Mechanically ventilated patients experience multiple physical and psychological symptoms including discomfort from the endotracheal tube;fear regarding recovery, and altered cognition. The majority of patients receive sedative medications to reduce symptoms. Although sedation may be indicated at times, it is associated with multiple adverse outcomes such as post traumatic stress disorder, depression, muscle weakness, and prolonged time on the ventilator. Physical and psychological difficulties can continue for years after intensive care unit (ICU) discharge impacting quality of life and ability to resume work. Changes in practice have lagged behind evidence of the harm of excess sedation. Studies of sedation and patient outcomes after mechanical ventilation have focused on time on the ventilator, length of ICU stay, and psychological and physical sequela. The effectiveness of sedation for symptom management during mechanical ventilation has not been evaluated with patient self report. Furthermore, few studies have assessed the impact of the pattern of sedation relying instead on cumulative sedative dose or average level of sedation. Consistent with the National Institute of Nursing Research goals for improving management of symptoms and health related quality of life during critical illness and recovery, the long term goal of this research is improvement of symptom management during mechanical ventilation to promote patient comfort and minimize short and long term complications of critical illness. The objectives of the proposed research are to describe the relationship between patients'assessment of mechanical ventilation and sedation patterns over the course of mechanical ventilation and to identify non-pharmacologic interventions that mechanically ventilated patients find effective for symptom amelioration. The proposed correlational study will use multilevel modeling to describe the pattern of sedation during mechanical ventilation and its relationship to patient recall and assessment of the experience. Assessment of mechanical ventilation will be measured by completion of three scales and checklists that provide a global evaluation of the subjects'experiences determine presence of specific memories;and evaluate the perceived benefits of nonpharmacologic interventions. Sedative medication data will be collected during the subject's ICU stay. Patient assessment data will be collected during in-person interviews conducted after ICU discharge. This study will assess the value of common interventions to reduce symptoms associated with mechanical ventilation. The knowledge gained from this study has significant public health implications for patients receiving ventilatory support in the United States-improving symptom management and recovery.
| Guttormson, Jill L; Bremer, Karin Lindstrom; Jones, Rachel M (2015) ""Not being able to talk was horrid"": A descriptive, correlational study of communication during mechanical ventilation. Intensive Crit Care Nurs 31:179-86 |
| Guttormson, Jill L (2014) ""Releasing a lot of poisons from my mind"": patients' delusional memories of intensive care. Heart Lung 43:427-31 |
