Patients Being Weaned From the Ventilator: Positive Effects of Guided Imagery

Background/Significance: Mechanical ventilation (MV) is a life-sustaining treatment for respiratory compromised patients with an estimated cost of $27 billion a year. Patients requiring MV may experience anxiety, psychological and emotional distress and delusional memories. Guided imagery may reduce the frequency and severity of these symptoms. Therefore, a study was conducted to assess the effects of guided imagery on sedation levels, sedative and analgesic volume consumption, and physiological responses of patients being weaned from mechanical ventilation and to assess nurse perception of feasibility and satisfaction of using guided imagery as an intervention

Methods: Forty-two patients were selected from two community acute care hospitals. One hospital served as the comparison group and provided routine care (no intervention) while the other hospital provided the guided imagery intervention. The intervention included two sessions, each lasting 60 minutes, offered during morning weaning trials from mechanical ventilation. Measurements were recorded in groups at baseline and 30- and 60- minute intervals and included vital signs and Richmond Agitation-Sedation Scale (RASS) score. Researchers developed four questions addressing feasibility and satisfaction for using guided imagery as intervention; survey rated on 5-point Likert scale. Nurses directly involved with patients receiving intervention completed surveys.

Results: Sedative and analgesic medication volume consumption were recorded 24 hours prior to and after the intervention. The guided imagery group had significantly improved RASS scores and reduced sedative and analgesic volume consumption. During the second session, oxygen saturation levels significantly improved compared to the comparison group. Guided imagery group had 4.88 less days requiring mechanical ventilation and 1.4 reduction in hospital length of stay compared to the comparison group. Of 42 surveys distributed, 23 nurses (55%) completed survey with mean scores for each question ranging from 4.09 to 4.83. Nurses felt guided imagery was an effective nursing intervention (M = 4.83, SD = .39), successfully incorporated into weaning process (M = 4.09, SD = .95), simple to implement (M = 4.13, SD =1.0), and intervention met intended purpose (M = 4.09, SD =1.08).

Discussion: Guided imagery may be a part of the multimodal treatment approach and serve as a substitute to administering high doses of sedatives to assist with keeping the patient calm and relaxed. Nurses perceived the intervention as effective and easily incorporated into the weaning process.

Conclusion: Guided imagery may be complementary and alternative medicine intervention to provide during mechanical ventilation weaning trials. Guided imagery appeared to be an effective, safe and feasible intervention to use in patients being weaned from mechanical ventilation.