PURPOSE: Patients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival. METHODS: A prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken. A clinical psychologist conducted a psychiatric interview to assess for the presence of depressive disorders. RESULTS: Of the 478 patients, 142 had persistent coma or delirium and were unable to be evaluated for depressive disorders. Of the remaining 336 patients, 142 (42%) were diagnosed with depressive disorders. In multivariate analysis, co-morbidity score [odds ratio (OR), 1.23; P = 0.007], functional dependence before the acute illness (OR, 1.70, P = 0.03) and history of psychiatric disorders (OR, 3.04, P = 0.0001) were independent predictors of depressive disorders. The rate of weaning failure was higher in patients with depressive disorders than in those without such disorders (61 vs. 33%, P = 0.0001), as was mortality (24 vs. 10%, P = 0.0008). The presence of depressive disorders was independently associated with mortality (OR, 4.3; P = 0.0002); age (OR, 1.06; P = 0.001) and co-morbidity score (OR, 1.24; P = 0.02) also predicted mortality. CONCLUSION: Depressive disorders were diagnosed in 42% of patients who were being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death.
PURPOSE:Patients who require mechanical ventilation are at risk of emotional stress because of total dependence on a machine for breathing. The stress may negatively impact ventilator weaning and survival. The purpose of this study was to determine whether depressive disorders in patients being weaned from prolonged mechanical ventilation are linked to weaning failure and decreased survival. METHODS: A prospective study of 478 consecutive patients transferred to a long-term acute care hospital for weaning from prolonged ventilation was undertaken. A clinical psychologist conducted a psychiatric interview to assess for the presence of depressive disorders. RESULTS: Of the 478 patients, 142 had persistent coma or delirium and were unable to be evaluated for depressive disorders. Of the remaining 336 patients, 142 (42%) were diagnosed with depressive disorders. In multivariate analysis, co-morbidity score [odds ratio (OR), 1.23; P = 0.007], functional dependence before the acute illness (OR, 1.70, P = 0.03) and history of psychiatric disorders (OR, 3.04, P = 0.0001) were independent predictors of depressive disorders. The rate of weaning failure was higher in patients with depressive disorders than in those without such disorders (61 vs. 33%, P = 0.0001), as was mortality (24 vs. 10%, P = 0.0008). The presence of depressive disorders was independently associated with mortality (OR, 4.3; P = 0.0002); age (OR, 1.06; P = 0.001) and co-morbidity score (OR, 1.24; P = 0.02) also predicted mortality. CONCLUSION:Depressive disorders were diagnosed in 42% of patients who were being weaned from prolonged ventilation. Patients with depressive disorders were more likely to experience weaning failure and death.
Authors: John P Kress; Brian Gehlbach; Maureen Lacy; Neil Pliskin; Anne S Pohlman; Jesse B Hall Journal: Am J Respir Crit Care Med Date: 2003-10-02 Impact factor: 21.405
Authors: James C Jackson; Robert P Hart; Sharon M Gordon; Ayumi Shintani; Brenda Truman; Lisa May; E Wesley Ely Journal: Crit Care Med Date: 2003-04 Impact factor: 7.598
Authors: M Vitacca; A Vianello; D Colombo; E Clini; R Porta; L Bianchi; G Arcaro; G Vitale; E Guffanti; A Lo Coco; N Ambrosino Journal: Am J Respir Crit Care Med Date: 2001-07-15 Impact factor: 21.405
Authors: Christina Jones; Paul Skirrow; Richard D Griffiths; Gerald H Humphris; Sarah Ingleby; Jane Eddleston; Carl Waldmann; Melanie Gager Journal: Crit Care Med Date: 2003-10 Impact factor: 7.598
Authors: J D Rollnik; J Adolphsen; J Bauer; M Bertram; J Brocke; C Dohmen; E Donauer; M Hartwich; M D Heidler; V Huge; S Klarmann; S Lorenzl; M Lück; M Mertl-Rötzer; T Mokrusch; D A Nowak; T Platz; L Riechmann; F Schlachetzki; A von Helden; C W Wallesch; D Zergiebel; M Pohl Journal: Nervenarzt Date: 2017-06 Impact factor: 1.214
Authors: Fabienne D Simonis; Ary Serpa Neto; Jan M Binnekade; Annemarije Braber; Karina C M Bruin; Rogier M Determann; Geert-Jan Goekoop; Jeroen Heidt; Janneke Horn; Gerard Innemee; Evert de Jonge; Nicole P Juffermans; Peter E Spronk; Lotte M Steuten; Pieter Roel Tuinman; Rob B P de Wilde; Marijn Vriends; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: JAMA Date: 2018-11-13 Impact factor: 56.272