Symptom assessment in non-vocal or cognitively impaired ICU patients: Implications for practice and future research

Abstract

Background: Symptom assessment in critically ill patients is challenging because many cannot provide a self-report.

Objectives: To describe the state of the science on symptom communication and the assessment of selected physical symptoms in non-vocal ICU patients.

Methods: This paper summarizes a 2014 American Thoracic Society Annual International Conference symposium presenting current evidence on symptom communication, delirium, and the assessment of common physical symptoms (i.e., dyspnea, pain, weakness, and fatigue) experienced by non-vocal ICU patients.

Results: Symptom assessment begins with accurate assessment, which includes an evaluation of delirium, and assistance in symptom communication. Simple self-report measures (e.g., 0-10 numeric rating scale), observational measures (e.g., Respiratory Distress Observation Scale and Critical-Care Pain Observation Tool), or objective measures (e.g., manual muscle testing and hand dynamometry) have demonstrated utility among this population.

Conclusion: Optimizing symptom assessment with valid and reliable instruments with minimum patient burden is necessary to advance clinical practice and research in this field.

Keywords: Communication; Delirium; Dyspnea; Fatigue; ICU; Pain; Symptom assessment; Weakness.