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: 6.31). 04/2002; 30(4):746-52. DOI: 10.1097/00003246-200204000-00004
Source: PubMed


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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Available from: Lakshmipathi Chelluri, Feb 17, 2014
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    • "Mechanical ventilation (MV) is a common, lifesaving and frequently employed treatment modality for a variety of medical diagnoses in intensive care units (ICU) (Besel, 2006). While this intervention itself is a life saving treatment, patients who are mechanically ventilated often face a variety of distressing situations including anxiety and agitation due to emotional distress, fear of pain or dying, fear raised from family members' previous experiences of those who have died in similar situations, discomfort, thirst, immobility, dyspnoea, confusion, and inability to relax (Dijkstra et al., 2010), pain, lack of sleep, tenseness, lack of control and loneliness, which are typically common stress and anxious reactions even when patients are sedated (Yagan et al., 2000; Rotondi et al., 2002; Thomas, 2003). Patients undergoing MV require endotracheal intubation and often have either intermittent or sustained periods of agitation because of the endotracheal tube itself. "
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    DESCRIPTION: This study provides evidence for the use of naturesound as an anxiolytic intervention
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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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