Transtornos de estresse pós-traumático após sepse grave ou choque séptico

Abstract

Post Traumatic Stress Disorder (PTSD) is a medical condition characterized by symptoms of anxiety and depression occurring in people who have a history of traumatic events. This disorder was initially diagnosed in patients that have been exposed to violent events, such as rape or war. Recently, however, PTSD has been also recognized in patients that survived after intensive care unit (ICU) stay. This phenomenon seems to be related to dysfunction of the hypothalamus-pituitary-adrenal axis (HPA) observed in patients treated in ICUs. Since it is known that severe sepsis and septic shock may lead to a situation called critical illness-related corticosteroid insufficiency (CIRCI), we hypothesized that PTSD development after severe sepsis could also be related to HPA dysfunction during sepsis treatment. We performed a literature search, using different databases and diverse combinations of the terms PTSD, sepsis and HPA. Fifteen articles were retrieved and only three filled all the requisites. These three publications were reviewed here. We conclude that the available data are not sufficient to confirm a direct relationship between a sepsis-related hypothalamic-pituitary-adrenal axis dysfunction and the development of post-traumatic stress disorder. Although there is concrete evidence about the existence of this correlation, the published articles represent the work of just one research group, include few patients and did not take into consideration the effect of the intensive care stay in their conclusions.