Differential Perceptions of Noninvasive Ventilation in Intensive Care among Medical Caregivers, Patients, and Their Relatives

Abstract

Background Noninvasive ventilation (NIV) requires a close “partnership” between a conscious patient and the patient’s caregivers. Specific perceptions of NIV stakeholders and their impact have been poorly described to date. The objectives of this study were to compare the perceptions of NIV by intensive care unit (ICU) physicians, nurses, patients, and their relatives and to explore factors associated with caregivers’ willingness to administer NIV and patients’ and relatives’ anxiety in relation to NIV. Methods This is a prospective, multicenter questionnaire-based study. Results Three hundred and eleven ICU physicians, 752 nurses, 396 patients, and 145 relatives from 32 ICUs answered the questionnaire. Nurses generally reported more negative feelings and more frequent regrets about providing NIV (median score, 3; interquartile range, [1 to 5] vs. 1 [1 to 5]; P < 0.0001) compared to ICU physicians. Sixty-four percent of ICU physicians and only 32% of nurses reported a high level of willingness to administer NIV, which was independently associated with NIV case-volume and workload. A high NIV session–related level of anxiety was observed in 37% of patients and 45% of relatives. “Dyspnea during NIV,” “long NIV session,” and “the need to have someone at the bedside” were identified as independent risk factors of high anxiety in patients. Conclusions Lack of willingness of caregivers to administer NIV and a high level of anxiety of patients and relatives in relation to NIV are frequent in the ICU. Most factors associated with low willingness to administer NIV by nurses or anxiety in patients and relatives may be amenable to change. Interventional studies are now warranted to evaluate how to reduce these risk factors and therefore contribute to better management of a potentially traumatic experience. (Anesthesiology 2016; 124:1347-59)

“I had the feeling that I was trapped”: a bedside qualitative study of cognitive and affective attitudes toward noninvasive ventilation in patients with acute respiratory failure

“…The study was approved as ancillary to the PARVENIR study [5] by the Comité de Protection des Personnes Ile-de-France 6 (ethical committee). The patients gave written, informed consent to participate.…”

“…Appropriately used, NIV brings important clinical benefits [2][3][4]. NIV also has its specific complications (e.g., facial skin lesions due to the pressure exerted by the mask) and can be perceived as a stressful experience: up to one-third of patients treated by NIV for acute respiratory failure associate it with high levels of anxiety [5]. Studies conducted in other contexts show that certain barriers to NIV can compromise adherence to treatment and even lead to its refusal [6].…”

“…Attitudes toward NIV for acute respiratory failure differ between ICU physicians, ICU nurses, the patients, and their relatives [5]. The "PARVENIR" study, a prospective multicenter study conducted in French and Belgian ICUs [5], showed that physicians tend to consider NIV more positively than nurses, even though both professions agree that the treatment is stressful for the patients [5].…”

“…Attitudes toward NIV for acute respiratory failure differ between ICU physicians, ICU nurses, the patients, and their relatives [5]. The "PARVENIR" study, a prospective multicenter study conducted in French and Belgian ICUs [5], showed that physicians tend to consider NIV more positively than nurses, even though both professions agree that the treatment is stressful for the patients [5]. Patient attitudes are mixed: they reported considering NIV "pleasant" more often than nurses and "traumatic" less often than nurses, but at the time of ICU discharge, about one-third expressed regret that they had received NIV rather than having been intubated [5].…”

“…The "PARVENIR" study, a prospective multicenter study conducted in French and Belgian ICUs [5], showed that physicians tend to consider NIV more positively than nurses, even though both professions agree that the treatment is stressful for the patients [5]. Patient attitudes are mixed: they reported considering NIV "pleasant" more often than nurses and "traumatic" less often than nurses, but at the time of ICU discharge, about one-third expressed regret that they had received NIV rather than having been intubated [5]. This is why we conducted the present research, as an addition to the PARVENIR study, with the aim of better understanding the determinants of the patients' final regretful opinion and to refine our knowledge of patients' cognitive representations of NIV (utility and efficacy) and their affective associations (feelings toward NIV).…”