Purpose: Mechanically ventilated patients routinely receive sedative medications to manage patient symptoms of anxiety and agitation. However, these medications are associated with multiple complications and the effectiveness of sedation for improving symptoms during mechanical ventilation has not been evaluated from the patient’s perspective. The purpose of this study is to examine the relationship between the pattern of sedation and mechanically ventilated patients’ evaluation of critical care and to identify non-pharmacologic interventions patients find effective during mechanical ventilation.
Subjects: Sixty-nine mechanically ventilated patients were enrolled from a medical surgical intensive care unit in a Midwestern community hospital of whom 35 completed post ICU interviews. Subjects completing interviews had a mean age of 66 (SD 12.6) and were mechanically ventilated for an average of 4.5 days (SD 6.8).
Methods: Level of arousal data utilizing the Motor Activity Assessment Scale and all sedative medication received were abstracted from the medical record. Subject interviews were conducted after ICU transfer and included the ICU Memory Tool and Intensive Care Experience Questionnaire. Latent Class Growth Analysis was used to classify subjects based on patterns of arousal and sedative exposure over the first 5 days of mechanical ventilation.
Results: The most common memory of ICU was confusion. Hallucinations, difficult communication, and feelings of loss of control were the most disturbing memories for subjects. Subjects that were minimally arousable over the first five days of mechanical ventilation had more delusional memories of ICU. There was no difference in patient satisfaction, awareness of surroundings, frightening experiences, memories of negative feelings, or factual memories based on level of arousal. Sedative exposure did not impact patients’ memories of ICU. A lower level of arousal and higher sedative exposure were associated with increased time on the ventilator and in the ICU. Subjects reported family presence, receipt of information, and freedom of movement as helpful during mechanical ventilation.
Conclusions: Deeply sedating mechanically ventilated patients may not be effective for improving the patient’s experience. Improving communication, frequent provision of information, providing choices to patients, and inclusion of patients’ families are basic interventions that may improve the patients’ experience of mechanical ventilation.
University of Minnesota Ph.D. dissertation. June 2011. Major: Nursing. Advisor: Linda Chhlan. 1 computer file (PDF); xii, 166 pages, appendices A-C.
Guttormson, Jill Lynn.
Patients' recall and evaluation of mechanical ventilation: impact of sedation..
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