Journal of Medical and Surgical Intensive Care Medicine 2014 , Vol 5, Issue 2
Role of Anxiety During Unsuccessful Weaning
Yusuf Savran 1 , Tuğba Başoğlu 1
1Dokuz Eylül Üniversitesi Tıp Fakültesi, Dahiliye Yoğun Bakım Bölümü, İzmir, Türkiye DOI : 10.5152/dcbybd.2014.342

One of the potential negative effects of anxiety in intensive care units is unsuccessful weaning trials. In patients who are clinically suitable for weaning, although there are no underlying respiratory pathology symptoms, like dyspnea, tachypnea, tachycardia, and sweating can be observed due to anxiety. Therefore, unsuccessful weaning trials and prolonged intubation can form a vicious cycle. We want to share our experience of unsuccessful weaning trials in a patient who had been extubated successfully under sedation afterwards. We admitted a 44-year-old male patient with the diagnosis of community-acquired pneumonia and related type 1 respiratory insufficiency. In his personal history, he had a renal transplantation from a living donor in April 2010 and was using immunosuppressive treatment. The patient had been intubated, and mechanical ventilatory support began on admission. In the following days, upon observing regression of infiltrations in x-ray and laboratory parameters, increase in compliance, hemodynamic stability, and increase in consciousness and muscle strength, sedation was ceased, and he was extubated. After 1 hour of successful spontaneous respiration, we observed dyspnea, tachypnea, excess sweating, agitation, and a decline in oxygen saturation, and we reintubated the patient. On being unsuccessful in our second extubation attempt, after 10 hours of spontaneous breathing, we reconsidered the patient’s clinical status. We agreed on giving psychological support to the patient, besides medical care. We explained all of the steps of his treatment and medical procedures. With the help of reading cards, we communicated with him and calmed him down and made him feel safe. This time, we continued midazolam infusion at a rate of 2 mg/hour and successfully extubated him. After extubation, we did not interrupt the midazolam infusion for 24 hours. After completing his treatment, we discharged the patient. The most important potential negative effect of anxiety in intensive care units is increased oxygen consumption and decreased benefit of mechanical ventilation. This leads to prolonged intubation and unsuccessful weaning trials. We also experienced unsuccessful weaning trials in our patient due to anxiety, although clinically, he was ready for extubation. As anxiety was clinically present, just like respiratory insufficiency, we could not be aware of it at the very beginning. We observed that giving psychological support, besides medical care, increases weaning success.

Keywords : Anxiety, weaning, extubation