Memphis Lung Research Program
University of Tennnessee Health Science Center
Coleman College of Medicine
956 Court Avenue, Room H316
Memphis, TN 38163

ARDS and Sepsis - Post Traumatic Stress Syndrome

Intensive care treatment of ARDS and septic shock is associated with a considerable amount of physical and emotional stress for patients. In addition to a highly stressful acute situation due to systemic infection and multiple organ dysfunction, many survivors of intensive care report emotionally traumatic episodes such as anxiety, pain, respiratory distress or nightmares (1-3). There is now considerable evidence to support the hypothesis that combined exposure to maximal physical and psychological stress can result in long-term emotional sequelae such as post-traumatic stress disorder (PTSD) in survivors. Post-traumatic stress disorder (PTSD) is a well-defined syndrome that follows the experience of one or more highly stressful events. Events that trigger PTSD involve experiencing a serious threat to one’s own physical integrity, which is experienced with intense fear, horror and helplessness.

There is evidence from a number of studies of a protective role of glucocorticoids for both animals and humans during high stress. If one regards PTSD as an undetermined and uncontrolled stress reaction, then the administration of stress doses of glucocorticoids during the stressful event could theoretical result in a lower incidence of PTSD. The secretion of cortisol from the adrenal cortex follows the initial release of catecholamines and cortisol plays an important role in down-regulating and terminating the stress-response. When the danger of the organism is past or the infection controlled, the inactivation of the stress response appears to be critical. If inactivation is inefficient, there is continued overexposure to stress mediators, which could lead to a number of chronic stress syndromes including post-traumatic stress disorder.

Effects of Glucocorticoid Treatment

ARDS and septic shock can be regarded as an extreme example of overwhelming stress. There is evidence that the glucocorticoids response during ARDS and septic shock is attenuated compared to the response in the much less stressful situation after recovery. The administration of glucocorticoids may help to correct this imbalance and to override glucocorticoid resistance.


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