Question
What is the impact of anxiety on the recovery of pulmonary patients?
Answer
Prolonged Mechanical Ventilation
Prolonged mechanical ventilation is the biggest consequence of anxiety. High levels of anxiety result in more ventilator days, 14 versus 6. We are definitely not going to be able to be weaning our patients as we like. High levels of anxiety result in longer lengths of stay, from 12 in this study versus five. Prolonged mechanical ventilation may also result in ventilator-acquired pneumonia, malnutrition, PTSD, or depression.
Device Disruption
Anxious or agitated patients are more likely to self-extubate, decannulate, pull off their high flow nasal oxygen, or pull out their catheter or NG tubes. This increases the risk of infection, injury, or other medical complications. When respiratory rates are above therapeutic levels, patients are unable to participate in therapy. They are unable to trial the speaking valve and unable to wean from the mechanical ventilator or the tracheostomy tube.
Anxiety and the Immune System
In addition, anxiety affects the immune system. Anxiety is stress, which affects the immune system, as well as all of our other systems. Even just a few minutes of anxiety or stress can inhibit the first responder activity of the immune system. The first responders of the immune system are the macrophages, the T-cells, and the B-cells that destroy pathogens. They just gobble them up. There are anti-microbial peptides that are released before the macrophages and the T and the B-cells are able to respond as a first responder for this type of stress and anxiety. Chronic anxiety weakens all types of immune responses. Elderly people, of those already ill, are more prone to stress and stress-related immune changes.
Anxiety and the Heart
Anxiety also has an effect on the heart. Eighty percent of those experiencing panic list rapid or irregular heart rate as a symptom. This may increase the risk of cardiac arrest. Chronic anxiety is related to a 26% increase in coronary heart disease. Anxiety also results in increased blood pressure, which weakens the heart muscle and increases the risk of coronary heart disease and stroke.
This Ask the Expert is an edited excerpt from the course, Caring for the High Anxiety Pulmonary Patient and Family, presented by Nancy Nathenson, BS, RRT.
