Location
Suwanee, GA
Start Date
14-5-2019 1:00 PM
End Date
14-5-2019 4:00 PM
Description
Anxiety should be a key factor for consideration in an inpatient setting, especially for those in the intensive care unit or any patient requiring long term mechanical ventilation. A multidisciplinary team from Dekalb Medical created a therapist driven protocol for prolonged mechanical ventilation weaning, which requires patients to be evaluated for ventilation associated anxiety. Presented here is a case of a 57-year-old African American female who reported to with a chief complaint of respiratory failure. Upon further investigation by the medical team, she was noted to be in hypercapnic respiratory failure and was initially treated with Bilevel Positive Airway Pressure (BiPAP) therapy and admitted to the intensive care unit. The patient’s respiratory status worsened despite BiPAP therapy, requiring her to be intubated and placed on mechanical ventilation. She was eventually placed on a daily spontaneous breathing trial, however, she continued to experience rapid and shallow breathing, indicating she was not ready to be extubated. Her anxiety was assessed using a modified Beck Anxiety Inventory scale on day 3 of hospitalization which revealed a score of 8. According to the hospital’s protocol, a total anxiety score of 7 or greater correlates to significant anxiety suggesting the need of ziprasidone, an atypical antipsychotic, to be initiated. The purpose of ziprasidone is to reduce anxiety which can ultimately assist in weaning the patient from ventilator support. On day 4 of hospitalization she was given ziprasidone 20mg intramuscularly twice daily for 3 days followed by ziprasidone 20mg by mouth twice daily for 29 days. During this 29-day period she was off the ventilator for 5 days. Therapy was continued with ziprasidone 20mg via percutaneous endoscopic gastronomy (PEG) tube twice daily for 10 days then ziprasidone 20mg by mouth twice daily for 18 days. During this last course of therapy, she was able to be taken off mechanical ventilation support permanently. Her anxiety score decreased while being treated with ziprasidone represented by a total score of 3 on day 7 and 2 on day 15 of hospitalization.
Embargo Period
1-28-2020
Use of atypical antipsychotics in prolonged mechanical ventilation related anxiety
Suwanee, GA
Anxiety should be a key factor for consideration in an inpatient setting, especially for those in the intensive care unit or any patient requiring long term mechanical ventilation. A multidisciplinary team from Dekalb Medical created a therapist driven protocol for prolonged mechanical ventilation weaning, which requires patients to be evaluated for ventilation associated anxiety. Presented here is a case of a 57-year-old African American female who reported to with a chief complaint of respiratory failure. Upon further investigation by the medical team, she was noted to be in hypercapnic respiratory failure and was initially treated with Bilevel Positive Airway Pressure (BiPAP) therapy and admitted to the intensive care unit. The patient’s respiratory status worsened despite BiPAP therapy, requiring her to be intubated and placed on mechanical ventilation. She was eventually placed on a daily spontaneous breathing trial, however, she continued to experience rapid and shallow breathing, indicating she was not ready to be extubated. Her anxiety was assessed using a modified Beck Anxiety Inventory scale on day 3 of hospitalization which revealed a score of 8. According to the hospital’s protocol, a total anxiety score of 7 or greater correlates to significant anxiety suggesting the need of ziprasidone, an atypical antipsychotic, to be initiated. The purpose of ziprasidone is to reduce anxiety which can ultimately assist in weaning the patient from ventilator support. On day 4 of hospitalization she was given ziprasidone 20mg intramuscularly twice daily for 3 days followed by ziprasidone 20mg by mouth twice daily for 29 days. During this 29-day period she was off the ventilator for 5 days. Therapy was continued with ziprasidone 20mg via percutaneous endoscopic gastronomy (PEG) tube twice daily for 10 days then ziprasidone 20mg by mouth twice daily for 18 days. During this last course of therapy, she was able to be taken off mechanical ventilation support permanently. Her anxiety score decreased while being treated with ziprasidone represented by a total score of 3 on day 7 and 2 on day 15 of hospitalization.