The Long-Term Psychological Effects of Daily Sedative Interruption on Critically Ill Patients

John P. Kress, Brian Gehlbach, Maureen Lacy, Neil Pliskin, Anne S. Pohlman, and Jesse B. Hall

Am J Respir Crit Care Med Vol 168. pp 1457–1461, 2003

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 PsychosocialAdjustment 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.

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