Weaning from prolonged mechanical ventilation using an antipsychotic agent in a patient with acute stress disorder

OBJECTIVE: To report the use of a second-generation antipsychotic agent to assist weaning from prolonged mechanical ventilation in an anxious patient. DESIGN: Case report. SETTING: Medical intensive care unit at the Hospital of the University of Pennsylvania. PATIENT: A 39-yr-old white female whose severe anxiety prohibited weaning from prolonged mechanical ventilation. INTERVENTIONS: Initiation of quetiapine as treatment for severe anxiety that was unresponsive to sedative hypnotics. MEASUREMENTS AND MAIN RESULTS: Once a therapeutic dose of quetiapine was reached, ventilator support was removed within 24 hrs. CONCLUSIONS: A second-generation antipsychotic agent was successfully used to facilitate weaning in a very anxious patient, possibly secondary to anxiolysis or direct effect on respiratory drive. Further investigations of pharmacologic intervention should be done to inform practice guidelines in difficult-to-wean patients suffering from severe anxiety.