Sedation and Its Association With Posttraumatic Stress Disorder After Intensive Care

Abstract

Overuse of sedation in patients treated with mechanical ventilation can increase duration of ventilation, duration of delirium, and time to discharge. Although current principles of care include implementation of sedation protocols and/or daily interruptions in sedation to improve patients’ outcomes, these strategies remain underused. Historically, a barrier to use of protocols has been a perception that being awake and aware while intubated is intrinsically distressing and could cause psychological harm. Evidence of a link between lighter sedation and decreased signs and symptoms of posttraumatic stress disorder has partially dispelled these fears and even prompted the adoption of no-sedation (eg, analgosedation) strategies. Published studies on posttraumatic stress disorder and sedation are limited by small sample size, heterogeneous sedation practices, and inadequate follow-up. Despite limitations, current data suggest contemporary sedation practices to keep patients calm and comfortable but awake, as appropriate, are not associated with increased rates or severity of posttraumatic stress disorder.

Prevalence of Posttraumatic Stress Disorder and Related Factors Among Patients Discharged From Critical Care Units in Kashan, Iran

“…Other studies showed that PTSD was more prevalent in patients with trauma ( 23 ) in those with substance abuse and patients with long-term hospitalization ( 10 ). However, some other studies found no significant association between substance abuse or length of hospitalization and experiencing PTSD symptoms ( 9 , 24 ). This study was performed due to limited performed studies in Iran and considering physical, psychological, social and economic consequences of PTSD and controversies about its prevalence and affecting factors.…”

How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups

“…The organisation of nursing work in ICUs and the application of care (maintenance of venous catheters, care of catheters and drainages and postural changes) can influence the appearance of delirium. 64 65 The number of interventions should be minimised in order to favour patient participation and early mobilisation. 64–66 This is a matter of particular importance during the night shifts in order to aid rest.…”

Intervention for Patients Intubated and Conscious to decrease Peritraumatic Distress (IPIC-PTD) – Acceptability and feasibility

“…This is the therapeutic approach now being promoted. Studies have shown that it does not influence the occurrence of psychological consequences, such as peritraumatic distress (PTD) or post-traumatic stress disorder (PTSD) following hospitalization in the ICU (Rock, 2014;Samuelson, Lundberg, & Fridlund, 2008). However, the depth of sedation can have an impact on the patient's perception of this period.…”