by Marina Iosifyan, Matthieu Schmidt, Amélie Hurbault,
Julien Mayaux, Christian Delafosse, Marina Mishenko, Nathalie Nion, Alexandre
Demoule and Thomas Similowski
Annals of Intensive Care volume 9,
Article number: 134 (2019)
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.
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