Epidemiology of unpleasant experiences in conscious critically ill patients during intensive care unit stay

Objective To survey the incidences of psychological and physiological unpleasant experiences in conscious critically ill patients during their intensive care unit (ICU) stay, and investigate the inducing factors. Methods A two-month consecutive nationwide investigation was prospectively performed in 31 academic hospital ICUs. An in-person questionnaire interview to each conscious patient was performed by specific trained staff from RMC-ROMIT Healthcare Consulting Company within 2 days after the patient was transferred from ICU. Results Two hundred and thirty-four cases were interviewed in this survey. One hundred and sixty-three of the 234 patients (69.6%) appeared psychological unpleasant experience. The ratio of patients with physiological unpleasant experience was as high as 97.0%, and 74.8% of whom were with serious physiological unpleasant experiences. The incidence of serious physiological unpleasant experiences was markedly higher in patients with than without psychological unpleasant experience (46.5% vs. 86.50%). The difference was shown to be statistical significant (P<0.01). The percentage of patients complained of ICU noise and medical or nursing manipulations not tolerable was 65.8% and 74.8%,respectively. Compared with the tolerable cases, the incidences of psychological and physiological unpleasant experiences were significantly increased in those patients (P<0.05 or P<0.01). Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score was the independent high risk factor inducing psychological unpleasant experience through multiple factor analysis [odds ratio (OR)=1.070, 95% confidence interval (CI)=1.020-1.130, P<0.05]. Age was the high risk factor inducing physiological unpleasant experience (OR=0.936, 95%CI=0.879-0.998, P<0.05). In addition, adequate sedation significantly reduced the incidence of the psychological and physiological unpleasant experiences. Conclusion A high incidence of unpleasant experience is found in conscious critically ill patients during their ICU stay. Patients with psychological unpleasant experiences are with higher possibility of occurring physiological unpleasant experiences. The data show that APACHE Ⅱ score is the independent high risk factor inducing psychological unpleasant experiences. ICU environment, noise for instance, and medical or nursing manipulations are closely related with the incidence of psychological and physiological unpleasant experiences. Meanwhile,adequate sedation is one of the effective methods to reduce the incidences of them. Key words: intensive care unit; psychological unpleasant experience; physiological unpleasantexperience; strategy of sedation