• Mary Jo Grap, Cindy L Munro, Paul A Wetzel, Jessica M Ketchum, James S Ketchum, William L Anderson, Al M Best, V Anne Hamilton, Nyimas Y Arief, Ruth Burk, Tenesha Bottoms, and Curtis N Sessler.
• Mary Jo Grap is an emeritus professor and Ruth Burk is affiliate faculty, Adult Health and Nursing Systems Department, School of Nursing, Virginia Commonwealth University, Richmond, Virginia. Cindy L. Munro is a professor and associate dean, Research and Innovation, University of South Florida, Tampa, Florida. Paul A. Wetzel is an associate professor, Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University. Jessica M. Ketchum is lead biostatistician, Craig Hospital, Englewood, Colorado. James S. Ketchum is a doctoral student, Department of Biostatistics, School of Medicine, Virginia Commonwealth University. William L. Anderson is senior data scientist and head of predictive modeling, Carolinas HealthCare System, Charlotte, North Carolina. Al M. Best is professor and director of faculty research development, School of Dentistry, Virginia Commonwealth University. V. Anne Hamilton is a family nurse practitioner, Gastrointestinal Specialists, Inc, Richmond, Virginia. Nyimas Y. Arief is chair of the science department, Tawheed Preparatory School, Richmond, Virginia. Tenesha Bottoms is a registered nurse, Virginia Commonwealth University Medical Center, Richmond, Virginia. Curtis N. Sessler is a professor, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University. mjgrap@vcu.edu.
• Am. J. Crit. Care. 2016 May 1; 25 (3): e48-55.

ObjectivesTo describe the number and type of stimulation events and the relationship of stimulation to sedation level in patients receiving mechanical ventilation.MethodsA 4-hour direct observation was conducted in 103 patients receiving mechanical ventilation. Stimulation events and sedation level before and after the stimulation were documented. Eight categories of stimulation events were developed in a previous pilot study of 36 patients receiving mechanical ventilation. Sedation was measured continuously by using a processed electroencephalographic score (patient state index [PSI]) and intermittently by using the Richmond Agitation-Sedation Scale.ResultsPatients were mostly alert/mildly sedated (54.4%) at study enrollment. During the 349 hours of observation, 58.8% of the time included stimulation events. General auditory types of stimulation were most common (41.2% of observed time), followed by respiratory management and tactile family stimulation. For all events, auditory-talking, tactile-general, tactile-noxious, and tactile-highly noxious stimuli were associated with higher PSIs (all P < .001) after stimulation; other stimuli were not. Level of consciousness influenced response to stimuli, with almost all types of stimuli increasing PSI for patients more deeply sedated (PSI < 60) just before the stimuli. However, the effect of stimulation on PSI for more alert patients (PSI > 60) was small and variable.DiscussionCritically ill patients receiving mechanical ventilation are subjected to various forms of auditory and tactile stimulation frequently throughout the day. All types of stimuli increased arousal in patients who were more deeply sedated. The effect of stimulation in patients who were not deeply sedated was minimal and inconsistent.©2016 American Association of Critical-Care Nurses.

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