Patterns of Anxiety in Critically Ill Patients Receiving Mechanical Ventilatory Support

School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
Nursing research (Impact Factor: 1.36). 05/2011; 60(3 Suppl):S50-7. DOI: 10.1097/NNR.0b013e318216009c
Source: PubMed


Mechanical ventilation is one of the most frequently used technological treatments in critical care units and induces great anxiety in patients.
Although mechanical ventilation and critical illness induce great anxiety and distress in hospitalized patients, little is known about anxiety ratings over the course of ventilatory support. Knowledge of anxiety ratings over time is needed to implement effective symptom management interventions. The purposes of this study were to describe anxiety ratings for a subgroup of mechanically ventilated patients over the duration of enrollment in a multisite clinical trial, to discern any pattern of change in anxiety ratings, to determine if anxiety decreases over time, and to explore the influence of sedative exposure on anxiety ratings.
Participants were 57 mechanically ventilated patients who were randomly assigned to the usual care group of a randomized controlled trial designed to assess the efficacy of music interventions on anxiety of mechanically ventilated patients in intensive care units. Anxiety ratings were obtained at study entry and daily for up to 30 days. A 100-mm visual analog scale was used to measure anxiety. Visual Analog Scale-Anxiety scores were plotted as a function of study time in days for each participant to discern possible patterns of change. A mixed-models analysis was performed to assess the nature and magnitude of change over time (slope) using 251 observations on 57 patients.
Results of the unconditional means model indicated that further modeling was appropriate. An autoregressive covariance structure with a random component for participant was chosen as the most appropriate covariance structure for modeling. An unconditional growth model indicated that the Visual Analog Scale-Anxiety ratings declined slowly over time: -.53 points per day (p = .09).
Anxiety is an individual patient experience that requires ongoing management with appropriate assessment and intervention over the duration of mechanical ventilatory support.

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Available from: Kay Savik, May 26, 2015
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    ABSTRACT: Little is known about the relationship between anxiety and pain in intensive care unit (ICU) patients despite its importance. The aims of the present study are to examine the correlation between pain and anxiety during ICU care and to investigate its effects on the dose of opioids and anxiolytics administered. The study subjects were awake critically ill patients admitted to an ICU over a 2-month period. Trained psychiatrists evaluated the nondelirious, noncomatose patients daily for anxiety and pain using the Numeric Rating Scale for Pain (NRS-Pain), Faces Anxiety Scale (FAS), and Hamilton Anxiety Rating Scale. Daily alterations of anxiety and pain were significantly correlated with one another among 123 patients. Both the FAS and the Hamilton Anxiety Rating Scale were positively correlated with the NRS-Pain (P < .001 for both). The NRS-Pain score (P = .016) and the FAS score (P = .007) both significantly correlated with the dose of anxiolytics. The dose of opioids was unaffected by the severity of pain or anxiety. Pain and anxiety among critically ill patients in the ICU were closely correlated. Pain and anxiety influenced the dose of anxiolytics administered. Therefore, a precise evaluation and comprehensive approach to the management of pain and anxiety are important for treating ICU patients. Copyright © 2015. Published by Elsevier Inc.
    No preview · Article · Jun 2015 · Journal of Critical Care
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    • "Second, in one study patients were evaluated while still in the ICU [55]. General anxiety symptoms may differ when measured in-hospital versus at 3-months following hospitalization given variability in general anxiety symptoms over time [56] or treatment interventions provided after hospital discharge. Clinical investigators have recently begun to assess whether early psychological intervention may prevent development of anxiety symptoms, including post-ICU posttraumatic stress disorder symptoms, among survivors of critical illness. "
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    ABSTRACT: Acute lung injury (ALI) is common in the intensive care unit (ICU), typically requiring life support ventilation. Survivors often experience anxiety after hospital discharge. We evaluated general anxiety symptoms 3months after ALI for: (1) associations with patient characteristics and ICU variables, and (2) cross-sectional associations with physical function and quality of life (QOL). General anxiety was assessed as part of a prospective cohort study recruiting patients from 13 ICUs at four hospitals in Baltimore, MD using the Hospital Anxiety and Depression Scale - Anxiety Subscale (HAD-A), with associations evaluated using multivariable linear and logistic regression models. Of 152 patients, 38% had a positive screening test for general anxiety (HAD-A≥8). Pre-ICU body mass index and psychiatric comorbidity were associated with general anxiety (OR, 95% confidence interval (CI): 1.06 (1.00, 1.13) and 3.59 (1.25, 10.30), respectively). No ICU-related variables were associated with general anxiety. General anxiety was associated with the number of instrumental ADL dependencies (Spearman's rho=0.22; p=0.004) and worse overall QOL as measured by EQ-5D visual analog scale (VAS) (rho=-0.34; p<0.001) and utility score (rho=-0.30; p<0.001), and by the SF-36 mental health domain (rho=-0.70; p<0.001) and Mental Component Summary score (rho=-0.73; p<0.001). Many patients have substantial general anxiety symptoms 3months after ALI. General anxiety was associated with patient characteristics and impaired physical function and quality of life. Early identification and treatment of general anxiety may enhance physical and emotional function in patients surviving critical illnesses.
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    ABSTRACT: Critical care areas are fast moving, often chaotic, and therefore confusing, even frightening, to patients attempting to understand what has happened to them. The nurse acts to mitigate these reactions by understanding the range of possibilities that can occur with patients, including potential psychiatric issues, and serving as patient advocate to ensure that appropriate treatment is initiated. Certainly there may be other psychiatric problems not described in the preceding text. The main possibilities are covered in this article. Assessing and acting early are tools the critical care nurse uses to meet patient needs and prevent behavioral problems that can interfere with life-preserving care.
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