next-time questions, many wanted to place limits on further medical interventions.<\/p>\n About a third would want to lower the level of aggressive care. Of those, about a quarter would want \u201cdo not resuscitate\u201d and \u201cdo not intubate\u201d orders, and almost 7% said they never wanted to return to an ICU.<\/p>\n Masterson is working hard to further his recovery. \u201cI haven\u2019t been out and about much,\u201d he said. \u201cI\u2019ve been kind of homebound.\u201d He hopes to get strong enough to resume running \u2014 he used to log 3 to 4 miles several times a week.<\/p>\n The future for patients contending with post-ICU syndrome often depends on their physical, mental, and cognitive health before their admission. Masterson\u2019s previous fitness and cognitively demanding work bode well for his further progress, Butcher said.<\/p>\n His family remains alternatively hopeful and worried. \u201cDown the road, what\u2019s it going to be like?\u201d Dedes, his brother-in-law, wondered. \u201cWe just take it day by day.\u201d<\/p>\n The New Old Age is produced through a partnership with\u00a0The New York Times<\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n