“I had the feeling that I was trapped”: a bedside qualitative study of cognitive and affective attitudes toward noninvasive ventilation in patients with acute respiratory failure

Abstract

Background: Noninvasive ventilation (NIV) is the application of mechanical ventilation through a mask. It is used to treat certain forms of acute respiratory failure in intensive care units (ICU). NIV has clinical benefits but can be anxiogenic for the patients. This study aimed at describing cognitive and affective attitudes toward NIV among patients experiencing NIV for the first time in the context of an ICU stay.Methods: Semi-structured interviews were conducted in 10 patients during their ICU stay and soon after their first NIV experience. None of the patients had ever received NIV previously. Evaluative assertion analysis and thematic analysis were used to investigate cognitive and affective attitudes toward NIV before, during, and after the first NIV experience, as well as patient attitudes toward caregivers and relatives.Results: Before their first NIV session, the cognitive attitudes of the patients were generally positive. They became less so and more ambiguous during and after NIV, as the patients discovered the actual barriers associated with NIV. Affective attitudes during NIV were more negative than affective attitudes before and after NIV, with reports of dyspnea, anxiety, fear, claustrophobic feelings, and reactivation of past traumatic experiences. The patients had more positive attitudes toward the presence of a caregiver during NIV, compared to the presence of a family member. Conclusion:This study corroborates the possibly negative-or even traumatic-nature of the NIV experience, with emphasis on the role of affective attitudes. This is a rationale for evaluating the impact of NIV-targeted psychological interventions in ICU patients with acute respiratory failure. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Exploring the Patient Experience with Noninvasive Ventilation: A Human-Centered Design Analysis to Inform Planning for Better Tolerance

“…Iosifan et al provided patients with detailed information prior to NIV treatment and most patients did not have anticipatory anxiety or fear. 16 In our study, patients reported that discussing this therapy before it is needed is not necessarily good because it could inflict more fear for the future. This is similar to the findings of Beckert et al and Lemoigan et al that suggested patients do not want information about their treatment before it is needed to make decisions, because information tends to discourage them.…”

“…Prior studies reported that patients express anxiety, fear, claustrophobia, and feelings of lacking control. [15][16][17] However, most prior studies were performed outside the United States (different roles of clinical staff) or in non-COPD patients.…”

Noninvasive Mechanical Ventilation of Critically Ill Patients in ICUs in Mainland China: A Cross-Sectional Study

“…The concept of "eCASH" was proposed by the European association for critical care medicine to establish optimal patient comfort, which advocate flexible multimodal analgesia to relieve the pain effectively as the first priority [32]. Because of Patients with NIV experienced mask-related pain and expressed as "I had the feeling that I was trapped" [33], analgesia was necessary for NIV patients to relieve pain and facilitate the successful implementation of the NIV.…”

“…All participating units were general ICUs. There were an average of 34 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39) beds in each ICU, accounting for 1.9% (1.7-2.2) of all hospital beds (Table 1). The protocol was approved by the Institutional Ethics Committee of Zhongda Hospital affiliated to Southeast University (the core center, Approval No.…”

Giving Patients a Voice Among the Inpatient Orchestra

“…Common barriers to NIV adaptation include dyspnea, mask discomfort, anxiety, and claustrophobia. 8 The current study included clinically stable outpatients who likely experience fewer communication obstacles than an individual in acute respiratory distress. Up to one third of patients on NIV for acute respiratory failure report significant anxiety.…”