Intensive cave unit drug use and subsequent quality of life in acute lung injury patients

Objective: To examine the relationship between the use of sedative and neur omuscular blocking agents during a patient's intensive care unit (ICU) stay and subsequent measures of health-related quality of life. Design: Cross-sectional mail survey and retrospective medical record abstra ction of a prospectively identified cohort of lung injury patients. Setting: ICUs in three teaching hospitals in a major metropolitan area. Patients: Patients with acute lung injury (n = 24). Interventions: None-observational study. Measurements and Main Results:Patients' charts were reviewed for those pati ents returning postdischarge quality-of-life questionnaires. Duration, dail y dose, and route of administration for sedatives and neuromuscular blockin g agents were abstracted from ICU flow sheets. Relationships among ICU vari ables (days of sedation, days of neuromuscular blockade, and severity of il lness as measured by Acute Physiology and Chronic Health Evaluation III sco re) and outcomes (symptoms of depression and symptoms of posttraumatic stre ss disorder) were assessed. Depressive symptoms at follow-up were correlate d with days of sedation (p = .007), but not with days of neuromuscular bloc kade or initial severity of illness. The composite posttraumatic stress dis order symptom impact score was correlated with days of sedation (p = .006) and days of neuromuscular blockade (p = .035), but not with initial severit y of illness. There were no significant differences between the frequency o f patients reporting a specific posttraumatic stress disorder symptom in th e high sedation group and the low sedation group, and there were no signifi cant differences in specific posttraumatic stress disorder symptoms between the group that had received neuromuscular blockade and those who had not. Conclusions: The use of sedatives and neuromuscular blocking agents in the ICU is positively associated with subsequent measures of depression and pos ttraumatic stress disorder symptoms 6-41 months after ICU treatment for acu te lung injury.