View Abstract

A6891 - Effectiveness of Treating Prolonged Mechanical Ventilation Related Anxiety with Atypical Antipsychotics
Author Block: L. H. Varner1, I. Khaki Najafabadi1, D. Larson2, J. T. Elder3, L. Patterson4; 1School of Pharmacy, Philadelphia College of Osteopathic Medicine School of Pharmacy, Suwanee, GA, United States, 2Respiratory Therapy, DeKalb Medical Center LTAC Hospital, Decatur, GA, United States, 3Neuropsychology, DeKalb Medical Center LTAC Hospital, Decatur, GA, United States, 4Pharmacy, DeKalb Medical Center LTAC Hospital, Decatur, GA, United States.
Introduction:
One of the biggest barriers to weaning ventilator patients in a long term acute care hospital is identifying and treating anxiety. This report details the only described case of using Geodon® to assist in weaning a patient off prolonged mechanical ventilation.
Case description:
A 78 –year-old Caucasian female with a history of severe COPD, and pulmonary hypertension developed cardiac arrest at her physician’s office. She was resuscitated with an automatic CPR device and during the process of resuscitation, sustained a gastric perforation as well as splenic laceration. She subsequently had surgery and required prolonged hospitalization due to complications from respiratory failure status post tracheostomy. She was transferred from an acute care hospital to a long-term care hospital for rehabilitation and for weaning following prolonged ventilation. The protocol approved for weaning patients from Prolonged Mechanical Ventilation at this facility required the patient to be evaluated for ventilator associated anxiety using an anxiety scale which was modified from the Beck Anxiety Inventory (BAI) and was approved by the facility’s neuropsychologist. The protocol also required patient assessment for ICU delirium using the CAM-ICU scale. If the patient’s initial anxiety evaluation reveals significant anxiety, a score of seven or greater, an order for Geodon® is requested to assist in reducing anxiety which in the case of this patient, assisted her from weaning from the ventilator. Her anxiety rating scale results showed a total score of 19 on day 3, and Geodon® 20mg per percutaneous endoscopic gastrostomy (PEG) tube twice a day was ordered for 18 days. Subsequent assessments revealed an anxiety score of 19 on day 7, which fell to a score of 4 on day 15 of admission. Geodon® was started on day 3 and continued for 18 days. She was subsequently weaned off the ventilator on day 10 of admission. Her hospital stay was complex in that she acquired a UTI revealing Klebsiella as well as Hospital Acquired Pneumonia, but after recovering from these events, she was transferred to the facility’s rehabilitation unit and was later discharged home.
Discussion:
In this case, the use of Geodon® allowed reduction of anxiety that was prohibiting the patient from weaning in a state of prolonged mechanical ventilation. This facility has used Geodon® for ten years as a major advancement in improving patient outcomes and ventilator weaning rates which promoted the facility becoming Disease Specific Certified in Respiratory Failure.