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A2636 - Unmasked: Description of Symptoms Experienced by Intensive Care Unit Patients While Receiving Non-Invasive Ventilation
Author Block: L. L. Chlan1, P. Peterson2, L. Striegel2, J. Johnson1; 1Division of Nursing Research, Mayo Clinic, Rochester, MN, United States, 2Mayo Clinic, Rochester, MN, United States.
RATIONALE: Noninvasive ventilation (NIV) is commonly used in the intensive care unit (ICU) to treat respiratory failure, and to avoid invasive mechanical ventilation or reintubation. However, not all patients tolerate this therapy which can result in limited adherence to the actual wearing of the device or mask for NIV. Previous studies describing patients’ experiences with NIV report vague feelings of anxiety and being uncomfortable with the device or mask. Further, little is known about the presence, intensity and distress of self-reported symptoms while patients receive NIV or how these symptoms may influence adherence to NIV therapy. Thus, the aim of this study was to provide a comprehensive assessment and description of ICU patients’ symptoms while receiving NIV. METHODS: A cross-sectional descriptive design was used to address the aim. Patients admitted to medical/multispecialty ICUs at a Midwestern teaching hospital receiving mask NIV due to respiratory distress or post-extubation from invasive ventilation who provided their own informed consent were assessed one time with the modified Edmonton Symptom Assessment Scale (MESAS). The MESAS assesses the: presence (yes, no) of 11 symptoms (tired, thirsty, anxious, restless, nausea, short of breath, pain, sad, scared, confused, hungry), intensity (mild, moderate, severe) and distress (mild, moderate, severe) of each endorsed symptom. Descriptive statistics (mean, median, frequencies, percentages) were used to describe the patients’ demographic data (age, sex, race, ethnicity), clinical data (NIV method and indication, illness severity by APACHE III) and MESAS responses. RESULTS: Seventeen (100% White, non-Hispanic, 53% female) patients with mean age of 68.7 (SD 10.9) years and mean APACHE III scores of 73.4 (SD 27.2) participated. Indications for NIV (BiPAP 59%, CPAP 23%, Auto-titrate 18%) included hypoxemia (30%), pneumonia (29%), and respiratory distress (41%); median Fi02 was 36%. The most frequently reported symptoms among patients were feeling tired (65%), thirsty (65%), anxious (71%), and restless (65%). Intensity (90%, 73%, 84%, 72%) and distress (82%, 90%, 91%, 90%) of each symptom was endorsed as moderate-severe respectively. Patients less frequently endorsed feeling nauseous (17%), short of breath (35%), pain (29%), sad (23%), scared (35%), confused (17%), and hungry (29%). These symptoms were appraised as mild-moderate for both intensity and distress (50-100%) except pain and scared were moderate-severe in both intensity and distress (80-100%). CONCLUSION: ICU patients receiving NIV reported the presence of intense and distressing symptoms. Interventions to effectively manage patients’ symptoms while receiving NIV are needed to assure adherence to this ICU therapy.