Following cardiac surgery, patients are typically admitted to the intensive care unit (ICU) for a short period of time. Studies suggest that 14 to 25 percent of these patients develop posttraumatic stress disorder (PTSD) and 23 to 32 percent develop depression. Corticosteroids produced via the hypothalamus-pituitary-adrenal (HPA) axis bind to glucocorticoid and mineralocorticoid receptors and help patients adapt to changing environments. Therefore, it is thought that patients with reduced HPA axis activity may be less able to adapt to such changes.
Kok, Hillegers, Veldhuijzen, et al. studied the effect of dexamethasone on the prevention of PTSD and depression among 1,125 patients admitted to the ICU following cardiac surgery between April 2006 and November 2011. Dexamethasone is a synthetic glucocorticoid, which acts on glucocorticoid receptors (GR) to produce anti-inflammatory effects. Of the 1,125 patients enrolled in this study, 561 patients received 1 mg/kg dexamethasone intravenously. This dose was administered following the start of anesthesia and prior to cardiopulmonary bypass. The remaining 564 patients received placebo.
In their 1.5-year follow-up, the authors report similar numbers of patients with PTSD or depression between the treatment and control groups. Among patients who received dexamethasone, 52 patients and 69 patients developed PTSD or depression, respectively. In comparison, 66 patients who received placebo had PTSD and 78 had depression at the time of follow-up. Overall, these results suggest that intraoperative administration of 1 mg/kg dexamethasone has no effect on patients’ likelihood of developing PTSD or depression following ICU discharge. However, dexamethasone was found to have a positive effect on female patients, reducing the prevalence of these psychiatric conditions in this subgroup.
Although this article specifically discusses the development of PTSD and depression following cardiac surgery, it is also applicable to other surgical procedures that require patients be admitted to the ICU. Therefore, this problem effects many patients we will see in the future as pharmacists. By suggesting that dexamethasone is not effective for the prevention of psychiatric conditions in patients following ICU discharge, the authors also demonstrate the need for further research for a solution.