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. 2010 May;36(5):828-35.
doi: 10.1007/s00134-010-1842-4. Epub 2010 Mar 16.

Depressive disorders during weaning from prolonged mechanical ventilation

Amal Jubran  1 , Gerald Lawm, Joanne Kelly, Lisa A Duffner, Gokay Gungor, Eileen G Collins, Dorothy M Lanuza, Leslie A Hoffman, Martin J Tobin
Affiliations

Depressive disorders during weaning from prolonged mechanical ventilation

Amal Jubran et al. Intensive Care Med. 2010 May.

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.

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Conflict of interest statement

No financial or other potential conflicts of interest exist

Figures

Figure 1
Figure 1
Study enrollment.
Figure 2
Figure 2
Distribution of functional status among enrolled patients the month before onset of respiratory failure. Hatched area of each column represents the number of patients diagnosed with depressive disorders at the weaning facility; clear area represents the number of patients without depressive disorders. Functional dependence (partially or totally bedridden) was 1.6 times more frequent among patients with depressive disorders than among those without such disorders (p=0.0006).
Figure 3
Figure 3
Number of patients with and without a depressive disorder. Hatched area of each column represents the number of patients who failed weaning (WF); clear area represent the number of patients who were successfully weaned (WS). Ventilator weaning was less frequent among patients with depressive disorders than among those without such disorders (p< 0.0001).
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