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.