Rotondi AJ, Chelluri L, Sirio C, et al. Patients’ recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit

University of Pittsburgh, Pittsburgh, PA.
Critical Care Medicine (Impact Factor: 6.15). 04/2002; 30(4):746-52. DOI: 10.1097/00003246-200204000-00004
Source: PubMed

ABSTRACT To describe stressful experiences of adult patients who received mechanical ventilation for > or =48 hrs in an intensive care unit.
Prospective cohort study.
Four intensive care units within an East Coast tertiary-care university medical center.
Patients were 150 adult intensive care unit patients receiving mechanical ventilation for > or =48 hrs.
As part of a study of the long-term outcomes of adult patients requiring prolonged mechanical ventilation, we used a 32-item questionnaire to collect data on patients' stressful experiences, both psychological (e.g., fearfulness, anxiety) and physical (e.g., pain, difficulty breathing), associated with the mechanical ventilation endotracheal tube and with being in an intensive care unit. Of 554 patients who met study criteria and survived prolonged mechanical ventilation, 150 consented and were oriented to person, place, and situation. Two thirds of these patients remembered the endotracheal tube and/or being in an intensive care unit. The median numbers of endotracheal tube and intensive care unit experiences remembered were 3 (of 7) and 9 (of 22), respectively. If a patient remembered an experience in the questionnaire, it was likely to be moderately to extremely bothersome. Some of the items that many patients found to be moderately to extremely bothersome were pain, fear, anxiety, lack of sleep, feeling tense, inability to speak/communicate, lack of control, nightmares, and loneliness. Stressful experiences associated with the endotracheal tube were strongly associated with subjects' experiencing spells of terror, feeling nervous when left alone, and poor sleeping patterns.
Subjects were more likely to remember experiences that were moderately to extremely bothersome. This might be because the more bothersome experiences were easier to recall or because most of these experiences are common and significant stressors to many of these patients. In either case, these data indicate that these patients are subject to numerous stressful experiences, which many find quite bothersome. This suggests the potential for improved symptom management, which could contribute to a less stressful intensive care unit stay and improved patient outcomes.

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    • "In a retrospective Rotondi et al., study [24] of stressful experiences of intubated patients in an ICU, a majority of subjects remembered having trouble speaking during intubation. Most of those subjects rated speaking difficulties as moderately to extremely bothersome. "
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    ABSTRACT: Background Intubated patients experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech which creates patient agitation. Aim To determine the impact of using augmented alternative communication methods on outcome of intubated COPD patients. Patients and methods Sixty male COPD intubated patients at the pulmonary critical care unit Mansoura University hospital were randomly assigned into two groups of 30 patients for each. The control group involved patients receiving the routine nursing communication practices while the study group involved patients who utilized modified communication board and paper/pen as an augmented alternative communication methods. Unconscious patients, visual and/or hearing impairment were excluded. Patient satisfaction questionnaire (PSQ), Patient Communication level, duration of intubation and mortality were adopted as endpoints. Results Based on PSQ, 10% in the study group were very dissatisfied compared to 53.33% in the control group the difference was statistically significant. On the other hand, 40% in the study group were very satisfied compared to 6.66% in the control which was a statistically significant increase p < 0.001. However, the mortality did not differ significantly in both groups 16.66% in the control group compared to 13.33% in the study group. Conclusion Alternative communication methods can improve the level of satisfaction and decrease distress but it did not change mortality in intubated COPD patients.
    08/2014; 64(1). DOI:10.1016/j.ejcdt.2014.07.006
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    • "Approximately 15.6% of participants in the present study did not have any recollection of their stay in the ICU. This rate disagrees with those reported by other authors, which were higher (34%,(16) 30%,(18) and 40%).(19) This divergence was most likely due to differences in the methods used for the assessment of participants. "
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    ABSTRACT: Objective: To investigate the relationship between sedation and the memories reported by patients subjected to mechanical ventilation following discharge from the intensive care unit. Methods: This prospective, observational, cohort study was conducted with individuals subjected to mechanical ventilation who remained in the intensive care unit for more than 24 hours. Clinical statistics and sedation records were extracted from the participants' clinical records; the data relative to the participants' memories were collected using a specific validated instrument. Assessment was performed three months after discharge from the intensive care unit. Results: A total of 128 individuals were assessed, most of whom (84.4%) reported recollections from their stay in the intensive care unit as predominantly a combination of real and illusory events. The participants subjected to sedation (67.2%) at deep levels (Richmond Agitation-Sedation Scale [RASS] -4 and -5) for more than two days and those with psychomotor agitation (33.6%) exhibited greater susceptibility to occurrence of illusory memories (p>0.001). Conclusion: The probability of the occurrence of illusory memories was greater among the participants who were subjected to deep sedation. Sedation seems to be an additional factor that contributed to the occurrence of illusory memories in severely ill individuals subjected to mechanical ventilation.
    Revista Brasileira de Terapia Intensiva 04/2014; 26(2):122-129. DOI:10.5935/0103-507X.20140018
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    • "Our study population is likely highly susceptible to anxiety in the short and long term due to prolonged ICU stay, multiple care transitions and repeated failed weaning attempts. Previous studies have identified substantial discomfort associated with the ETT (Rotondi et al., 2002) though no identified studies examine patient experience of tracheostomy in similar depth. A large randomised trial found early tracheostomised patients were 'comfortable' using subjective assessment by bedside nurses for more days than late tracheostomised patients (Trouillet et al., 2011). "
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    ABSTRACT: To compare memories and recall of intensive care unit and specialised weaning centre admission, characterise health-related quality of life and psychological morbidity, and examine the relationship between delusional memories and psychological outcomes. We recruited participants following hospitalisation that included ICU admission and subsequent weaning in a specialised centre. We administered validated questionnaires to assess memory and recall of both care locations, anxiety, depression, post-traumatic stress symptomatology and health-related quality of life. Of 53 eligible patients discharged from the weaning centre over seven years, we recruited 27 participants. Participants had similar numbers of factual and feeling memories but reported more delusional memories for ICU than the weaning centre (1.6 vs. 0.7, P=0.004). Nine (39%) participants scored ≥11 on the hospital anxiety and depression scale (anxiety) and were more likely to experience delusional memories (P=0.008). Thirst (70%), no control (70%), noise (65%) were most frequently recalled ICU experiences. Procedures (83%), night awakening (70%), inability to sleep (70%) most frequently recalled from the weaning centre. Delusional memories and anxiety disorder were prevalent and associated suggesting interventions to ameliorate delusional memories may reduce anxiety. Difficulty sleeping and thirst were common experiences.
    Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 12/2013; 30(3). DOI:10.1016/j.iccn.2013.11.002
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