Shapiro Anna Bovill, Chauhan Mohit, Martin Archer Kilbourne, Sanghavi Devang
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida.
Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida.
JHLT Open. 2023 Sep 23;1:100005. doi: 10.1016/j.jhlto.2023.100005. eCollection 2023 Oct.
A 68-year-old with a history of ischemic cardiomyopathy, chronic kidney disease, hypertension, and anxiety was admitted to the intensive care unit (ICU) in cardiogenic shock. After an intubation and several days in the ICU, he expressed hopelessness with further care and was considering a transition to hospice. The treatment team was concerned that clinical depression was influencing his decision. After obtaining consent, depression was treated with 0.5 mg/kg of intravenous ketamine for 3 days, with rapid and significant improvement in his mood. He made an informed choice to pursue a workup for heart transplantation. Besides improving his mood, ketamine led to vivid subjective experiences. This case provides a qualitative account of the patient's experience. It raises crucial questions about the influence of depressive symptoms in decision-making in critically ill patients and the potential role of ketamine in the rapid resolution of depressive symptoms and subsequent changes in care decisions.
一名68岁男性，有缺血性心肌病、慢性肾病、高血压和焦虑症病史，因心源性休克入住重症监护病房（ICU）。在插管并在ICU治疗数天后，他对进一步治疗表示绝望，并考虑转至临终关怀。治疗团队担心临床抑郁症影响了他的决定。在获得同意后，使用0.5mg/kg静脉注射氯胺酮治疗抑郁症3天，他的情绪迅速且显著改善。他做出了明智的选择，接受心脏移植检查。除改善情绪外，氯胺酮还导致了生动的主观体验。本病例对患者的经历进行了定性描述。它提出了关于重症患者决策中抑郁症状的影响以及氯胺酮在快速缓解抑郁症状和随后护理决策变化中的潜在作用的关键问题。
