Patients' Recall and Assessment of Mechanical Ventilation: Impact of Sedation

描述（由申请人提供）：机械通气患者会出现多种生理和心理症状，包括气管内管不适；对康复的恐惧和认知的改变。大多数患者接受镇静药物治疗以减轻症状。虽然镇静有时可以指征，但它与多种不良后果相关，如创伤后应激障碍、抑郁、肌肉无力和呼吸机使用时间延长。在重症监护病房（ICU）出院后，身体和心理困难可能持续数年，影响生活质量和恢复工作的能力。实践的变化落后于过量镇静危害的证据。机械通气后镇静和患者预后的研究主要集中在呼吸机使用时间、ICU住院时间以及心理和生理后遗症。镇静对机械通气期间症状管理的有效性尚未通过患者自我报告进行评估。此外，很少有研究评估依赖于累积镇静剂量或平均镇静水平的镇静模式的影响。与美国国家护理研究所（National Institute of Nursing Research）在危重疾病和康复期间改善症状管理和健康相关生活质量的目标一致，本研究的长期目标是改善机械通气期间的症状管理，以提高患者舒适度，最大限度地减少危重疾病的短期和长期并发症。拟议研究的目的是描述在机械通气过程中患者对机械通气和镇静模式的评估之间的关系，并确定机械通气患者认为对症状改善有效的非药物干预措施。提出的相关研究将使用多水平模型来描述机械通气期间镇静的模式及其与患者回忆和评估经验的关系。机械通气的评估将通过完成三个量表和检查表来衡量，这些量表和检查表提供了对受试者经历的总体评估，确定了特定记忆的存在；并评估非药物干预的感知益处。镇静用药数据将在受试者ICU住院期间收集。患者评估数据将在ICU出院后进行的面对面访谈中收集。本研究将评估减少机械通气相关症状的常用干预措施的价值。从这项研究中获得的知识对美国接受呼吸支持的患者具有重要的公共卫生意义-改善症状管理和恢复。

DESCRIPTION (provided by applicant): 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.