Potential effects of stress in critical illness through the role of stress neuropeptides.
OBJECTIVE
To critically review evidence on the hypothesis that the multitude of cognitive and psychological stressors perceived by critically ill individuals may contribute to the development of pathophysiologic sequlae through modulation of the levels of stress neuropeptides.


BACKGROUND
Critically ill individuals experience high levels of stress and intense adverse emotions. Although psychological stress has long been recognized as a factor in disease, and despite the nursing tenet on the importance of patients' psychological responses, in critical care, the potential physiologic effects of stress have received little attention. DESIGN, METHODS: Narrative critical review. Databases searched included Medline, CINAHL, PubMed and the Cochrane Library. Evidence on the role of stress neuropeptides and pertinent findings in critically ill individuals are reviewed.


RESULTS
Limbic and extra-limbic brain structures along with specific stress neuropeptides [corticotrophin releasing hormone (CRH), adrenocorticotropin hormone (ACTH), neuropeptide Y , vasopressin, prolactin, oxytocin, substance P, cholecystokinin, endorphins, enkephalins, somatostatin, noradrenaline, melatonin] are involved in emotional and stress responses. Research evidence indicates that stress neuropeptide levels may be altered in critical illness. Moreover, they mediate processes such as immunity, endothelial response and oxidative stress. A framework for future research and practice is presented.


CONCLUSIONS
It is probable that, in critical illness, psychological stress accentuates pathophysiological sequlae, through release of neuropeptides. The role of neuropeptides is suggested as an important field of investigation for critical care nursing. However, currently available data are insufficient to draw firm conclusions. Focussed studies on the physiologic correlates of psychological stress in the critically ill are needed.


CONCLUSIONS
If this hypothesis is corroborated, bedside quantification of selected neuropeptides may contribute to the assessment of stress and of the effectiveness of psychological support interventions in the future. Moreover, psychosocial and, probably, pharmacological support interventions may be effective adjuncts to the care of the critically ill.
Papathanassoglou
Elizabeth D E
ED
University of Athens School of Nursing, Athens, 123 Papadiamantopoulou st., GR-11527, Hellas, Greece. elipapa@nurs.uoa.gr
Giannakopoulou
Margarita
M
Mpouzika
Meropi
M
Bozas
Evangelos
E
Karabinis
Andreas
A
D016638:Critical Illness / Q000523:psychology*; D006801:Humans; D009479:Neuropeptides / Q000378:metabolism*; D009732:Nursing Care / Q000379:methods; D009742:Nursing Theory; D013315:Stress, Psychological / Q000503:physiopathology*
D009479:Neuropeptides