title: The long-term psychological effects of daily sedative interruption on critically ill patients.
abstract: Critically ill patients often receive sedatives, which may delay liberation from mechanical ventilation and intensive care unit discharge. Daily interruption of sedatives alleviates these problems, but the impact of this practice on long-term psychological outcomes is unknown. We compared psychological outcomes of intensive care unit patients undergoing daily sedative interruption (intervention) with those without this protocol (control). Assessments using (1) the Revised Impact of Event Scale (evaluates signs of posttraumatic stress disorder [PTSD]), (2) the Medical Outcomes Study 36 item short-form health survey, (3) the State-Trait Anxiety Inventory, (4) the Beck Depression Inventory-2, (5) and the Psychosocial Adjustment to Illness score (overall quality of adjustment to current or residual effects of illness) were done by blinded observers. The intervention group had a better total Impact of Events score (11.2 vs. 27.3, p=0.02), a trend toward a lower incidence of PTSD (0% vs. 32%, p=0.06), and a trend toward a better total Psychosocial Adjustment to Illness score (46.8 vs. 54.3, p=0.08). We conclude that daily sedative interruption does not result in adverse psychological outcomes, reduces symptoms of PTSD, and may be associated with reductions in posttraumatic stress disorder.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL 60637, USA. jkress@medicine.bsd.uchicago.edu
authors.forename: John P
authors.initials: JP
authors.lastname: Kress
authors.forename: Brian
authors.initials: B
authors.lastname: Gehlbach
authors.forename: Maureen
authors.initials: M
authors.lastname: Lacy
authors.forename: Neil
authors.initials: N
authors.lastname: Pliskin
authors.forename: Anne S
authors.initials: AS
authors.lastname: Pohlman
authors.forename: Jesse B
authors.initials: JB
authors.lastname: Hall
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000523:psychology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced* / Q000523:psychology; D008606:Mental Processes / Q000187:drug effects; D008875:Middle Aged; D011584:Psychology; D012121:Respiration, Artificial / Q000379:methods / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology*; D013375:Substance Withdrawal Syndrome / Q000150:complications* / Q000523:psychology; D013995:Time; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives