Objective: To evaluate the mental stress level and alterations in circulatory physiology in conscious patients during cardiopulmonary resuscitation (CPR) performed next bed in intensive care unit (ICU), and to investigate the possible effective interventions.
Methods: Eighty-seven conscious patients, selected consecutively from June 2003 to September 2006, were randomly allocated into control group (received normal saline), psychological nursing group (received psychological nursing intervention) or sedation group (received midazolam 0.1 mg/kg intravenous injection based on psychological nursing intervention) when CPR was performed in our ICU. Plasma concentrations of norepinephrine, epinephrine, cortisone and glucose were analyzed at the time points of beginning of CPR, 10 minutes, 4 and 24 hours after CPR in the first 40 patients. Heart rate (HR), systolic blood pressure (SBP), mean arterial pressure (MAP) and arrhythmia within 24 hours after CPR were recorded in all patients.
Results: Plasma levels of norepinephrine, epinephrine and cortisone were significantly increased at 10 minutes after CPR and persisted for 4 hours in 13 patients of the control group (P<0.05 or P<0.01). Though with the similar tendency, significant increase of cortisone level was observed in 13 patients who had received psychological nursing intervention (P<0.05 or P<0.01). The analyzed stress hormones showed little variation in 14 patients who were given midazolam at 10 minutes and 4 hours after CPR. Notably, 24 hours after CPR, they were decreased below the levels which were observed at the beginning of CPR (all P<0.01). Blood glucose levels were markedly higher in both control and psychological nursing groups than the level in sedation group within 24 hours. HR was accelerated 10 minutes after CPR, SBP was significantly increased, the incidence rate of arrhythmia was high (84.6%, 22/26; 54.5%, 18/33) in the non-sedation groups. Circulatory physiological alterations were least marked in sedation group (21.4%, 6/28, both P<0.01).
Conclusion: Mental stress is significantly heightened in conscious patients during CPR performed next bed in ICU, and it induces severe circulatory physiological alterations. Psychological nursing alone is not affective in alleviating this acute mental stress. However, low dose of midazolam is found to be an effective intervention.