Post-traumatic Stress Disorder After Weaning from Prolonged Mechanical Ventilation

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2010 Jul 28

PMID 20661726

Citations 37

Authors

Amal Jubran

Gerald Lawm

Lisa A Duffner

Eileen G Collins

Dorothy M Lanuza

Leslie A Hoffman

Martin J Tobin

Affiliations

Soon will be listed here.

Abstract

Purpose: Weaning from prolonged mechanical ventilation may be associated with mental discomfort. It is not known whether such discomfort is linked with the development of post-traumatic stress disorder (PTSD). Accordingly, we investigated whether PTSD occurs in patients after weaning from prolonged ventilation. We also determined whether administering a questionnaire would identify patients at risk for developing PTSD.

Methods: A prospective longitudinal study of patients transferred to a long-term acute-care hospital for weaning from prolonged ventilation was undertaken: 72 patients were studied 1 week after weaning, and 41 patients were studied again 3 months later. An experienced psychologist conducted a structured clinical interview 3 months after weaning to establish a diagnosis of PTSD. To assess for the presence of PTSD-related symptoms, the post-traumatic stress syndrome (PTSS-10) questionnaire was administered 1 week after weaning and 3 months later.

Results: The psychologist diagnosed PTSD in 12% of patients 3 months after ventilator weaning. Patients who developed PTSD were more likely to have a previous history of psychiatric disorders (P < 0.02). A PTSS-10 score >20 one week after weaning reliably identified patients who were diagnosed with PTSD 3 months later: sensitivity 1.0; specificity 0.76; area under the receiver-operating characteristic curve 0.91.

Conclusion: PTSD was diagnosed in 12% of patients who were weaned from prolonged ventilation. A PTSS-10 score >20 one week after weaning identified patients diagnosed with PTSD 3 months later. This finding suggests that a simple questionnaire administered before hospital discharge can identify patients at risk for developing PTSD.

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References

Sukantarat K, Greer S, Brett S, Williamson R . Physical and psychological sequelae of critical illness. Br J Health Psychol. 2007; 12(Pt 1):65-74. DOI: 10.1348/135910706X94096. View

Jones C, Griffiths R, Humphris G, Skirrow P . Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med. 2001; 29(3):573-80. DOI: 10.1097/00003246-200103000-00019. View

Samuelson K, Lundberg D, Fridlund B . Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study. Acta Anaesthesiol Scand. 2007; 51(6):671-8. DOI: 10.1111/j.1399-6576.2007.01292.x. View

Jubran A, Mathru M, Dries D, Tobin M . Continuous recordings of mixed venous oxygen saturation during weaning from mechanical ventilation and the ramifications thereof. Am J Respir Crit Care Med. 1998; 158(6):1763-9. DOI: 10.1164/ajrccm.158.6.9804056. View

Jubran A, Grant B, Laghi F, Parthasarathy S, Tobin M . Weaning prediction: esophageal pressure monitoring complements readiness testing. Am J Respir Crit Care Med. 2005; 171(11):1252-9. DOI: 10.1164/rccm.200503-356OC. View

Griner P, Mayewski R, Mushlin A, Greenland P . Selection and interpretation of diagnostic tests and procedures. Principles and applications. Ann Intern Med. 1981; 94(4 Pt 2):557-92. View

Jubran A, Tobin M . Passive mechanics of lung and chest wall in patients who failed or succeeded in trials of weaning. Am J Respir Crit Care Med. 1997; 155(3):916-21. DOI: 10.1164/ajrccm.155.3.9117026. View

Weinert C, Sprenkle M . Post-ICU consequences of patient wakefulness and sedative exposure during mechanical ventilation. Intensive Care Med. 2007; 34(1):82-90. DOI: 10.1007/s00134-007-0829-2. View

Jones C, Backman C, Capuzzo M, Flaatten H, Rylander C, Griffiths R . Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Med. 2007; 33(6):978-85. DOI: 10.1007/s00134-007-0600-8. View

10.

Deja M, Denke C, Weber-Carstens S, Schroder J, Pille C, Hokema F . Social support during intensive care unit stay might improve mental impairment and consequently health-related quality of life in survivors of severe acute respiratory distress syndrome. Crit Care. 2006; 10(5):R147. PMC: 1751069. DOI: 10.1186/cc5070. View

11.

Kessler R . Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry. 2000; 61 Suppl 5:4-12; discussion 13-4. View

12.

Griffiths J, Fortune G, Barber V, Young J . The prevalence of post traumatic stress disorder in survivors of ICU treatment: a systematic review. Intensive Care Med. 2007; 33(9):1506-18. DOI: 10.1007/s00134-007-0730-z. View

13.

Girard T, Shintani A, Jackson J, Gordon S, Pun B, Henderson M . Risk factors for post-traumatic stress disorder symptoms following critical illness requiring mechanical ventilation: a prospective cohort study. Crit Care. 2007; 11(1):R28. PMC: 2151865. DOI: 10.1186/cc5708. View

14.

Schelling G, Stoll C, Vogelmeier C, Hummel T, Behr J, Kapfhammer H . Pulmonary function and health-related quality of life in a sample of long-term survivors of the acute respiratory distress syndrome. Intensive Care Med. 2000; 26(9):1304-11. DOI: 10.1007/s001340051342. View

15.

Haljamae H . Assessment of patients' experience of discomforts during respirator therapy. Crit Care Med. 1989; 17(10):1068-72. DOI: 10.1097/00003246-198910000-00021. View

16.

Twigg E, Humphris G, Jones C, Bramwell R, Griffiths R . Use of a screening questionnaire for post-traumatic stress disorder (PTSD) on a sample of UK ICU patients. Acta Anaesthesiol Scand. 2007; 52(2):202-8. DOI: 10.1111/j.1399-6576.2007.01531.x. View

17.

Watson C, Juba M, Manifold V, Kucala T, Anderson P . The PTSD interview: rationale, description, reliability, and concurrent validity of a DSM-III-based technique. J Clin Psychol. 1991; 47(2):179-88. DOI: 10.1002/1097-4679(199103)47:2<179::aid-jclp2270470202>3.0.co;2-p. View

18.

Nickel M, Leiberich P, Nickel C, Tritt K, Mitterlehner F, Rother W . The occurrence of posttraumatic stress disorder in patients following intensive care treatment: a cross-sectional study in a random sample. J Intensive Care Med. 2004; 19(5):285-90. DOI: 10.1177/0885066604267684. View

19.

Treggiari M, Romand J, Yanez N, Deem S, Goldberg J, Hudson L . Randomized trial of light versus deep sedation on mental health after critical illness. Crit Care Med. 2009; 37(9):2527-34. DOI: 10.1097/CCM.0b013e3181a5689f. View

20.

Stoll C, Kapfhammer H, Rothenhausler H, Haller M, Briegel J, Schmidt M . 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(7):697-704. DOI: 10.1007/s001340050932. View