Trastornos Psicoemocionales al alta en pacientes que desarrollan Sedación Difícil en la Unidad de Cuidados Intensivos.

Identifier:  TDX:3220

Handle: https://hdl.handle.net/20.500.11797/TDX3220

Authors:  Gil Castillejos, Diana

Abstract:
Background Critical care survivors often experience symptoms of anxiety, depression or post-traumatic stress disorder (PTSD). Aims To determine the prevalence of these symptoms during the first six months after discharge from the intensive care unit (ICU) and to examine the association with difficult sedation (DS) during admission. Design Descriptive and prospective analysis of analgesia/sedation and psychological symptoms in patients in a medical-surgical ICU over a two-year period. Methods Patients who required more than 24 hours (h) of mechanical ventilation (MV) during their ICU admission. We compared complications, clinical outcomes and psychological sequelae according to whether or not patients had been difficult to sedate. Descriptive analysis and multivariate logistic regression were performed. Results. Data were obtained for 195 patients, of whom 30% experienced difficult sedation. Difficult to sedate patients were younger (p=.001), less critically ill (APACHE II score p=.002) and more likely to engage in harmful use of alcohol (p=.001) and to have used psychoactive/psychotropic drugs during the previous three months. They also spent longer in the ICU (p=.001) and a greater percentage of time on mechanical ventilation (p<.001). At 1-month follow up, 87.7% of difficult-to-sedate patients reported anxiety (vs. 45.4%; p=.001), with the corresponding figures at 3 and 6 months being 75.5% (vs. 29%; p=.001) and 70.8% (vs. 23.7%; p=.001). Depression was reported by 82.4% (vs. 43.1%; p=.001), 66% (vs. 33.9%; p=.001) and 60.4% (vs. 27.2%; p=.001) of difficult-to-sedate patients at 1, 3 and 6 months, respectively. At I month, 28.1% of these patients (vs. 11.5%; p=.007) reported symptoms of PTSD. Conclusions. Critical care survivors who were difficult to sedate are more likely to present psychological sequelae. Early identification of at-risk patients is necessary so as to implement appropriate preventive strategies.