Does family understanding about mechanical ventilation change during ICU stay?(RESPIRATORY RESEARCH)

This issue's column is based on the peer-reviewed article by Tasnim Sinuff MD, PhD, Mita Giacomini, PhD, Rhona Shaw, MA, PhD, Marilyn Swinton, MSc and Deborah J. Cook, MD, MSc, for the CARENET (Canadian Researchers at the End-of-Life Network) entitled: "'Living with dying': The evolution of family members' experience of mechanical ventilation." It was published in Critical Care Medicine, January 2009: Volume 37 (Number 1): pages 154-158. We'll review this article by sections to teach the scientific method for research: Background or Introduction, Question, Hypothesis, Methods, Results, Discussion/Reflections, Future Research, Conclusions, Acknowledgements, Conflicts of Interest and Bibliography.

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The Background or Introduction of the research project explains interest in the topic and why the topic is significant. The authors indicate that when an ICU patient has no previously defined healthcare directives, the ICU team is left to discuss life support and end-of-life care with family members. Mechanical ventilation is the most commonly administered and the most commonly withdrawn life support. However, no studies have investigated what family members experience and understand about mechanical ventilation. The authors desired the information about how family members of critically ill patients experience and understand the application of mechanical ventilation separate from end-of-life discussions. Therefore, their study was designed to address this gap of knowledge and, if successful, provide a basis for more respectful and meaningful communication with families about the daily care plan, life support and end-of-life issues.

The Question being asked by the researchers was: Do family experiences and understanding of mechanical ventilation change overtime in the ICU? Note: The Question asked in a research project may have the possible answers: "yes" and "no" as in this study, or may be a numerical result. The preconceived answer by the researchers to the Question is called the Hypothesis. The authors implied that with proper experimental design and data gathering their hypothesis was yes, family experiences and understanding of mechanical ventilation do change over time in the ICU.

The Methods for the research project describe the study design, setting and steps to answer the Question. This study was approved by the Institutional Review Ethics Board. Patients and their family members were recruited at a tertiary care Med-Surg ICU. Patients included were receiving mechanical ventilation for at least one week in the ICU and had a 50% or greater probability of death per the Attending. The family member or designated spokesperson needed to agree to multiple audio taped interviews conducted up to the fourteenth day in the ICU. Each interview was 45-60 minutes long and included participants' feelings and experiences when 1) seeing their loved one receiving mechanical ventilation, 2) visiting their loved one in the ICU, and, 3) interacting with the ICU team. Every interview was transcribed verbatim and reviewed for recurrent themes arranged by the day of the interview. This permitted a separation of earlier and later ICU experiences, with changes evident.

The Results section displays the data compiled to answer the Question. A total of 376 families were screened, of which 31 were eligible and 27 agreed to participate in the study. A faulty audiotape eliminated 1 family interview, leaving 26 in the study. Mean patient age was 71.1 years, with an Acute Physiology and Chronic Health Evaluation (APACHE) II score of 28.5. Interview participants were spouses (n = 10), children (n = 14), father (n = l) and brother-in-law (n = l). None of the patients had DNR status prior to ICU admission. Interviews indicated the participants' experiences and understanding changed with time in the ICU. The earliest theme expressed by the participants was "living with dying" as they had difficulty understanding if their loved ones receiving mechanical ventilation were alive or dead. At first, ...