Safety, Trust, and Empowerment: Transforming ICU Research Through Trauma-Informed Care Principles

Introduction: Medical trauma affects approximately 20% of survivors of critical illness, with many developing post-traumatic stress disorder (PTSD), anxiety, and depression post-discharge. Despite widespread adoption of trauma-informed care (TIC) in clinical settings, its integration into critical care research remains unexplored. We conducted a narrative review to characterize the application of TIC in ICU research to minimize re-traumatization, honor participant welfare, and improve research quality.


Methods: We analyzed six SAMHSA-established TIC principles (safety, trustworthiness/transparency, peer support, collaboration/mutuality, cultural considerations, empowerment/voice/choice) and developed strategies for integration across research phases. Clinical vignettes illustrate trauma risks in ICU research settings


Results: ICU research presents significant retraumatization risks through multiple pathways including surrogate consent processes that leave patients unaware of their participation while experiencing loss of autonomy, hospital-based activities that trigger traumatic memories during return visits, and research questions requiring recollection of ICU experiences. To address these risks, we identified specific integration strategies for each of the TIC principles: Safety through comprehensive staff trauma training, non-hospital meeting locations when feasible, and predictable research environments; Trustworthiness/Transparency via jargon-free communication, consistent procedures, and clear data usage explanations; Peer Support including Lived Experience Advisory Boards and trauma survivors as trained peer interviewers; Collaboration/Mutuality through participatory research models and attention to power differentials; Cultural Issues addressed via pre-study trigger assessments, multilingual materials, and diverse representation; and Empowerment/Voice/Choice through permission-seeking protocols, ongoing consent reaffirmation, and frequent check-ins reinforcing participant control.


Conclusions: TIC integration can transform ICU research from potentially harmful to healing-centered, enhancing participant safety while improving data quality. Given high trauma prevalence among those experiencing critical illness, TIC should become standard practice in critical care research.