Critical Care survivors: Margaret Herridge In this podcast, Margaret Herridge considers this well-known quote from Nietzsche, “That which doesn’t kill us makes us stronger.” But… Does it? What about our patients who suffer from a critical illness? The continuum of critical illness and what lies ahead for recovery should not be underestimated. Post critical illness, it is not uncommon for patients to suffer from a functional disability, a neuropsychological disability, or a decline in their general sense of wellness and vitality. Patients who have suffered from a critical illness regularly have trouble trying to reintegrate back into normal life. What about the mental illness concerns for both patients and their families post critical illness? We know that post traumatic stress disorder is common for recovering patients and their families. So… knowing this, are our patients actually stronger post illness? Traditionally, the focus of critical care has simply been on keeping patients alive. This is not enough, now we need to focus on giving them their lives back too. We need to make sure that we know our patients and their families and that we help people understand the continuum of illness and recovery. We need to make sure that the treatment which we deliver every day aligns with the goals and values of our patients and their families. We must know them in order to understand this. Margaret explains post traumatic growth as a change in the perception of oneself, a change in the experience of relationships or a change in one’s life philosophy. So... post critical illness perhaps there is an opportunity for growth and this is a positive outcome, however we must not underestimate what it means to be a critical illness survivor. From DAS SMACC, Margaret Herridge delivers an inspirational talk on what it means to be a critical care survivor. For more like this, head to our podcast page. #CodaPodcast

1. Did Nietzsche Know Anything
about Critical Illness Survivors?
Margaret Herridge

2. I have no conflict of interest to declare

3. That which doesn’t kill us makes us stronger

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5. Toronto ARDS
Outcomes Program

6. N Engl J Med 2011; 364:1293-304

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Am J Resp Crit Care Med 1999:160:50
Brain Imaging and Behavior 4:22-34, 2010
N Engl J Med 2013;369:1306-16
• Cognitive Dysfunction
• Moderate TBI
• Mild Alzheimer Dementia
• Depression 17-43%

8. Persecutory Delusions/PTSD
Crit Care Med 1998; 26: 651-9
BMJ 1999; 319:427-9
Crit Care 2010; 14: 125

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General Health and Vitality Decline
Linked to Healthcare Utilization and Cost
N Engl J Med 2011; 364:1293-304

10. Toronto ARDS
Outcomes Program

11. Toronto ARDS
Outcomes Program

12. Toronto ARDS
Outcomes Program

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• ~30 % moderate to severe depressive
symptoms and PTSD at 1 year
AJRCCM 2005; 17: 987-994
N Engl J Med 2016;374:1831-41

18. Post Traumatic Growth
Trauma may be defined as any event that
profoundly changes an individual’s fundamental
schemas, beliefs, goals and that affects the
individual’s narrative
Subjective experience of positive psychological
change as a result of struggle with trauma- may
occur with mood disorders
Clinical Psychology Review 2006;26:626-53

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Determinants of PTG
• Women > Men
• Younger > Older
• Higher Income and Education
• Extraversion/Openness/Agreeableness
Journal of Traumatic Stress 2004:17:11-21
Journal of Loss and Trauma 2009;14:364-388

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1. Changes in Perception of Self
2. Changes in Experience of Relationships
3. Change in One’s Life Philosophy

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Preparedness and Resilience
• Ability of transformed assumptive worlds
to resist subsequent trauma
• To ‘bounce back’ from another psychological
earthquake
Caloun and Tedeshi, 2014

22. He who has a why to live can bear almost any how

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• Embrace continuum of illness and recovery
• Disability, Resilience and Growth
• Know your Patient and their Loved Ones
• Listen and Sustain Hope
• Be Honest about Uncertainty