Quantitative assessment of perceived discomfort in critically ill patients

Abstract

Potential sources of discomfort or stressors associated with an intensive care unit (ICU) stay can be classified as intrinsic or patient-related factors, environmental factors (such as noise and excess of light), and organizational factors. Two approaches facilitate the assessment of ICU-related stressors: first an objective approach by measuring physical or physiological parameters that characterize either ICU-related stressors or their impact on the critically ill patient, and second, a subjective approach using questionnaires (patient-related outcomes). Pain is frequently reported by ICU patients as the main stressful condition, in relation to many therapeutic or diagnostic procedures. Thirst and sleep deprivation are also perceived very negatively by ICU patients in studies based on questionnaires investigating patient-related outcomes. ICU stays without control of stressors may induce agitation and confusion (ICU psychosis) and increase the risk of developing a post-traumatic stress disorder. Promoting the IPREA (Inconforts des Patients de REAnimation, discomfort in critically ill patients) questionnaire and its implementation in routine clinical practice could be the starting point for the development of quality assurance programs based on the Deming Approach—PDCA “Plan Do Check Act.”