title: Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit.
abstract: OBJECTIVE
  To describe stressful experiences of adult patients who received mechanical ventilation for > or =48 hrs in an intensive care unit.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Four intensive care units within an East Coast tertiary-care university medical center.
  
  
  METHODS
  Patients were 150 adult intensive care unit patients receiving mechanical ventilation for > or =48 hrs.
  
  
  METHODS
  None.
  
  
  RESULTS
  As part of a study of the long-term outcomes of adult patients requiring prolonged mechanical ventilation, we used a 32-item questionnaire to collect data on patients' stressful experiences, both psychological (e.g., fearfulness, anxiety) and physical (e.g., pain, difficulty breathing), associated with the mechanical ventilation endotracheal tube and with being in an intensive care unit. Of 554 patients who met study criteria and survived prolonged mechanical ventilation, 150 consented and were oriented to person, place, and situation. Two thirds of these patients remembered the endotracheal tube and/or being in an intensive care unit. The median numbers of endotracheal tube and intensive care unit experiences remembered were 3 (of 7) and 9 (of 22), respectively. If a patient remembered an experience in the questionnaire, it was likely to be moderately to extremely bothersome. Some of the items that many patients found to be moderately to extremely bothersome were pain, fear, anxiety, lack of sleep, feeling tense, inability to speak/communicate, lack of control, nightmares, and loneliness. Stressful experiences associated with the endotracheal tube were strongly associated with subjects' experiencing spells of terror, feeling nervous when left alone, and poor sleeping patterns.
  
  
  CONCLUSIONS
  Subjects were more likely to remember experiences that were moderately to extremely bothersome. This might be because the more bothersome experiences were easier to recall or because most of these experiences are common and significant stressors to many of these patients. In either case, these data indicate that these patients are subject to numerous stressful experiences, which many find quite bothersome. This suggests the potential for improved symptom management, which could contribute to a less stressful intensive care unit stay and improved patient outcomes.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Rotondi
authors.forename: Lakshmipathi
authors.initials: L
authors.lastname: Chelluri
authors.forename: Carl
authors.initials: C
authors.lastname: Sirio
authors.forename: Aaron
authors.initials: A
authors.lastname: Mendelsohn
authors.forename: Richard
authors.initials: R
authors.lastname: Schulz
authors.forename: Steven
authors.initials: S
authors.lastname: Belle
authors.forename: Kelly
authors.initials: K
authors.lastname: Im
authors.forename: Michael
authors.initials: M
authors.lastname: Donahoe
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
mesh_terms: D001007:Anxiety; D015331:Cohort Studies; D005239:Fear; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000523:psychology; D008132:Loneliness; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D010146:Pain; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000523:psychology*; D013315:Stress, Psychological; D011795:Surveys and Questionnaires