Analgesics and sedatives are integral for the relief of pain and anxiety in critically ill patients. However, these agents may contribute to amnesia for intensive care unit (ICU) events; which has been associated with development of posttraumatic stress disorder. Drug administration strategies that minimize sedative use have been associated with less amnesia. The objective of this pilot study was to evaluate recall of ICU stay in patients managed with 2 sedation strategies: a sedation protocol or a combination of sedation protocol and daily sedative/analgesic interruption.
A questionnaire was administered on day 3 following ICU discharge to evaluate patients' recollections of pain, anxiety, fear, and sleep, as well as memories for specific ICU procedures. Participants were ICU survivors who had been enrolled in SLEAP - a randomized pilot trial comparing two sedation strategies, at 3 university-affiliated medical/surgical ICUs.
Twenty-one patients who regained orientation within 72 hours of ICU discharge completed the questionnaire. More than 50% of patients recalled experiencing pain, anxiety, and fear to a moderate or extreme extent; and 57% reported inadequate sleep while in the ICU. Of the 21 patients, 48%, 33%, and 29% had no memories of endotracheal tube suctioning, being on a "breathing machine," and being bathed, respectively.
A notable percentage of patients discharged from the ICU report moderate to extreme pain, anxiety, and fear, and inability to sleep during their ICU stay; and 29% to 48% have no recall of specific ICU events.
"Standard protocols for systematic pain and sedation assessment and treatment are associated with improved quality and outcomes (Girard et al., 2008; Jacobi et al., 2002). Despite this, studies show that the recommendations suggested are still not implemented (Ethier et al., 2011; Martin et al., 2007; Mehta et al., 2009). Fewer than 50% of patients treated with analgesics and sedatives were systematically assessed in a French multi-centre study (Payen et al., 2009). "
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: To examine nurses' experiences of performing clinical judgements of patient pain and sedative requirements after implementation of assessment tools, and how the tools influenced these judgements. BACKGROUND: Clinical judgement in ICU pain and sedation management is complex. There appears to be a gap between knowledge, attitudes and practice, reflecting an overall lack of adherence among nurses to standardised care. DESIGN: Exploratory qualitative investigation based on principles from Tanner's Clinical Judgment Model, using focus group interviews. METHODS: Fourteen ICU nurses were included in two focus groups and interviewed twice during the implementation period. The interviews reflected central themes on the use of assessment tools related to the nurses' clinical experience in ICU pain treatment and sedation, and were interpreted through a systematic classification process of coding and identification of themes and patterns. FINDINGS: Four themes emerged as central: (1) balancing clinical judgement and the use of tools; (2) improvement of collaboration, documentation and goal achievement; (3) enhanced evaluation of the patient's response and (4) emphasis on the ICU patient's characteristics. CONCLUSION: The use of tools was perceived to improve the quality of pain control and sedation, and supported nurses in their decision-making. Great importance was attached to personal knowledge and experience.
Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 12/2012; 29(3). DOI:10.1016/j.iccn.2012.11.003
[Show abstract][Hide abstract] ABSTRACT: Transplantation leads the patients through an out-of-the-norm illness course as the context and the treatments are accompanied sometimes with extreme physical and psychological constraints and strains. For some patients, a passage in an intensive care unit is part of this illness and treatment course. The experience of an intensive care context and of continuous care confront the transplanted patient to extreme negative experiences: hallucinations, delusions, psychotic experiences, depressive anxiety and intensive care unit syndrome or relocation syndrome. Pathologizing diagnoses negatively perceived by the patients, preventing them from talking freely about these disturbing experiences. In interviews conducted in a longitudinal qualitative study, 22 heart, lung and liver transplanted patients discussed their out-of-the norm experiences during their intensive care unit stay after transplantation. Patients described how these out-of-the-norm experiences questioned their existential values. Negative but also positive experiences were mentioned. These results are compared to the available theoretical backgrounds and research, which do not account for the emotional transformation and awareness that accompany these out-of-the-norm experiences. Medication, a threatening environment and invasive care can provide some explanations that do not correspond to the reality and the emotional presence of these experiences which leave long lasting traces. Non-normative psychological support is discussed in the context of existential therapy background and in the perspective of the new propositions in consultation for the future DSM-V. Transplantation confronts the patients and the professionals to the unexpected and requires new interpretative paradigms in order to account for the patients’ experience. These results are disturbing as physical and psychological suffering is mentioned in spite of medication and attentive care. These out-of-he-norm experiences are grounded in a medical objective reality, and should be confronted to the medical history of the patients.
[Show abstract][Hide abstract] ABSTRACT: The Spanish Society of Critical Care Medicine (SEMICYUC) has recently published an updated version of Quality Indicators in Critical Care. Daily sedative interruption is included among them. As this practice is controversial, research studies are revised and guidelines for its implementation are proposed.
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