Effect of guided imagery on dyspnea in trauma ICU patients: a randomized controlled trial

Dyspnea is a prevalent and distressing symptom among critically ill patients, particularly in trauma intensive care units, and is often poorly managed in semi-conscious individuals. While guided imagery has shown benefits in various chronic and palliative contexts, its efficacy in ICU trauma patients remains understudied.

In this randomized controlled trial, 102 trauma ICU patients with Glasgow Coma Scale scores of 9-13 were randomly allocated to an intervention group (n = 51) or a control group (n = 51). The intervention group received nature-based guided imagery sessions twice daily for six consecutive days, in addition to standard ICU care. Respiratory distress was evaluated using the Intensive Care Respiratory Distress Observational Scale (IC-RDOS). Secondary outcomes included PaO₂, PaCO₂, HCO₃^-, hemoglobin, and Behavioral Pain Scale (BPS) ratings.

The intervention group experienced a greater reduction in respiratory distress (IC-RDOS) at Day 6 compared with controls (mean post-test IC-RDOS: 5.36 vs 6.22; between-group p < 0.001). Oxygenation improved in the intervention group (mean PaO₂ at Day 6: 73.8 vs 63.9 mmHg; between-group p < 0.001), while PaCO₂ showed a within-group decrease in the intervention arm but no significant between-group difference (mean post-test PaCO₂: 42.1 vs 43.1 mmHg; between-group p = 0.35). Pain (BPS) decreased modestly in the intervention group compared with the control (mean post-test BPS: 3.68 vs 4.31; between-group p < 0.001). No intervention-related adverse events were reported.

Guided imagery may be a feasible adjunctive therapy for alleviating respiratory distress and promoting clinical stability in trauma ICU patients with impaired consciousness. Larger trials are needed to confirm safety and effectiveness before routine clinical implementation.

Incorporating guided imagery into routine ICU nursing care could provide a practical, non-invasive method to reduce respiratory distress in semi-conscious trauma patients, potentially enhancing patient comfort and supporting respiratory function.