A qualitative study into the lived experience of post-CABG patients during mechanical ventilator weaning

Summary

Aim

Research into mechanical ventilator weaning has predominantly been devoted to analysis and evaluation of predictors of weaning success. Few studies have examined the patient experience of weaning. The aim of this study was to provide a contemporary description of the patient experience of weaning, in order to up-date this aspect of knowledge in the context of newer modalities of mechanical ventilation and sedation.

Methodology

The study had a descriptive qualitative design focusing on the lived experience of post-CABG (coronary artery bypass graft) patients ventilated ≥24 h (n = 10). Data were generated using semi-structured depth interviews conducted 2–5 months after hospital discharge. A hermeneutic phenomenological approach was used to analyze the data.

Results

The article presents selected themes that emerged during the process of analysis. The main findings relate to general phenomena such as discomfort and impaired communication, psychological phenomena such as loss of control and loneliness, and existential phenomena such as temporality and human interaction.

Conclusion

Newer modalities of sedation and mechanical ventilation have not entirely eliminated the discomforts of critical illness; the human aspects of suffering remain. In order to address some of the general, psychological, and existential patient experiences, care should be taken to acknowledge the patient and to respect the patient domain and individual time frames. In nurse–patient communication, it is recommended that caregivers give accurate and unambiguous information.

Introduction

A great deal of research into mechanical ventilator weaning has been devoted to analyzing factors predictive of sustained extubation, or to evaluating alternative methods to hasten the safe liberation from mechanical ventilation. Predictors of weaning success have been studied extensively, primarily from physiologic and technologic perspectives (Burns et al., 2003, Crocker, 2002, Egerod, 2003, Ely et al., 2001, Grap et al., 2003, Henneman et al., 2002, Kollef et al., 1997, MacIntyre et al., 2001, Marelich et al., 2000, Schou et al., 2005). Few studies have explored the patient experience of weaning. Studies are emerging, however, that examine the relationship between memories of the intensive care unit (ICU) and levels of anxiety after ICU discharge. These memories may be associated with the development of acute posttraumatic stress disorder (PTSD)-related symptoms (Jones et al., 2001). Patients who require prolonged ventilator support have been shown to recall experiences that were moderately to extremely distressing (Rotondi et al., 2002). Qualitative studies show that mechanical ventilation is stressful and anxiety provoking because of the constraints on communication inherent with intubation and sedation. The inability to speak causes anxiety, not only during the ICU stay, but also after discharge (Arslanian-Engoren and Scott, 2003, Patak et al., 2004, Russell, 1999).

Studies have demonstrated that patients may experience phenomena such as stress, panic, nightmares, hallucinations, insecurity, helplessness, and discomfort related to sedation, technical equipment, and various nursing procedures (Gardner, 2005, Johnson, 2004, Jones et al., 2001, Rotondi et al., 2002, van de Leur et al., 2004, Wunderlich et al., 1999). Patients, who lack orientation to time and place have described it as a state of chaos as they regained consciousness following sedation. This could lead to loss of control over body, mind and circumstances, and lead to a condition of persistent inner tension or prolonged fear (Granberg et al., 1998). Patients need information about their situation and illness in order to reduce feelings of anxiety and to become involved in decisions about their care (Cook et al., 2001, Logan and Jenny, 1997, Russell, 1999).

Critical care nurses need to be cognisant of the importance of maintaining a close and supportive environment for the patient. They need to apply technologies and treatments in a manner that acknowledges the lived experience of individual patients. If not, it could reduce the quality of life in terms of physical and psychological health and lead to symptoms of PTSD (Hellgren and Stahle, 2005, Jones et al., 2001).

Some of the seminal studies of patient experiences of mechanical ventilation were conducted more than a decade ago (Bergbom-Engberg et al., 1988, Bergbom-Engberg and Haljamae, 1988, Gjengedal, 1994). Within the past 10–15 years modes of mechanical ventilation and sedation regimes have gone through changes that may influence the patient experience of sedation and mechanical ventilation (Park, 2002). Mechanical ventilation has evolved from the constraining and uncomfortable volume control mode to more physiologic and interactive modes such as PRVC (patient regulated volume control). Deep sedation and paralysis with neurological blockade have been gradually replaced by analgo-sedation, which is directed at pain management and lighter sedation (Egerod et al., 2006a, Egerod et al., 2006b). The present study has been conducted in order to up-date knowledge on patient experiences in the context of newer modalities of mechanical ventilation and sedation. The aim of the study is to provide a contemporary description of the patient experience of mechanical ventilator weaning.