Case Report Crit Care & Shock (2015) 18:31-33 Psychological ventilator dependence: A case report Harshal Sathe, Nilesh Shah, Avinash De Sousa Abstract Weaning a patient off mechanical ventilation, especially when they have been dependent on it for a long time, can be a difficult task. Many physical and psychological factors contribute towards dependence on the ventilator. We re- . port a case of a 28-year-old female patient that developed anxiety and a psychological depend- ence on the ventilator thereby making weaning off difficult. Timely psychiatric intervention resulted in successful weaning off the ventilator. Key words: Weaning, mechanical ventilation, psychological dependence. Crit Care & Shock 2015 Vol. 18 No. 1 31 Address for correspondence: Dr. Avinash De Sousa Carmel, 18, St. Francis Road, Off SV Road, Santacruz West, Mumbai 400054, India Tel: 91-22-26482869 Email: avinashdes888@gmail.com From Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India (Harshal Sathe, Nilesh Shah, and Avinash De Sousa). Patients admitted to critical care unit and on me- chanical ventilation usually have severe medical illnesses and weaning a patient off this assisted ventilation once the illness recovers is often a complex process. (1) Patients who have been on mechanical ventilation may develop a physical and psychological dependency on the ventilation pro- cess and weaning may become difficult. This is in keeping with various factors like age, level of emo- tional and cognitive function, past history of psy- chological problems, cultural issues, fear and a sense of degradation physically that develops. (2) Patients on mechanical ventilation often show mul- tiple complications due to polypharmacology, sleep disruptions and cognitive deficits in orienta- tion, short and long term memory, language and reasoning that may develop in as many as 1 in 5 cases. (3) Good support of the relatives and family members along with proper communication and reassurance by the treating doctor is instrumental in successful removal of mechanical ventilation once the patient is better. (4) Psychiatric comorbid- ity is very high in this population and up to 52% of these cases may have delirium as well as 30-40% show symptoms of anxiety, depression and psy- . Introduction chological distress. (5) We present herewith a case of a 28-year-old female patient admitted to the in- tensive care unit of our hospital and was on me- chanical ventilation, but developed complications in the weaning off phase which on careful analysis turned out to be purely psychological in nature. Case report A 28-year-old female patient who had a road traf- fic accident on a bike was admitted to a private trauma centre. She was put on the ventilator due to difficulty in breathing. She was on full assisted breathing mode (volume AC mode) and also on supportive management. Gradually over 30 days as her arterial blood gas (ABG) parameters normal- ized she was weaned to SIMV mode (Synchro- nized Intermittent Mandatory Ventilation mode) and then to CPAP (Continuous Positive Airway Pressure mode) where she could breathe spontane- ously. The intensivist’s plan of action was to re- move ventilator support thereafter as her ABG stats were normalized and put her on the T-piece. But the moment the ventilator tube was removed she started hyperventilating and violently shaking with intense chest and abdominal movements, which would give the intensive care specialist a feeling that the patient had breathlessness and they would put her again on the ventilator support. This continued for about 10 days and on noticing that the doctors were unable to wean her successfully, her relatives decided to shift her to the intensive care unit at our hospital. She was admitted to in- tensive care ward where the same attempts of weaning her off the ventilator were made but any such attempt would be unsuccessful. The doctors suspected that the patient was developing a psy- .