What is the psychological pharmaceutical approach for patients with mechanical ventilation dependence?

From the Guidelines

The psychological pharmaceutical approach for patients with mechanical ventilation dependence should prioritize the use of nonbenzodiazepine sedatives, such as propofol or dexmedetomidine, over benzodiazepines due to their improved short-term and long-term outcomes, including reduced duration of mechanical ventilation, delirium, and mortality. When managing patients with mechanical ventilation dependence, it is essential to consider the potential benefits and risks of different sedative agents. According to the study published in 2024 1, nonbenzodiazepine sedatives like propofol and dexmedetomidine have been shown to have improved outcomes compared to benzodiazepines. Some key points to consider when selecting a sedative agent include:

• The choice of sedative should be based on the individual patient's needs and medical history, with consideration of factors such as the underlying cause of respiratory failure, the anticipated duration of mechanical ventilation, and the presence of any comorbidities.
• Propofol and dexmedetomidine are preferred over benzodiazepines due to their more favorable pharmacokinetic profiles and lower risk of delirium and other adverse effects.
• Daily sedation interruptions should be performed to assess the patient's neurological status and prevent oversedation, with the goal of maintaining a lightly sedated state where the patient is comfortable but arousable.
• Pain control is also essential, as uncontrolled pain can worsen psychological distress and prolong the duration of mechanical ventilation.
• The use of antipsychotics, such as haloperidol or quetiapine, may be necessary to manage delirium, but should be used judiciously and with careful monitoring of the patient's mental status. The study published in 2018 1 also supports the use of nonbenzodiazepine sedatives, highlighting their improved short-term outcomes, such as reduced ICU length of stay and duration of mechanical ventilation. Overall, a balanced approach that prioritizes the use of nonbenzodiazepine sedatives, minimizes the use of benzodiazepines, and incorporates daily sedation interruptions and pain control can help prevent ventilator dyssynchrony and minimize complications like delirium, prolonged ventilation, and psychological trauma from the ICU experience.

From the Research

Psychological Pharmaceutical Approach for Mechanical Ventilation Dependence

The psychological pharmaceutical approach for patients with mechanical ventilation dependence involves a combination of pharmacological and non-pharmacological interventions to manage anxiety, stress, and other psychological complaints.

• Pharmacological Interventions: Pharmacological treatments such as benzodiazepines are commonly employed to manage anxiety in mechanically ventilated patients 2. However, these therapies often cause undesired side effects, highlighting the need for additional therapies.
• Non-Pharmacological Interventions: Non-pharmacological interventions such as music therapy 3 and virtual reality therapy 2 have shown potential in managing anxiety and promoting relaxation in mechanically ventilated patients.
• Psychological Support: Psychological support should be offered to patients and their family members to help them cope with the technical and psychological aspects of mechanical ventilation 4. This support should be provided well before discharge and periodically during ambulatory sessions.
• Communication and Family Commitment: The level of communication within the family and the degree of commitment between all family members are important factors associated with adaptation to mechanical ventilation and the transition from the hospital environment to the home 4.
• Anxiety Management: Anxiety is a common experience for patients receiving mechanical ventilatory support, and it requires ongoing management with appropriate assessment and intervention over the duration of mechanical ventilatory support 5. Anxiety levels can vary among patients based on individual differences and clinical factors, such as gender, ethnicity, medical indication for ventilation, and length of mechanical ventilation 6.

Key Findings

• Music therapy has been found to be effective in decreasing anxiety and promoting relaxation in mechanically ventilated patients 3.
• Virtual reality therapy has shown potential as a means of managing anxiety in patients undergoing mechanical ventilation 2.
• Anxiety ratings have been found to decline slowly over time in mechanically ventilated patients 5.
• State anxiety levels have been found to vary widely among mechanically ventilated patients, with moderate anxiety levels reported on average 6.