Intensive Care Medicine

, Volume 36, Issue 5, pp 828–835

Depressive disorders during weaning from prolonged mechanical ventilation

  • Amal Jubran
  • Gerald Lawm
  • Joanne Kelly
  • Lisa A. Duffner
  • Gokay Gungor
  • Eileen G. Collins
  • Dorothy M. Lanuza
  • Leslie A. Hoffman
  • Martin J. Tobin
Original

DOI: 10.1007/s00134-010-1842-4

Cite this article as:
Jubran, A., Lawm, G., Kelly, J. et al. Intensive Care Med (2010) 36: 828. doi:10.1007/s00134-010-1842-4

Abstract

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.

Keywords

Mechanical ventilation Weaning Depressive disorders 

Supplementary material

134_2010_1842_MOESM1_ESM.doc (34 kb)
Supplementary material (DOC 34 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2010

Authors and Affiliations

  • Amal Jubran
    • 1
  • Gerald Lawm
    • 2
  • Joanne Kelly
    • 2
  • Lisa A. Duffner
    • 2
  • Gokay Gungor
    • 1
  • Eileen G. Collins
    • 3
  • Dorothy M. Lanuza
    • 4
  • Leslie A. Hoffman
    • 5
  • Martin J. Tobin
    • 1
  1. 1.Division of Pulmonary and Critical Care Medicine, Edward Hines Jr. Veterans Affairs HospitalHines IL and Loyola University of Chicago Stritch School of MedicineMaywoodUSA
  2. 2.RML Specialty HospitalHinsdaleUSA
  3. 3.Center for Management of Complex Chronic Care, Edward Hines Jr. Veterans Affairs HospitalHines IL and University of Illinois at Chicago College of NursingChicagoUSA
  4. 4.University of Wisconsin School of NursingMadisonUSA
  5. 5.University of Pittsburgh School of NursingPittsburghUSA

Personalised recommendations