Depressive disorders during weaning from prolonged mechanical ventilation

Abstract

PurposeâPatients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival.MethodsâA prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken. A clinical psychologist conducted a psychiatric interview to assess for the presence of depressive disorders.ResultsâOf the 478 patients, 142 had persistent coma or delirium and were unable to be evaluated for depressive disorders. Of the remaining 336 patients, 142 (42%) were diagnosed with depressive disorders. In multivariate analysis, co-morbidity score (odds ratio [OR], 1.23, p=0.007), functional dependence before the acute illness (OR, 1.70, p=0.03), and history of psychiatric disorders (OR, 3.04, p=0.0001) were independent predictors of depressive disorders. The rate of weaning failure was higher in patients with depressive disorders than in those without such disorders (61% versus 33%, p=0.0001), as was mortality (24% versus 10%, p=0.0008). The presence of depressive disorders was independently associated with mortality (OR, 4.3; p=0.0002); age (OR, 1.06; p=0.001) and comorbidity score (OR, 1.24; p=0.02) also predicted mortality.ConclusionâDepressive disorders were diagnosed in 42% of patients who are being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death.

Noninvasive ventilation for weaning in hypoxemic respiratory failure: not ready for prime time

“…Ignoring this fundamental tenet exposes patients to unnecessary morbidity and mortality [1][2][3]. The three components of management include treatment of the cause of respiratory failure, measurement of weaning predictors, and trials of unassisted breathing [4] (Fig.…”

Praying for healthy minds and healthy bodies in ICU survivors

“…Clinical depression has been described by the same authors in over 40% of weaning unit patients [2]. Cognitive abnormalities suggesting delirium or subsyndromal delirium [3] occur in 70-80% of ICU patients.…”

Research Needs and Strategies to Establish Best Practices and Cost Effective Models for Chronic Critical Illness

“…However, pain, anxiety, and depression are still common, [13][14][15] and research is needed on effective treatment regimens that are targeted to objective assessments of need. There has been some interest in the past in stimulant medications to improve motivation of depressed patients during weaning, but this should be studied for efficacy and potential complications.…”