PTSD May Signal Special Sedation for Mechanical Ventilation

MONTREAL — For patients with pre-existing post-traumatic stress disorder (PTSD), mechanical ventilation in the intensive care unit (ICU) can be particularly traumatizing, leading to a greater need for sedation and other psychoactive drugs, according to new research.

"We think that certain aspects of care in mechanically ventilated patients may 'awaken' previous traumatic experiences," said study investigator Philippe Jaoude, MD, from the State University of New York at Buffalo.

"Our study is focused on veterans with combat-related PTSD, but it is quite possible that the intrusive nature of ICU care may have a similar effect on patients with noncombat-related PTSD," he told Medscape Medical News.

Mechanically ventilated patients can feel restrained and "perceive that they are tied up and unable to move while not fully understanding why," Dr Jaoude explained. "The sounds of alarms and monitors in the ICU, the presence of endotracheal tubes, the positive pressure ventilation, and the unfamiliar faces, procedures, and blood sticks are all examples of things that may precipitate PTSD symptoms in these patients."

Dr Jaoude presented results from the retrospective cohort study here at CHEST 2015.

The study involved 174 mechanically ventilated patients being treated in the ICU at the VA Western New York Healthcare System; 87 had pre-existing PTSD and 87 matched for age, sex, and illness did not.

Mechanically ventilated patients can feel restrained and perceive that they are tied up and unable to move while not fully understanding why.

There was no difference in the number of ventilator-free days at 28 days — the primary outcome — between the PTSD and no-PTSD groups, but the duration of sedation — a secondary outcome — was longer in the PTSD group than in the no-PTSD group.

Although there was no significant difference in ICU mortality, there was a trend toward an increase in the PTSD group, he said.

"Increased agitation, signs of physical or psychological pain or distress, and delirium" are typical symptoms and signs that can lead to an increase in sedatives dose, Dr Jaoude explained.

The development of sedation regimens specifically tailored to PTSD patients could "reduce their sedative requirements and improve their ICU experience and outcome," he pointed out.

Dr Jaoude has disclosed no relevant financial relationships.

CHEST 2015: American College of Chest Physicians Meeting: Poster 38691. Presented October 25, 2015.

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