Discomforts in Critically ill Patients: Our Experience in Intensive Care Unit of a Tertiary Care Hospital in India

摘要

Patients admitted in the Intensive Care Units (ICUs) experiences various discomforts which may be recognised or unrecognised.These discomforts may arise from the environment, may be related to the ICU care and discomfort related to the health status of the patient and critical care interventions.Aim: To identify the various discomforts in ICU patients, to classify them with respective causes, identify the most common cause among them and whether ICU sedation helps in reducing discomforts.Materials and Methods: This observational study was conducted from 15th July to 15th October 2018 on 120 mixed ICU patients in a Tertiary Care Hospital in India.Patients who were admitted to ICU for more than 24 hours, aged 18 years and above, those who gave written informed consent were observed and enquired for any discomfort.Discomforts have been identified and recorded by a fulltime intensivist by direct observation, by interacting with the patients and asking the family members and others (indirect approach).Through this study discomforts of critically ill patients were broadly classified into four categories 1.Due to existing illness, 2.Due to ICU interventions, 3.Due to improper nursing care and 4.Due to environmental factors.Results: Out of 120 patients studied, 84 patients (70%) reported some kind of discomfort during their ICU stay.Existing illness was the most common cause of discomfort, 80 patients (66.6%) suffered due to it.ICU interventions was the second most common cause, 71 patients (59.1%) had discomfort due to interventions.Thirty five patients (29.1%) suffered due to improper nursing care and 25 patients (20.8%) suffered due to the environmental factors.In this study, it was observed that sedation reduces all kind of discomforts.Conclusion: In this study 70% of patients, who were admitted to ICU due to various illness reported some kind of discomfort.The most common cause of ICU discomforts was existing illness followed by ICU interventions.In this study it was observed that sedation reduces all kind of discomforts.Sedated patients tolerate the endotracheal tube better and they had less environmental and procedure related discomforts.With the present study observation it can be suggested that ICU charts of nurses and doctors can carry a separate column for mentioning discomforts in different duty shifts.However, with the use of appropriate analgesia and sedation discomfort can be reduced.