Symptom Assessment for Mechanically Ventilated Patients: Principles and Priorities: An Official American Thoracic Society Workshop Report

Abstract

Mechanically ventilated patients experience many adverse symptoms, such as anxiety, thirst, and dyspnea. However, these common symptoms are not included in practice guideline recommendations for routine assessment of mechanically ventilated patients. An American Thoracic Society-sponsored workshop with researchers and clinicians with expertise in critical care and symptom management was convened for a discussion of symptom assessment in mechanically ventilated patients. Members included nurses, physicians, a respiratory therapist, a speech–language pathologist, a critical care pharmacist, and a former intensive care unit patient. This report summarizes existing evidence and consensus among workshop participants regarding 1 ) symptoms that should be considered for routine assessment of adult patients receiving mechanical ventilation; 2 ) key symptom assessment principles; 3 ) strategies that support symptom assessment in nonvocal patients; and 4 ) areas for future clinical practice development and research. Systematic patient-centered assessment of multiple symptoms has great potential to minimize patient distress and improve the patient experience. A culture shift is necessary to promote ongoing holistic symptom assessment with valid and reliable instruments. This report represents our workgroup consensus on symptom assessment for mechanically ventilated patients. Future work should address how holistic, patient-centered symptom assessment can be embedded into clinical practice.

Occurrence, co-occurrence and persistence of symptoms of depression and post-traumatic stress disorder in survivors of COVID-19 critical illness

“…These differences between studies could be attributed to the use of different mental health questionnaires and diagnostic criteria, or to the characteristics of the cohorts (i.e. general ICU survivors in their study vs. COVID-19 survivors in ours) (Guttormson et al, 2023 ). On the other hand, our findings are consistent with those of a large multicentre study, also conducted before the COVID-19 pandemic in general ICU survivors, but in which the HADS-D and a PTSD questionnaire equivalent to the DTS were used (Hatch et al, 2018 ).…”

“…Critically ill patients often suffer a strong emotional impact related to their illness or the ICU environment and certain medical procedures (e.g. facing one's own death, experiencing dyspnea, presenting with delirium, being hooked up to machines) that can be stressful, even traumatic, for some people (Guttormson et al, 2023 ). This can result in psychological disorders such as depression and post-traumatic stress disorder (PTSD), which often coexist (Jackson et al, 2014 ; Rabiee et al, 2016 ).…”

Determinants of Communication Failure in Intubated Critically Ill Patients: A Qualitative Phenomenological Study from the Perspective of Critical Care Nurses

“…In a similar manner, Handberg and Voss [49] highlighted the strong influence that staff's cultural beliefs in a biomedical setting such as the ICU have on care values and practises regarding communication with intubated patients. As several authors stated recently, a cultural shift is necessary for a proper approach to communication with critical patients who are mechanically ventilated [52].…”

Breathlessness assessment, management and impact in the intensive care unit: a rapid review and narrative synthesis

“…Besides generating immediate and intense fear and distress in ICU patients receiving mechanical ventilation, breathlessness (defined as a subjective experience of breathing discomfort [ 4 ], and medically known as dyspnoea) is associated with serious unfavourable consequences, such as an associated higher-risk of weaning failure during a spontaneous breathing trial, (SBT) [ 5 ] and post-traumatic stress disorders [ 6 ]. Yet, unlike other symptoms such as pain [ 7 ], and despite an evidence-base for breathlessness management in general [ 8 ], in the ICU setting [ 9 ] breathlessness management is not supported by any guidelines [ 10 ].…”