Ventilator Dependent Patients Successfully Weaned with Cognitive Behavioral Therapy: A Case Series

Abstract Objective A large subset of patients on intensive care units (ICU) struggle to wean from mechanical ventilation despite medical readiness. Prolonged ventilation is associated with 40% of all ICU costs and medical complications. Current weaning protocols do not directly address anxiety and, when anxiety is targeted in clinical practice, pharmacotherapy is often the first-line intervention, despite a host of side effects. Data Sources We present two case studies investigating whether cognitive behavioral therapy (CBT) is an effective treatment for anxiety in the ventilated patient, and whether it facilitates ventilator weaning. Outcome variables were self-report questionnaires and time off the ventilator. Findings CBT reduced respiratory anxiety, panic symptoms, generalized anxiety, depression and facilitated weaning from mechanical ventilation. Conclusions This case series suggests that CBT for the ventilated patient may have significant implications for reducing morbidity, mortality, length of stay, and the expenses associated with prolonged ventilation. Implications and future directions are discussed.