Long-term psychological effects of a no-sedation protocol in critically ill patients

Thomas Strøm, Mette Stylsvig, Palle Toft, Thomas Strøm, Mette Stylsvig, Palle Toft

Abstract

Introduction: A protocol of no sedation has been shown to reduce the time patients receive mechanical ventilation and to reduce intensive care and total hospital length of stay. The long-term psychological effects of this strategy have not yet been described. The purpose of the study was to test whether a strategy of no sedation alters long-term psychological outcome compared with a standard strategy with sedation.

Methods: During intensive care stay, 140 patients requiring mechanical ventilation were randomized to either no sedation or sedation with daily interruption of sedation. This study was done as a single-blinded cohort study. After discharge, patients were interviewed by a neuropsychologist assessing quality of life, depression, anxiety, and posttraumatic stress disorder.

Results: Two years after randomization, 38 patients were eligible for interview, and 26 patients were interviewed (13 from each group). No difference was found with respect to quality of life (Medical Outcome Study, 36-item short-form health survey). Both mental and physical components were nonsignificant. The Beck depression index was low in both groups (one patient in intervention group versus three patients in the control group were depressed, p = 0.32). Evaluated with the Impact of Events Scale, both groups had low stress scores (one in the intervention group versus two in the control group had scores greater than 32; p = 0.50). State anxiety scores were also low (28 in the control group versus 30 in the intervention group, p = 0.58).

Conclusions: Our data suggest that a protocol of no sedation applied to critically ill patients undergoing mechanical ventilation does not increase the risk of long-term psychological sequelae after intensive care compared with standard treatment with sedation.

Trial registration: ClinicalTrials.gov NCT00466492.

Figures

Figure 1
Figure 1
Consort diagram showing the flow of patients in the trial.

References

    1. Hopkins RO, Jackson JC. Long-term neurocognitive function after critical illness. Chest. 2006;130:869–78. doi: 10.1378/chest.130.3.869.
    1. Jacobi J, Fraser GL, Coursin DB, Riker RR, Fontaine D, Wittbrodt ET, Chalfin DB, Masica MF, Bjerke HS, Coplin WM, Crippen DW, Fuchs BD, Kelleher RM, Marik PE, Nasraway SA Jr, Murray MJ, Peruzzi WT, Lumb PD. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med. 2002;30:119–41. doi: 10.1097/00003246-200201000-00020.
    1. Kress JP, Gehlbach B, Lacy M, Pliskin N, Pohlman AS, Hall JB. The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med. 2003;168:1457–61. doi: 10.1164/rccm.200303-455OC.
    1. Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001;29:573–80. doi: 10.1097/00003246-200103000-00019.
    1. Treggiari MM, Romand JA, Yanez ND, Deem SA, Goldberg J, Hudson L, Heidegger CP, Weiss NS. Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009;37:2527–34. doi: 10.1097/CCM.0b013e3181a5689f.
    1. Jackson JC, Girard TD, Gordon SM, Thompson JL, Shintani AK, Thomason JW, Pun BT, Canonico AE, Dunn JG, Bernard GR, Dittus RS, Ely EW. Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med. 2010;182:183–91. doi: 10.1164/rccm.200903-0442OC.
    1. Strom T, Martinussen T, Toft P. A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet. 2010;375:475–80. doi: 10.1016/S0140-6736(09)62072-9.
    1. Ogundele O, Yende S. Pushing the envelope to reduce sedation in critically ill patients. Crit Care. 2010;14:339. doi: 10.1186/cc9339.
    1. Brochard L. Less sedation in intensive care: the pendulum swings back. Lancet. 2010;375:436–8. doi: 10.1016/S0140-6736(10)60103-1.
    1. Vasilevskis EE, Pandharipande PP, Girard TD, Ely EW. A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors. Crit Care Med. 2010;38:S683–S691.
    1. Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med. 2000;342:1471–7. doi: 10.1056/NEJM200005183422002.
    1. Bjørner J, Trab D, Watt P, Bech L, Rasmussen K, Søndergaard K, Modvig S, Thunedborg H. Dansk manual til SF-36 [Danish manual SF-36] 1997. S.l.: Lif.
    1. Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588–97. doi: 10.1207/s15327752jpa6703_13.
    1. Spielberger CD, Gorsuch L. State-trait anxiety inventory for adults:Sampler set: manual, test, scoring key. Redwood City, Calif: Mind Garden; 1983.
    1. Wilson JP, Keane TM. Assessing psychological trauma and PTSD. New York: Guilford Press; 1997.
    1. Stoll C, Kapfhammer HP, Rothenhausler HB, Haller M, Briegel J, Schmidt M, Krauseneck T, Durst K, Schelling G. Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med. 1999;25:697–704. doi: 10.1007/s001340050932.
    1. Jones C, Humphris G, Griffiths RD. Preliminary validation of the ICUM tool: a tool for assessing memory of the intensive care experience. Clin Intensive Care. 2000;11:251–5. doi: 10.1080/714028717.
    1. Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med. 1999;27:2609–15. doi: 10.1097/00003246-199912000-00001.
    1. Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008;371:126–34. doi: 10.1016/S0140-6736(08)60105-1.
    1. Davydow DS, Gifford JM, Desai SV, Needham DM, Bienvenu OJ. Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. Gen Hosp Psychiatry. 2008;30:421–34. doi: 10.1016/j.genhosppsych.2008.05.006.
    1. Griffiths J, Fortune G, Barber V, Young JD. The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med. 2007;33:1506–18. doi: 10.1007/s00134-007-0730-z.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere