Authors

• Romana Ivelić — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-7447-5541
• Hrvoje Topalović — University Hospital Centre Zagreb, Zagreb, Croatia — ORCID: 0000-0001-6246-970X

Keywords

anxiety, mechanical ventilation, intensive care unit

DOI

Full Text

Patients on mechanical ventilation in intensive care units often experience “invisible suffering” associated with anxiety. This emotional response arises from loss of control, inability to communicate, sensations of suffocation, and constant exposure to invasive procedures. Recognizing signs of anxiety is essential for ensuring quality of care and preventing long-term consequences. The most significant factor contributing to anxiety is the inability to communicate. Patients report feelings of isolation, frustration, and helplessness, which further intensify fear and uncertainty (1). The use of alternative communication methods can alleviate these difficulties, but such methods are rarely applied systematically. Another key source of anxiety is the respiratory experience of dyspnea and the sensation of air hunger. This phenomenon may occur even when ventilator parameters are technically optimal. The experience of breathlessness directly triggers fear and panic and is considered one of the most distressing experiences during mechanical ventilation (2). Additional sources of distress include light, noise, airway suctioning, and painful procedures. In some patients, signs of anxiety appear despite sedation, underscoring the need for an individualized approach and continuous monitoring of psychological status. In the long term, anxiety during ventilation has been associated with the development of post-traumatic stress disorder, depression, and persistent anxiety after discharge from the intensive care unit (3). This highlights the importance of using standardized assessment tools, such as the Faces Anxiety Scale or the Richmond Agitation–Sedation Scale. Anxiety in mechanically ventilated patients often goes unrecognized, despite its significant impact on treatment outcomes and quality of life after discharge. The most common sources are the inability to communicate and the sensation of suffocation. Systematic assessment, communication support, and nursing interventions aimed at reducing stressors are essential to alleviate this “invisible suffering”.

Literature

1. Baumgarten M, Poulsen I. Patients’ experiences of being mechanically ventilated in an ICU: a qualitative metasynthesis. Scand J Caring Sci. 2015 June;29(2):205–14. https://doi.org/10.1111/scs.12177
2. Demoule A, Hajage D, Messika J, Jaber S, Diallo H, Coutrot M, et al. REVA Network (Research Network in Mechanical Ventilation). Prevalence, Intensity, and Clinical Impact of Dyspnea in Critically Ill Patients Receiving Invasive Ventilation. Am J Respir Crit Care Med. 2022 April 15;205(8):917–26. https://doi.org/10.1164/rccm.202108-1857OC
3. Samuelson KA, Lundberg D, Fridlund B. Stressful memories and psychological distress in adult mechanically ventilated intensive care patients - a 2-month follow-up study. Acta Anaesthesiol Scand. 2007 July;51(6):671–8. https://doi.org/10.1111/j.1399-6576.2007.01292.x