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Differential Perceptions of Noninvasive Ventilation in Intensive Care among Medical Caregivers, Patients, and Their
Matthieu Schmidt1, Emmanuelle Boutmy-Deslandes, Sébastien Perbet
1From the Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (M.S., T.S.); INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (M.S., T.S.); AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France (M.S., M.D., T.S., A.D.); Hôpital Saint Louis, Service de Biostatistique, Paris, France (E.B.-D.); Hôpital Gabriel-Montpied, Service de Réanimation Médico-Chirurgicale, Clermont Ferrand, France (S.P.); Hôpital Cochin, Service de Réanimation Médicale, Paris, France (N.M.); Hôpital Kremlin Bicêtre, Service de Réanimation Médicale, Bicêtre, France (M.D.); Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, CARMAS Research Group 51, Créteil, France (K.R.); Hôpital Européen Georges Pompidou, Service de Réanimation Médicale, Paris, France (E.G.); INSERM, U1075, and Université de Caen, and CHRU Caen, Service de Réanimation Médicale, and CHU Caen, Service de Réanimation Médicale, Caen, France (N.T.); Hôpital de Bligny, Service de Réanimation, Bligny, France (P.A.); Hôpital Saint Antoine, Service de Réanimation Médicale, Paris, France (M.A.); Hôpital Bichat-Claude-Bernard, Service de Réanimation Médicale et des Maladies Infectieuses, Paris, France (R.S.); Hôpital d'Angoulême, Service de Réanimation Polyvalente, Angoulême, France (C.C.); Hôpital Percy, Service de Réanimation Médico-Chirurgicale, Clamart, France (V.P.); Hôpital de Saint Malo, Service de Réanimation Polyvalente, Saint Malo, France (F.C.); Hôpital Antoine Béclère, Service de Réanimation Médicale, Clamart, France (B.S.); Hôpital Louis Mourier, Service de Réanimation Médico-Chirurgicale, Colombes, France (C.R.); Hôpital Saint-Louis, Service de Réanimation Médicale, Paris, France (D.R.); Hôpital de Roanne, Service de Réanimation Médic
Background:
Noninvasive ventilation (NIV) requires a close "partnership" between a conscious patient and the patient's caregivers. Specific perceptions of NIV stakeholders and their impact have been poorly described to date. The objectives of this study were to compare the perceptions of NIV by intensive care unit (ICU) physicians, nurses, patients, and their relatives and to explore factors associated with caregivers' willingness to administer NIV and patients' and relatives' anxiety in relation to NIV.
Methods:
This is a prospective, multicenter questionnaire-based study.
Results:
Three hundred and eleven ICU physicians, 752 nurses, 396 patients, and 145 relatives from 32 ICUs answered the questionnaire. Nurses generally reported more negative feelings and more frequent regrets about providing NIV (median score, 3; interquartile range, [1 to 5] vs. 1 [1 to 5]; P < 0.0001) compared to ICU physicians. Sixty-four percent of ICU physicians and only 32% of nurses reported a high level of willingness to administer NIV, which was independently associated with NIV case-volume and workload. A high NIV session-related level of anxiety was observed in 37% of patients and 45% of relatives. "Dyspnea during NIV," "long NIV session," and "the need to have someone at the bedside" were identified as independent risk factors of high anxiety in patients.
Conclusions:
Lack of willingness of caregivers to administer NIV and a high level of anxiety of patients and relatives in relation to NIV are frequent in the ICU. Most factors associated with low willingness to administer NIV by nurses or anxiety in patients and relatives may be amenable to change. Interventional studies are now warranted to evaluate how to reduce these risk factors and therefore contribute to better management of a potentially traumatic experience. (Anesthesiology 2016; 124:1347-59).
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