Adult intensive care patients' perception of endotracheal tube-related discomforts: A prospective evaluation

doi:10.1016/j.hrtlng.2009.12.009

Heart & Lung

Volume 40, Issue 1, January–February 2011, Pages 49-55

https://doi.org/10.1016/j.hrtlng.2009.12.009 Get rights and content

Abstract

Objective

This study was designed to investigate adult patients' perceptions of endotracheal tube (ETT)-related discomfort at 5 days and 2 months after discharge from the intensive care unit (ICU).

Methods

This prospective cohort study in 2 general ICUs included 250 intubated, mechanically ventilated adults admitted for more than 24 hours. Patients were interviewed 5 days and 2 months after discharge from the ICU about their ETT-related discomfort, using a modified Swedish ETT version of the ICU Stressful Experience Questionnaire that comprises 14 items.

Results

Of 116 patients describing their ETT experience during their ICU stay, 88% rated their discomfort as moderately to extremely stressful. At 2 months after discharge from the ICU, 23% (51/226) reported bothersome discomfort, vs. 46% (104/226) 5 days after discharge from the ICU, and 10 patients suffered from severe, persistent hoarseness.

Conclusion

The incidence of bothersome subjective complaints after tracheal intubation in the intensive-care setting is high, and severe ETT-related problems may persist several months after extubation.

Section snippets

Design, Setting, and Routines

This study was a part of a prospective cohort study conducted over 18 months, from September 2003 to February 2005, in 2 general ICUs at 2 Swedish university hospitals. Data concerning memory and sedation, stressful memories, and psychological distress were previously published.3, 7, 19 The study was approved by the Ethics Committee at Lund University (Lund, Sweden). Intensive-care practice was similar in the 2 ICUs. Usually, during invasive mechanical ventilation, patients were lightly

Results

Among the 250 patients interviewed, 134 (54%) did not remember the ETT during their ICU stay. Of 116 who remembered, 102 (88%) rated at least 1 ETT-related discomfort during the ICU ventilation phase as moderately to extremely bothersome. General discomfort and inability to speak were the 2 most stressful and remembered experiences (Table 2). Among 250 patients, 103 (41%) remembered the extubation procedure, and 50 of them rated the experience as moderately to extremely bothersome. After

Discussion

In this study, the ETT was remembered by 46% of patients, similar to previous research involving large samples (50%, 49%, and 52%).1, 8, 22 Moreover, compared with the study of Rotondi et al,¹ discomfort or pain associated with the ETT and inability to speak because of the ETT were almost equally remembered and rated, despite differences in patient samples, settings, routines, and sedation practices. Most patients in this study who remembered the ETT rated the items “discomfort associated with

Conclusions

This study confirms a high incidence of subjective complaints after tracheal intubation in the intensive-care setting. Furthermore, the results indicate that some ETT-related discomforts, including severe hoarseness, may persist several months after extubation. To reduce patients' discomfort, it appears worthwhile for ICUs to review their practices, if necessary, in terms of improved information and support services, communication methods, symptom management, and follow-up routines.

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Kalfon et al., 2010; Puntillo et al., 2018; Samuelson, 2011). Various sources can be ascribed to this negative experience, including invasive procedures, noise, feelings of shame and hopelessness; leading to discomfort, especially mechanically ventilated patients (Hajiabadi et al., 2018; Hofhuis et al., 2008; Ma et al., 2010; Samuelson, 2011). For many years, sedation and analgesia have been used to alleviate patients' pain and discomfort, especially those who were mechanically ventilated.
Routine care in intensive care units (ICU) results in patient pain and discomfort. While pain is treated with analgesics, discomfort is generally not well characterised or addressed. Since many ICU patients communicate only non-verbally, practitioners often cannot discern between pain or discomfort when treating such patients, potentially leading to inappropriate analgesic administration. A first step in discriminating between pain and discomfort is understanding how patients perceive their discomfort.
To describe mechanically ventilated ICU patients’ perceptions of discomfort and how they differentiate discomfort from pain.
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Two main discomfort themes were identified: unpleasant physical sensations and unpleasant psychological feelings. Each theme was further divided into subcategories. Most patients did not describe high levels of pain and did not associate physical discomfort with pain.
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During mechanical ventilation, patients may feel stress and find it difficult to adapt to the treatment due to thirst, noise, immobilisation, pain, communication difficulties, inability to speak, insomnia and the pressure of the endotracheal tube over the lips and the vestibule of mouth (Khalaila et al., 2011; Tracy and Chlan, 2011; Karlsson et al., 2012; Cappell, 2013). These problems and the general discomfort that occurs with endotracheal intubation during mechanical ventilation treatment result in decreased patient comfort and an increased anxiety level, which in turn slow the recovery period (Samuelson, 2011a; Samuelson, 2011b; Tate et al., 2012; Karlsson et al., 2012; Engström et al., 2013). As a result, the length of care given to the patient and the patient's hospital stay can be prolonged and the likelihood of complications may increase.
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: Cite this article: Samuelson, K. A. M. (2011, JANUARY/FEBRUARY). Adult intensive care patients' perception of endotracheal tube-related discomforts: A prospective evaluation. Heart & Lung, 40(1), 49-55. doi:10.1016/j.hrtlng.2009.12.009.

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Issues in Critical CareAdult intensive care patients' perception of endotracheal tube-related discomforts: A prospective evaluation

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Design, Setting, and Routines

Results

Discussion

Conclusions

Appl Nurs Res

Intensive Crit Care Nurs

Intensive Crit Care Nurs

Heart Lung

Heart Lung

Br J Anaesth

Intensive Crit Care Nurs

Heart Lung

Heart Lung

Heart Lung

Heart Lung

Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit

Crit Care Med

Discomfort and factual recollection in intensive care unit patients

Crit Care

Stressful experiences in relation to depth of sedation in mechanically ventilated patients

Nurs Crit Care

Self-reported symptom experience of critically ill cancer patients receiving intensive care

Crit Care Med

The symptom burden of chronic critical illness

Crit Care Med

Issues in Critical Care
Adult intensive care patients' perception of endotracheal tube-related discomforts: A prospective evaluation