Intensive care: Patients' experiences

Coming round and regaining consciousness in ICU

In intensive care people receive many separate medicines, including sedatives and painkillers, which can affect them in different ways. These medicines aim to reduce pain and to keep people calm or in a deep sleep so they are more tolerant of the tubes and equipment attached to them. Some of the people we talked to had been unconscious - one man described it as 'comatose' - for varying lengths of time. Some said they'd been looked after in intensive care for several weeks before they could remember coming round. Others were unconscious or sedated for only a few days. Here men and women discuss coming round in ICU.

Nursing and other medical staff usually talk to sedated people and tell them what is happening as they may be able to hear even if they can't respond. Some people had only vague memories whilst under sedation. They'd heard voices but couldn't remember the conversations or the people involved. Some had responded but couldn't remember any of these conversations once they were fully conscious, whether these had been with health professionals, family, friends or colleagues. Others recollected snippets of conversations they'd had between being sedated and fully conscious.

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Some people remembered talking to their families before sedation but nothing else until they came round. Others had no memories of sedation or of their ICU stay. 

Feelings of security and haziness 
People who had come round in intensive care after planned surgery knew what had happened, though many felt 'hazy'. Some people who'd had heart surgery, though, felt 'wonderful' because they'd been so much weaker before their operations (see 'Reasons for admission: planned admissions').

Some people, who had been admitted to intensive care as emergencies, described coming round as like coming out of a 'dreamtime' or 'dream-like state'. Others said they were confused for a few days after coming round but soon began to realise what was going on. Some people said they drifted in and out of consciousness for a while before becoming more alert and aware. One man knew what had happened when he came round and was moved to a general ward soon afterwards. 

Although he drifted in and out of consciousness, one man said he felt secure and warm despite being unable to speak or move very much. It was only later that he realised how seriously ill he was. Another noticed all the equipment attached to him, but felt calm and cared for by all the nurses.

Confusion and disorientation
The unfamiliar surroundings of intensive care, the equipment, medications, the actual illness or injuries can all cause people to feel confused, disorientated, anxious or frightened. Many people who had been admitted because of emergencies had no idea how ill they were when they came round. They wondered what had happened and where they were.

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Another woman felt extremely confused and thought she'd been in several different hospitals. She'd temporarily forgotten many personal details. 

For one woman coming round was 'a nightmare' and she remembered looking down at her toes that had been blackened by infection. Another was 'terrified', despite reassurances from her family that she was safe, because she had no idea what was happening to her.

One woman felt angry when she came round. She couldn't understand why she couldn't move or how much time had elapsed. For many, it was a further shock when they tried to write and were unable to do so because of the muscle loss or neuropathy they'd developed whilst sedated. ICU neuropathy is the extreme weakness that makes normal daily tasks difficult. Although its causes are poorly understood, it is estimated that 33 - 57 percent of patients who stay in the ICU for longer than 7 days could get neuropathy.* Exact data is hard to obtain as variation exists in defining the condition.

Even while people are sedated, a lot of vital medical activity is taking place. This includes checking monitors, turning patients while they are in bed, and physiotherapy. Other nursing care, including cleaning around the mouth, shaving and nail-care, is also carried out. One woman felt confused and frightened when she came round because a nurse was brushing her teeth.

Sleep and Hallucinations
Some people were confused when they came round because they were having hallucinations. Many 'drifted in and out of consciousness' or were 'lucid and then disorientated again', and said that it was some time before they felt clear about what had happened. Disorientation can also be related to the lighting in ICU and lack of windows. Some people didn't know whether it was day or night and said that their sleep patterns had been completely disrupted (see 'Sleep, dreams and hallucinations'). 

ICU equipment and environment
The noise of equipment and machinery in ICU, including alarms, can add to the sense of confusion and disorientation when people come round. Some said that these noises, coupled with their hallucinations, led them to believe they were on ships or planes. One man thought he was at a party in the hospital. This confusion also happens because normal processing of sensory information is affected.

Breathing tubes caused many people to feel uncomfortable or frustrated after coming round, and made communication with staff and visitors difficult. 

Some people were told that they'd come round on a number of occasions but were sedated again to prevent them from pulling out equipment. 

Coming round and feeling thirsty was difficult for some people as they were unable to drink. Seeing medical staff drinking tea in ICU often left them craving for a drink.

A few people had felt reassured when nurses told them what was happening to them or what to expect. Others felt isolated when they came round and would have liked more reassurance, interaction and explanation (see 'Nursing care in ICU'). 

* Johnson, KL (Apr–Jun 2007). "Neuromuscular complications in the intensive care unit: critical illness polyneuromyopathy.". AACN Advanced Critical Care 18 (2): 167–80; quiz 181–2. doi:10.1097/01.AACN.0000269260.99169.70. PMID 17473545.
 

Last reviewed May 2015.

Last updated May 2015.

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