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Symptoms experienced by intensive care unit patients at high risk of dying*

Puntillo, Kathleen A. RN, DNSc, FAAN; Arai, Shoshana RN, PhD; Cohen, Neal H. MD, MPH, MS; Gropper, Michael A. MD, PhD; Neuhaus, John PhD; Paul, Steven M. PhD; Miaskowski, Christine RN, PhD, FAAN

doi: 10.1097/CCM.0b013e3181f267ee
Clinical Investigations

Objective: To provide a focused, detailed assessment of the symptom experiences of intensive care unit patients at high risk of dying and to evaluate the relationship between delirium and patients' symptom reports.

Design: Prospective, observational study of patients' symptoms.

Setting: Two intensive care units in a tertiary medical center in the western United States.

Patients: One hundred seventy-one intensive care unit patients at high risk of dying.

Interventions: None.

Measurements and Main Results: Patients were interviewed every other day for up to 14 days. Patients rated the presence, intensity (1 = mild; 2 = moderate; 3 = severe), and distress (1 = not very distressing; 2 = moderately distressing; 3 = very distressing) of ten symptoms (that is, pain, tired, short of breath, restless, anxious, sad, hungry, scared, thirsty, confused). The Confusion Assessment Method-Intensive Care Unit was used to ascertain the presence of delirium. A total of 405 symptom assessments were completed by 171 patients. Patients' average age was 58 ± 15 yrs; 64% were males. Patients were mechanically ventilated during 34% of the 405 assessments, and 22% died in the hospital. Symptom prevalence ranged from 75% (tired) to 27% (confused). Thirst was moderately intense, and shortness of breath, scared, confusion, and pain were moderately distressful. Delirium was found in 34.2% of the 152 patients who could be evaluated. Delirious patients were more acutely ill and received significantly higher doses of opioids. Delirious patients were significantly more likely to report feeling confused (43% vs. 22%, p = .004) and sad (46% vs. 31%, p = .04) and less likely to report being tired (57% vs. 77%, p = .006) than nondelirious patients.

Conclusions: Study findings suggest that unrelieved and distressing symptoms are present for the majority of intensive care unit patients, including those with delirium. Symptom assessment in high-risk intensive care unit patients may lead to more focused interventions to avoid or minimize unnecessary suffering.

From the University of California, San Francisco, CA.

This study was supported by a grant from the National Institute for Nursing Research (NR008247).

This study was conducted at the University of California, San Francisco.

The authors have not disclosed any potential conflicts of interest.

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© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins