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Published ahead of print on October 2, 2003, doi:10.1164/rccm.200303-455OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1457-1461

A more recent version of this article appeared on December 15, 2003
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Submitted on March 31, 2003
Accepted on September 29, 2003

The Long Term Psychological Effects of Daily Sedative Interruption in Critically Ill Patients

John P Kress1*, Brian Gehlbach1, Maureen Lacy2, Neil Pliskin2, Anne S Pohlman1, and Jesse B Hall1

1 Medicine, University of Chicago, Chicago, IL, USA, 2 Psychiatry, University of Chicago, Chicago, IL, USA

* To whom correspondence should be addressed. E-mail: jkress{at}medicine.bsd.uchicago.edu.

Critically ill patients often receive sedatives, which may delay liberation from mechanical ventilation and ICU discharge. Daily interruption of sedatives alleviates these problems, but the impact of this practice on long term psychological outcomes is unknown. We compared psychological outcomes of ICU patients undergoing daily sedative interruption (intervention) to those without this protocol (control). Assessments using: (1) Revised Impact of Event Scale (evaluates signs of post-traumatic stress disorder); (2) SF-36 health survey; (3) State-Trait Anxiety Inventory; (4) Beck Depression Inventory-2; (5) Psychosocial Adjustment to Illness Score (overall quality of adjustment to current or residual effects of illness) were done by blinded observers. The intervention group had a better total Impact of Events score (11.2 vs. 27.3; P = 0.02), a trend toward a lower incidence of post-traumatic stress disorder (0% vs. 32%; P = 0.06), and a trend toward a better total Psychosocial Adjustment to Illness score (46.8 vs. 54.3; P = 0.08). We conclude that daily sedative interruption does not result in adverse psychological outcomes, reduces symptoms of post-traumatic stress disorder and may be associated with reductions in post-traumatic stress disorder.
Key words: sedatives, ventilation, mechanical, neuropsychological tests, outcomes research




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