Stress and stress disorders during and after intensive care

Abstract

We provide an overview of the multilevel/multidimensional approach to stress and stress disorders, and integrate research findings into the intensive care context. Recent findings are discussed within the context of well studied biopsychological theories of stress and stress disorders. The stress response must be viewed as a process. It should be discussed in terms of perception, immediate response and prolonged manifestations. There are correlations with biological principles, in that neurotransmitters can be distinguished on the basis of speed of response, duration of action and range of activity. Nevertheless, discussions on vulnerability to stress and the ability to cope with stressors are important. Findings regarding the influence of chronic stress and dysfunction of the hypothalamo-pituitary axis on stress disorders after intensive care encourage us to consider preoperative interventions that reduce chronic stress and therefore re-establish proper function of the hypothalamo-pituitary axis. Stress disorders can be viewed as a consequence either of the action of humoral substances or of failure to recover. Studies on the process of psychophysiological recovery in the intensive care unit are urgently needed. Patient factors such as type of illness, age and sex should be considered modifiers of the stress response. In addition, the interaction between molecular mechanisms of the tissue healing process and the psychophysiological stress response require more intensive study.