Association of analgosedation with psychiatric symptoms and health-related quality of life in ARDS survivors: Post hoc analyses of the DACAPO study

Sebastian Blecha, Florian Zeman, Magdalena Rohr, Frank Dodoo-Schittko, Susanne Brandstetter, Christian Karagiannidis, Christian Apfelbacher, Thomas Bein, DACAPO study group, Sebastian Blecha, Florian Zeman, Magdalena Rohr, Frank Dodoo-Schittko, Susanne Brandstetter, Christian Karagiannidis, Christian Apfelbacher, Thomas Bein, DACAPO study group

Abstract

Background: The acute respiratory distress syndrome (ARDS) is a life-threatening condition with the risk of developing hypoxia and thus requires for invasive mechanical ventilation a long-term analgosedation. Yet, prolonged analgosedation may be a reason for declining health-related quality of life (HRQoL) and the development of psychiatric disorders.

Methods: We used data from the prospective observational nation‑wide ARDS study across Germany (DACAPO) to investigate the influence of sedation and analgesia on HRQoL and the risk of psychiatric symptoms in ARDS survivors 3, 6 and 12 months after their discharge from the intensive care unit (ICU). HRQoL was measured with the Physical and Mental Component Scale of the Short‑Form 12 Questionnaire (PCS‑12, MCS‑12). The prevalence of psychiatric symptoms (depression and post‑traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire‑9 and the Post‑Traumatic Stress Syndrome‑14. The associations of analgosedation with HRQoL and psychiatric symptoms were investigated by means of multivariable linear regression models.

Results: The data of 134 ARDS survivors (median age [IQR]: 55 [44-64], 67% men) did not show any significant association between analgosedation and physical or mental HRQoL up to 1 year after ICU discharge. Multivariable linear regression analysis (B [95%‑CI]) yielded a significant association between symptoms of psychiatric disorders and increased cumulative doses of ketamine up to 6 months after ICU discharge (after 3 months: depression: 0.15 [0.05, 0.25]; after 6 months: depression: 0.13 [0.03, 0.24] and PTSD: 0.42 [0.04, 0.80)]).

Conclusions: Up to 1 year after ICU discharge, analgosedation did not influence HRQoL of ARDS survivors. Prolonged administration of ketamine during ICU treatment, however, was positively associated with the risk of psychiatric symptoms. The administration of ketamine to ICU patients with ARDS should be with caution.

Trial registration: Clinicaltrials.gov: NCT02637011 (Registered 15 December 2015, retrospectively registered).

Conflict of interest statement

CK reports personal fees from Maquet, personal fees from Xenios, personal fees from Bayer, non‑financial support from Speaker of the German register of ICUs, grants from the German Ministry of Research and Education, during the conduct of the study. All other authors (SB, FZ, FDS, SuB, MB, CA, and TB) declare no conflict of interest.

Figures

Fig 1. Flow chart of patients with…
Fig 1. Flow chart of patients with ARDS throughout the study.
Fig 2. Relationship between cumulative dose of…
Fig 2. Relationship between cumulative dose of ketamine and psychiatric symptoms in ARDS survivors 3, 6 and 12 months after ICU discharge.
Fig 3. Relationship between cumulative dose of…
Fig 3. Relationship between cumulative dose of midazolam and psychiatric symptoms in ARDS survivors 3, 6 and 12 months after ICU discharge.

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