SESSION TITLE: Critical Care Poster Discussion
SESSION TYPE: Original Investigation Poster Discussion
PRESENTED ON: Sunday, October 25, 2015 at 01:30 PM - 03:00 PM
PURPOSE: Posttraumatic Stress Disorder (PTSD) is a prevalent disabling psychiatric disorder among Veterans. We examined the effect of pre-existing PTSD on the course of ICU hospitalization. We hypothesized that patients with PTSD who were admitted to the ICU and placed on mechanical ventilation required more sedation and had worse outcomes compared to patients without PTSD.
METHODS: This was a retrospective cohort study of all adult patients with pre-existing PTSD who were mechanically ventilated in the ICU at VHA Western New York Healthcare System between 1/1/2003 and 6/30/2013. The control group consisted of adult patients without PTSD, who were mechanically ventilated in the same ICU, and matched for age, sex and severity of illness. Primary outcome: 28-day ventilator-free days (28D-VFD). Secondary outcomes: use of sedatives and analgesics, ICU mortality, 30 day mortality, ICU length of stay (LOS), hospital LOS, rate of reintubation, incidence of delirium, 30-day ICU readmission.
RESULTS: Overall, 1569 patients were identified, of whom 164 had pre-existing PTSD, and 87 fit our criteria. The control group consisted of 87 matched patients. There was no significant difference in 28D-VFD (8.17 vs 9.48 days; p=0.47), 30-day mortality, ICU LOS, hospital LOS, mechanical ventilation days, rate of reintubation, incidence of delirium or 30-day ICU readmissions. Patients with PTSD had a longer duration of sedation with benzodiazepines (3.04 vs 2.43 days; p=0.042) and opiates (3.29 vs 2.47 days; p=0.049). The propofol infusion rate (19.93 vs 14.67 mcg/kg/min; p=0.04) and the mean propofol daily dose (28,698 vs 21,132 mcg/kg; p=0.04) were higher in the PTSD group. There was a trend toward an increased ICU mortality in the PTSD group (61 vs 50; p=0.08).
CONCLUSIONS: Mechanically ventilated patients with PTSD had higher sedation requirements. Although not statistically significant, a trend toward increased ICU mortality was seen. Patients with PTSD may thus exhibit higher sedation needs. This highlights the necessity to better comprehend the interaction between PTSD and ICU care. Developing sedation regimens tailored to PTSD patients may indeed reduce their sedative requirements and improve their ICU experience and outcome.
CLINICAL IMPLICATIONS: More than 10% of our VA ICU patients suffer from PTSD. Their ICU care should incorporate proper awareness of their PTSD, with particular attention to their sedation regimen. Long term outcomes and guidance for optimal ICU care may ensue from larger studies with long-term follow up.
DISCLOSURE: The following authors have nothing to disclose: Jad Kebbe, Ashima Lal, Ali El-Solh, Philippe Jaoude
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