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Brief mindfulness intervention prior to simulated central venous access device insertion: A pilot randomised
Denis O'Dwyer1, Ashwin Subramaniam1,2,3, Dean McKenzie1,4
1Department of Intensive Care, Epworth Hospital, Epworth Healthcare, Richmond, VIC, Australia.
Background:
Acute stress impairs attention and procedural performance in high-acuity environments. Whether brief mindfulness-based interventions are feasible and affect performance in intensive care unit (ICU) simulation training is unknown.
Objectives:
To evaluate the feasibility of a brief mindfulness-based intervention before simulated ultrasound-guided central venous access device (CVAD) insertion.
Design Setting And Participants:
Single-centre pilot randomised feasibility study at a tertiary ICU simulation centre. Twelve of thirteen ICU registrars with prior CVAD experience were randomised 1:1 to mindfulness or an active control.
Intervention:
A 3-min recorded mindfulness meditation focused on breath awareness and attentional regulation, or a time-matched active control (standardised observation chart review), delivered immediately prior to simulation.
Main Outcome Measures:
Feasibility thresholds: recruitment ≥80%, adherence ≥90%, data completeness ≥95%, and assessor blinding. Exploratory outcomes included procedural performance (checklist, global rating scale, and total score), physiological arousal (heart rate and blood pressure), psychological state anxiety (STAI-State), confidence, and cognitive workload (NASA-TLX).
Results:
All feasibility thresholds were met (recruitment [92%], adherence, and data completeness [100%, respectively]; blinding maintained). Mindfulness produced greater transient reductions in heart rate (-12.4 vs -5.3 beats/min) and systolic blood pressure (-13.5 vs -3.7 mmHg). STAI-State decreased in the mindfulness group but was unchanged in controls. Postsimulation confidence was higher in the mindfulness group (mean 13.7 vs 11.8). Procedural performance was numerically lower in the mindfulness group across all domains (total score 41.3 vs 52.0), and critical procedural errors were more frequent (4/6 vs 1/6). Confidence intervals were wide throughout, reflecting the small sample.
Conclusions:
A brief preprocedural mindfulness intervention was feasible and transiently reduced physiological arousal and state anxiety, but did not improve procedural performance; scores were numerically lower in the mindfulness group and critical errors were more frequent, though chance imbalance cannot be excluded given the small sample. These findings support progression to a larger, multicentre, adequately powered trial.
