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

描述(申请人提供)：机械通气患者会出现多种生理和心理症状，包括气管插管的不适、对康复的恐惧和认知改变。大多数患者接受镇静药物治疗以减轻症状。虽然有时可能需要镇静，但它与多种不良后果有关，如创伤后应激障碍、抑郁、肌肉无力和长时间使用呼吸机。在重症监护病房(ICU)出院后，身体和心理上的困难可能会持续多年，影响生活质量和恢复工作的能力。实践中的变化落后于过度镇静危害的证据。对机械通气后镇静和患者结局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方面。镇静对机械通气期间症状管理的有效性尚未通过患者自己的报告进行评估。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。这项研究的长期目标是改善危重疾病和康复期间的症状管理和与健康相关的生活质量，这与国家护理研究所的目标一致，即改善机械通气期间的症状管理，以提高患者的舒适度，并将危重疾病的短期和长期并发症降至最低。这项拟议研究的目的是描述患者对机械通气的评估与机械通气过程中的镇静模式之间的关系，并确定非药物干预措施，使机械通气患者能够有效地改善症状。拟议的相关性研究将使用多水平建模来描述机械通气过程中的镇静模式及其与患者回忆和评估经验的关系。对机械通气的评估将通过完成三个量表和核对表来衡量，这些量表和核对表提供对受试者经历的全面评估，确定特定记忆的存在，并评估非药物干预的感知益处。镇静药物数据将在受试者入住ICU期间收集。患者评估数据将在ICU出院后进行的面谈中收集。这项研究将评估常见干预措施在减少机械通气相关症状方面的价值。从这项研究中获得的知识对在美国接受呼吸机支持的患者具有重大的公共卫生意义--改善症状管理和康复。

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.