Improving Psychological Outcomes for Acute Respiratory Failure Survivors Using a Self-Management Intervention

Statement of the Problem. An increasing number of adults develop acute respiratory failure (ARF) requiring mechanical ventilation in an intensive care unit (ICU). To improve patient outcomes, evidence-based guidelines recommend titrating sedatives to allow for patient wakefulness while in the ICU. However, among awake acute respiratory failure patients, anxiety can be a common and long-lasting problem. Outside of the ICU setting, cognitive behavioral therapy based self-management is an established, evidence-based, first-line treatment for patients with anxiety. However, there is limited evidence about the feasibility and benefit of cognitive behavioral therapy interventions for acute respiratory failure patients with anxiety during hospitalization.

Specific Aims. This award proposal seeks to conduct a pilot randomized controlled trial of a tailored self-management protocol vs. usual care in the ICU and subsequent hospital ward to establish its feasibility, acceptability (primary outcome; Aim 1a), and potential efficacy in reducing anxiety symptoms and associated outcomes at hospital discharge (Aim 1b) and at 3-month follow-up (secondary outcomes; Aim 2). Experimental Approach. Pilot randomized controlled trial with blinded outcome assessment and 3-month phone-based follow-up.

Significance of the results. ARF patients experience significant anxiety during ICU stay, reporting feelings of terror, fear of death, and loss of control. Up to 50% of ARF patients report clinically significant anxiety at ICU discharge, and up to 40% report persistent symptoms up to 5 years after ICU. This project provides an essential foundation for evaluating a novel intervention, with a strong evidence-base outside of the ICU, to reduce anxiety in acute respiratory failure patients.

Inclusion criteria

• ≥18 years old
• English speaking and not aphasic
• ARF with mechanical ventilation via endotracheal tube > 24 hours
• Expected hospital stay of >7 days at time of eligibility
• Alert (ie, Richmond Agitation Sedation Scale sedation score = -1, 0, or 1)
• Not delirious (ie, negative Confusion Assessment Method -ICU score)
• Presence of anxiety symptoms (Visual Analog Scale-Anxiety score ≥50)**

Exclusion criteria

• Pre-existing cognitive impairment (AD-8 score ≥2)
• History of major psychiatric illness (i.e., psychotic disorder, bi-polar disorder, suicide attempt in past 24 months, pervasive developmental disorder, active substance use disorder)
• Declines or incapable of informed consent
• Anticipated discharge to hospice, primary focus on palliative care, or >90% probability of in-hospital death