Anxiety and Agitation in Mechanically Ventilated Patients

Abstract

During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently, and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients; (b) explore how clinicians recognize and interpret anxiety and agitation and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety-Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients’ ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians’ attributions about anxiety or agitation and “knowing the patient” contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or patient’s appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice.

Ethnographic Investigation of Oral Care in the Intensive Care Unit

“…This finding aligns with the results of other research, indicating that routine ICU activities (eg, repositioning and suctioning) are a source of patients' distress [33][34][35] and that corresponding assessment and management of pain, agitation, and delirium are needed. 36 Although patients' discomfort during oral procedures has been examined in other populations of patients, [37][38][39] this issue in ICU patients has received limited attention.…”

Weaning From Mechanical Ventilation: A Scoping Review of Qualitative Studies

“…Most reviews of weaning from mechanical ventilation have examined only quantitative data [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Range of health care professionals [25][26][27][28][29][30][31][32][33][34][35] Patients only [36][37][38][39][40][41][42][43][44][45] Physicians only (intensivists or anesthetists working in intensive care units) [46][47][48][49] Patients' family members 50,51 Patients and nurses Participant interviews and observation 12,13,27,28,[31][32][33]40<...>…”

“…Themes for enablers of weaning success included the role of health care providers, patients' family members, self (ie, the patient), and faith. For the 2 studies (1 primary 49 and 1 secondary 50 analysis of the first study) that included members of a patient's family, 1 category was detected: duality of the positive and negative influence of family presence and surveillance on weaning success and anxiety management.…”

Study protocol: Intensive care anxiety and emotional recovery (Icare)—A prospective study

“…restlessness) and physiological (e.g. tachycardia) manifestations (24,25). Unfortunately, clinicians' observations of these two components are unreliable indicators of state anxiety in ICU settings since common conditions such as delirium or pain share similar physiological and behavioural characteristics with this emotion which may lead to erroneous symptom interpretation (25).…”