PTSD Common in ARDS Survivors

Laurie Barclay, MD

January 21, 2004

Jan. 21, 2004 — A follow-up study published in the January issue of the American Journal of Psychiatry showed a high rate of posttraumatic stress disorder (PTSD) in survivors of acute respiratory distress syndrome (ARDS). The investigators elaborate on other medical situations that may lead to PTSD and speculate as to likely traumatizations.

"Intensive care often means exposure to physical and psychological stress, with long-lasting emotional sequelae for most patients," write Hans P. Kapfhammer, MD, PhD, from the Karl-Franzens-University of Graz in Austria, and colleagues. "ARDS can result from various disorders (e.g., trauma, pneumonia, sepsis). The threat to the normal matter-of-factness of breathing, dependency on supportive apparatus, and the enormously impaired ability to communicate during intubation are central aspects of these patients' frightening experiences."

In this psychiatric follow-up study, 46 long-term survivors were enrolled after receiving standard, protocol-driven intensive care treatment. At discharge, 20 patients suffered from PTSD and four from sub-PTSD, based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. At follow-up (median, eight years after treatment), 11 patients still met criteria for PTSD and eight for sub-PTSD.

Patients with PTSD had major impairments in some dimensions of health-related quality of life, whereas those without PTSD had scores comparable to those of the general population. Compared with patients with sub-PTSD and no PTSD, patients with PTSD had a marked tendency toward somatization and state anxiety, and they had a longer duration of stay on the intensive care unit. All three groups were otherwise similar in social support, symptoms of cognitive dysfunction, age, sex, sociodemographic variables, premorbid psychopathology, and initial severity of illness.

Study limitations include retrospective design, long interval between follow-up and intensive care treatment, follow-up rate of only 58%, possible recall bias, nonrandom subject selection, and a patient population that already showed signs of increased posttraumatic stress reaction in a previous study.

"In our view, weaning from mechanical ventilation represents a decisive phase for the subjective perception of trauma in patients with ARDS," the authors write. "Besides pharmacology-related withdrawal syndromes (not registered, however, in our study), which can contribute to deliria and conditions of massive anxiety, the main experience for the patient with acute respiratory distress is the threatened respiration without further mechanical support, or a feeling of suffocation. This destructive experience is potentiated by the continued limited ability to communicate and the lack of possibilities to flee."

The Eli Lilly International Foundation supported this study.

Am J Psychiatry. 2004;161:45-52

Reviewed by Gary D. Vogin, MD

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