"It was torture for him, and it was torture for us to see him like that": understanding multiple ICU-related triggers of family PTSD symptoms-a qualitative thematic study.

purposeFamily members of patients admitted to intensive care units (ICU) are at high risk of developing post-traumatic stress disorder (PTSD) in the months following ICU discharge. We aimed to explore relatives' ICU experiences and identify common ICU-phase triggers shaping PTSD symptom experiences.

methodsQualitative study using in-depth, semi-structured interviews and thematic analysis. We included family members of adult ICU patients who received invasive mechanical ventilation for at least 48 h and who presented clinically significant PTSD symptoms 3 months after ICU discharge or death.

resultsOf 18 eligible family members approached, 17 agreed to participate; 8 were bereaved relatives and 9 were relatives of patients alive at 6 months. Mean age was 45 (21-70), and interviews lasted a mean of 1h38mins (49 min-2 h 35). Three main themes emerged: (1) Biographical trajectories and ICU admission, characterized by sudden illness onset, guilt, and major disruption of daily life; (2) Navigating the ICU environment, marked by distress related to the technical setting, altered relationships, vicarious suffering, and waiting; and (3) Dying and death in the ICU, describing the emotional intensity of preparation for death, interactions with medical devices, and the moment of death. PTSD symptoms appeared to arise from the accumulation of stressors throughout the illness trajectory rather than from a single event.

conclusionMultiple triggers related to personal history, the ICU environment, clinician communication, and end-of-life experiences were identified, highlighting the need for continuous, family-centered support throughout the ICU stay, including empathetic communication and preparation for critical transitions, to help reduce psychological distress.