Weaning from prolonged mechanical ventilation using an antipsychotic agent in a patient with acute stress disorder

To report the use of a second-generation antipsychotic agent to assist weaning from prolonged mechanical ventilation in an anxious patient.

Case report.

Medical intensive care unit at the Hospital of the University of Pennsylvania.

A 39-yr-old white female whose severe anxiety prohibited weaning from prolonged mechanical ventilation.

Initiation of quetiapine as treatment for severe anxiety that was unresponsive to sedative hypnotics.

Once a therapeutic dose of quetiapine was reached, ventilator support was removed within 24 hrs.

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.