Management of post-extubation anxiety in the intensive care unit

Abstract

Post-extubation anxiety causes significant distress in intensive care unit patients. This review provides treatment recommendations for managing anxiety during weaning and extubation from mechanical ventilation. Factors predisposing to anxiety include cerebral vascular disease, endocrine disorders, cardiopulmonary decompensation, disrupted sleep-wake cycles, and the stressful ICU environment. This review analyzed 21 articles sourced from Google Scholar and PubMed, focusing on case reports, case series, systematic reviews, and meta-analyses. These studies reported that dexmedetomidine effectively reduces extubation time and ICU length of stay through its anxiolytic properties. Antipsychotics, like quetiapine, showed potential in managing anxiety during ventilator weaning, but high-dose haloperidol posed risks. Benzodiazepines were linked to paradoxical agitation and respiratory suppression. Non-pharmacological treatments, such as aromatherapy, music therapy, and massage therapy, appeared to reduce anxiety and improve sleep quality. Caregiver approaches, including parental presence and psychological training, also reduced anxiety. In conclusion, non-pharmacological approaches should be prioritized, and pharmacological treatments considered when necessary. More research is essential to identify optimal treatments for post-extubation anxiety with minimal patient risk and effective symptom control.

Keywords: Anxiety, ICU patients, critically ill patients, post-extubation