The Experience of Acute Mechanical Ventilation From the Patient's Perspective

Abstract

Background The Pain, Agitation, and Delirium guidelines influenced practice to support targeted, light sedation for the mechanically ventilated patient. This practice is associated with improved clinical outcomes, but it remains unclear how it impacts the patient experience. Objective The objective was to determine the pervasive patient experience components and how the experience may have been influenced by targeted, light sedation practices. Methods A prospective observational study using mixed methodology and a convenience sample was conducted after institutional review board approval was obtained. Inclusion criteria were the following: acute mechanical ventilation of less than 14 days, 18 years or older and able to provide consent, English speaking, and delirium-free. Exclusion criteria were the presence of delirium or intravenous opioids/sedatives within 24 hours prior to the interview. The quantitative component included simple yes or no questions and identification of quantitative adjectives describing the mechanical ventilation experience. Every 10th patient was invited to participate in an expanded qualitative interview. Results Data were collected for 12 months with a total sample size of 130 patients participating in the quantitative component and a subset of 15 patients also participating in the qualitative interview. Sixty percent of the total sample consisted of cardiothoracic surgery patients, and 40% were mixed intensive care unit patient populations. Descriptive statistics include the following averaged values: Richmond Agitation Sedation Scale scores −1.7 throughout mechanical ventilation, aged 59.9 years, days mechanically ventilated 1.4, intensive care unit length of stay 4.6 days, and Acute Physiology and Chronic Health Evaluation II score 16.1. The most significant finding was that 56.2% of patients who could not communicate reported feeling afraid, whereas 32.5% of those who could communicate reported feeling afraid (P < .027). The themes identified in the qualitative component of the study reinforced these quantitative findings; 10 of the 15 patients interviewed reported experiencing fear, and all of the patients reported issues with communication. Discussion The clinical implications of this research study primarily affect critical care nursing. Changes in nursing practice can address these findings to improve and more effectively acknowledge the patient experience.

Adult Patients’ Experience of Coercion in Intensive Care: A Scoping Review

“…In the collection of patient experiences of acute mechanical ventilation reported by Roberts et al, the majority of patients had memory of mechanical ventilation. They associated restraining measures and mechanical ventilation with fear and helplessness [29]. When patients were able to recall their ICU stay and experience with restraints, they expressed a range of negative feelings, which could be related to some forms of restraint.…”

“…Table 4 shows that negative experiences in the ICU were not only related to the use of physical restraints; other aspects commonly linked to negative perceptions included lack of control, helplessness, noise, anxiety, pain, ventilation, dependency, insomnia and delirium with or without accompanying hallucinations. Endotracheal tubes, which interfere with active communication during ventilation, were especially linked to the perception of helplessness and dependency [24][25][26][27][28][29][30]32]. Many patients attributed a sense of loss of dignity to dependency and lack of control [25][26][27]29].…”

“…Endotracheal tubes, which interfere with active communication during ventilation, were especially linked to the perception of helplessness and dependency [24][25][26][27][28][29][30]32]. Many patients attributed a sense of loss of dignity to dependency and lack of control [25][26][27]29]. Moreover, feelings like powerlessness, uncertainty, and 'feeling lost' were commonly described in combination with anxiety [27].…”

“…A number of studies reported that patients had incomplete, confusing or delirious memories[24][25][26][27][28][29][30]. Minnick et al describe incomplete recollection in 60% of patients who underwent restraining measures during their stay in the ICU…”

Long-Term Prognosis of Older Adults Who Survive Emergency Mechanical Ventilation

“…5 In addition, mechanically ventilated patients often cannot communicate well, making it difficult to express their wishes; most of these patients report feeling afraid. 6,7 Yet, there is significant heterogeneity in the goals of care of seriously ill older adults, many of whom considered some disease states, including requiring a breathing tube to live, to be worse than death. 8 Therefore, emergency mechanical ventilation in older adults is a high-risk intervention with uncertain or variable efficacy to meet the patient's goals.…”