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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2018 Mar 27

DOI: 10.23736/S0375-9393.18.12425-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Conscious sedation in critically ill patients is associated with stressors perception lower than assessed by caregivers

Giovanni MISTRALETTI 1, 2 , Michele UMBRELLO 2, Vera MARIANI 3, Elisabetta CARLONI 4, Sara MIORI 1, Martina TAVERNA 2, Giovanni SABBATINI 2, Paolo FORMENTI 2, Stefano TERZONI 3, Anne L. DESTREBECQ 3, Davide CHIUMELLO 2, 3, Egidio A. MOJA 3, Gaetano IAPICHINO 1, 2

1 Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milano, Italy; 2 U.O.C. Anestesia e Rianimazione, ASST Santi Paolo e Carlo, Ospedale San Paolo - Polo Universitario, Milano, Italy; 3 Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; 4 U.O. Anestesia Rianimazione, Casa di Cura San Pio X, Milano, Italy


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BACKGROUND: In ICU, the stay is frequently a stressful experience. Caregivers may help to understand patients’ perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of “conscious sedation” on ICU patients memories. Purpose of this prospective, observational study is to analyze the stress perception in consciously-sedated ICU-patients, comparing it to caregivers and staff members.
METHODS: Twenty-nine high-risk ICU-patients treated with awake/cooperative sedation were enrolled. Before discharge, patients received a validated questionnaire for ICU stressors evaluation, also administered to their main caregiver (N=29), to caregivers of other ICU patients not enrolled in the study (N=33) and to staff members (ICU nurses, attending physicians, residents, medical students, N=56).
RESULTS: Total stress score was: patients 141±41, patient relatives 210±63, other relatives: 202±73, ICU staff: 232±44, p<0.001. Among patients, older age (p=0.031), longer ICU-stay (p=0.018) and awake-sedation (p=0.022) were associated with lower stress; sex and illness severity had no effect; mechanical ventilation length (p=0.021) and agitation (p=0.029) were associated with higher stress. Nurses tended to overestimate stressors more than attending physicians and trainees. Within staff members, age (p=0.021) and years of experience (p=0.069) were positively associated with overestimation.
CONCLUSIONS: Conscious sedation is associated with stress perception lower than stress assessed by caregivers: relatives and staff members tend to overestimate ICU patient stress, more so with increasing age or expertise. A number of stressors underestimated by staff and families could be target of specific interventions to ameliorate quality of life during ICU stay.


KEY WORDS: Conscious sedation - Critical illness - Psychological stress - Caregivers - Quality of life

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Publication History

Article first published online: March 27, 2018
Manuscript accepted: March 14, 2018
Manuscript revised: February 26, 2018
Manuscript received: September 14, 2017

Cite this article as

Mistraletti G, Umbrello M, Mariani V, Carloni E, Miori S, Taverna M et al. Conscious sedation in critically ill patients is associated with stressors perception lower than assessed by caregivers. Minerva Anestesiol 2018 Mar 27. DOI: 10.23736/S0375-9393.18.12425-4

Corresponding author e-mail

giovanni.mistraletti@unimi.it