Patient Perspectives on Repeat Intubation Following Mechanical Ventilation: A Pilot Retrospective Survey Study

Abstract

Mechanical ventilation is a common life-saving intervention in critically ill patients; however, little literature exists examining how prior intubation experiences influence future patient preferences regarding repeat intubation or Do Not Intubate (DNI) status. This pilot study evaluated patient perceptions following mechanical ventilation and assessed willingness to undergo repeat intubation if medically necessary. We conducted a pilot observational survey study of adult patients previously hospitalized at a community teaching hospital who underwent mechanical ventilation identified through intubation/extubation order sets. Participants completed a structured survey evaluating awareness of intubation, understanding of the indication for intubation, recollection of the experience, perceived pain and discomfort, adequacy of sedation and pain control, and willingness to undergo repeat intubation. Responses regarding prior consideration of DNI status and post-hospitalization code-status preferences were also collected. Twenty-seven patients completed the survey. Most participants were aware they had been intubated (81.5%), and 74.1% reported understanding why intubation was required. Intubation was described as painful by 29.6% of participants and uncomfortable by 55.6%. While 70.4% felt adequately sedated and 74.1% felt their pain was adequately controlled, recollection of the mechanical ventilation experience varied: 44.4% remembered none of their time intubated, 33.3% remembered some, 14.8% remembered most, and 7.4% remembered all of the experience. When asked whether they would agree to repeat intubation if medically necessary, 77.8% responded yes, while 11.1% responded no, 7.4% responded maybe, and 3.7% remained undecided. Prior to hospitalization, only 22.2% had previously considered or discussed DNI status. Following their hospitalization, 11.1% expressed interest in becoming Do Not Resuscitate (DNR), while 7.4% remained uncertain. Family influence on DNI-related decision-making was reported by 42.9% of respondents.