Marina Iosifyan1,2,3, Matthieu Schmidt4, Amélie Hurbault2, Julien Mayaux2, Christian Delafosse5, Marina Mishenko6,7, Nathalie Nion2, Alexandre Demoule1,2, Thomas Similowski8,9. 1. UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France. 2. Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France. 3. Department of Psychology, National Research University Higher School of Economics, Moscow, Russia. 4. Service de Réanimation Médicale de l'Institut de Cardiologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 75013, Paris, France. 5. Service de Pneumologie-Explorations du Sommeil, Hôpital Simone Veil, 95600, Eaubonne, France. 6. Laboratoire Psychopathologie et Processus de Santé, EA 4057, Université Paris Descartes, 75005, Paris, France. 7. Laboratoire de psychologie du développement et de l'éducation de l'enfant, UMR 8240, CNRS, Université Paris Descartes & Université Caen Basse-Normandie, 75005, Paris, France. 8. UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France. thomas.similowski@upmc.fr. 9. Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France. thomas.similowski@upmc.fr.
Abstract
BACKGROUND: Noninvasive ventilation (NIV) is the application of mechanical ventilation through a mask. It is used to treat certain forms of acute respiratory failure in intensive care units (ICU). NIV has clinical benefits but can be anxiogenic for the patients. This study aimed at describing cognitive and affective attitudes toward NIV among patients experiencing NIV for the first time in the context of an ICU stay. METHODS: Semi-structured interviews were conducted in 10 patients during their ICU stay and soon after their first NIV experience. None of the patients had ever received NIV previously. Evaluative assertion analysis and thematic analysis were used to investigate cognitive and affective attitudes toward NIV before, during, and after the first NIV experience, as well as patient attitudes toward caregivers and relatives. RESULTS: Before their first NIV session, the cognitive attitudes of the patients were generally positive. They became less so and more ambiguous during and after NIV, as the patients discovered the actual barriers associated with NIV. Affective attitudes during NIV were more negative than affective attitudes before and after NIV, with reports of dyspnea, anxiety, fear, claustrophobic feelings, and reactivation of past traumatic experiences. The patients had more positive attitudes toward the presence of a caregiver during NIV, compared to the presence of a family member. CONCLUSION: This study corroborates the possibly negative-or even traumatic-nature of the NIV experience, with emphasis on the role of affective attitudes. This is a rationale for evaluating the impact of NIV-targeted psychological interventions in ICU patients with acute respiratory failure.
BACKGROUND: Noninvasive ventilation (NIV) is the application of mechanical ventilation through a mask. It is used to treat certain forms of acute respiratory failure in intensive care units (ICU). NIV has clinical benefits but can be anxiogenic for the patients. This study aimed at describing cognitive and affective attitudes toward NIV among patients experiencing NIV for the first time in the context of an ICU stay. METHODS: Semi-structured interviews were conducted in 10 patients during their ICU stay and soon after their first NIV experience. None of the patients had ever received NIV previously. Evaluative assertion analysis and thematic analysis were used to investigate cognitive and affective attitudes toward NIV before, during, and after the first NIV experience, as well as patient attitudes toward caregivers and relatives. RESULTS: Before their first NIV session, the cognitive attitudes of the patients were generally positive. They became less so and more ambiguous during and after NIV, as the patients discovered the actual barriers associated with NIV. Affective attitudes during NIV were more negative than affective attitudes before and after NIV, with reports of dyspnea, anxiety, fear, claustrophobic feelings, and reactivation of past traumatic experiences. The patients had more positive attitudes toward the presence of a caregiver during NIV, compared to the presence of a family member. CONCLUSION: This study corroborates the possibly negative-or even traumatic-nature of the NIV experience, with emphasis on the role of affective attitudes. This is a rationale for evaluating the impact of NIV-targeted psychological interventions in ICU patients with acute respiratory failure.
Authors: Jill L McCormick; Taylar A Clark; Christopher M Shea; Dean R Hess; Peter K Lindenauer; Nicholas S Hill; Crystal E Allen; MaryJo S Farmer; Ashley M Hughes; Jay S Steingrub; Mihaela S Stefan Journal: Chronic Obstr Pulm Dis Date: 2022-01-27