• Armando J Rotondi, Lakshmipathi Chelluri, Carl Sirio, Aaron Mendelsohn, Richard Schulz, Steven Belle, Kelly Im, Michael Donahoe, and Michael R Pinsky.
• University of Pittsburgh, Pittsburgh, PA.
• Crit. Care Med. 2002 Apr 1;30(4):746-52.

ObjectiveTo describe stressful experiences of adult patients who received mechanical ventilation for > or =48 hrs in an intensive care unit.DesignProspective cohort study.SettingFour intensive care units within an East Coast tertiary-care university medical center.PatientsPatients were 150 adult intensive care unit patients receiving mechanical ventilation for > or =48 hrs.InterventionNone.Measurements And Main ResultsAs 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.ConclusionsSubjects 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.

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