Intoxication and psychiatric disorders

CONFUSIONAL STATE IN ICU PATIENTS AFTER. WEANING FROM MECHANICAL VENTILATION AND SEDATION. F Pochard, JJ Lanore, M Belghith, JP Mira, B Renaud, F Bellivier, I Hamy, JF Vax; laire, F Brunet, JF Dhainaut. Confusional state (CS) is known to be frequent in ICU pts. It can result in a poorer prognosis at time of weaning from mechanical ventilation (MV). The aim of this study was to prospectively assess the incidence of CS in pts requiring MV and sedation during more than 24 hours, at time of weaning. Thirty-three survivor pts, Age 48.3, SAPS 15.4, OSF 1.7, OMEGA score 34a, were consecutively included. Reason for admission to ICU was acute lung injury (20), cardiac failure (5), septic shock (3), other (5). Length of MV was 17 days. Pharmacological agents used were flunitrazepam for narcose (33 pts, 35 mg/d, 11 d) and phenoperidine for analgesia (30 pts, 39 mg/d, 12 d). Neither pt had psychosis previous history, nor neurological disease. Fourteen pts suffered CS, defined as the onset of at least 2 of the following signs: disorientation, anxiety, auditory or visual hallucinations, agitation, clouding of consciousness, incoherence, perceptive disturbances, sleep disorders, after weaning from MV. No CS appeared in the 10 pts who had sedation during less than 5 days; in the other23 pts, incidence of CS was 64 % (p < .001). No metabolic etiology was found. The incidence of CS is high in ICU patients when weaning from MV and sedation; this incidence increases with the duration of MV. It should be treated with neuroleptics drugs. Further studies should be performed, in order to consider prevention of CS.