Intensive Care Unit Sedation, Patient Memories, and Post–Intensive Care Psychological Distress

BACKGROUND: Post-intensive care syndrome affects 1.5 million US patients yearly, and understanding the modifiable risk factors for this syndrome can reduce its incidence. OBJECTIVES: To investigate whether delusional memories after critical illness are associated with psychological distress and whether sedation practices affect the presence and character of intensive care unit (ICU) memories. METHODS: This was a retrospective study of patients in the Critical Illness Survivorship Clinic from October 2021 through August 2023. Clinic documentation included ICU memory descriptions and screening tests for post-traumatic stress disorder (PTSD), depression, and anxiety. Memories were coded as none, concrete, delusional, or concrete and delusional. Data from the ICU stay were collected from the electronic medical record. Logistic regression was used to evaluate whether delusional memories were associated with PTSD, depression, or anxiety and whether duration, depth, or type of sedation was associated with delusional memories. RESULTS: Sixty-six of 94 patients had sufficient data for inclusion. Their mean age was 54 years (SD, 13.6 years), and 48% were female. Development of PTSD, depression, and anxiety did not differ significantly between those with and without delusional memories (P > .05). Point estimates for PTSD, depression, and anxiety were lower for those with delusional or no memories than for those with concrete memories. Sedation variables were not associated with delusional memories (P > .05). CONCLUSIONS: No association was found between memory type and post-ICU psychological distress or between memory type and sedation use. Patients' experience of sedation and its impact on outcomes need further study.