ICU patients frequently experience confusion, anxiety, sleeplessness, pain, and/or loneliness. Sedative and anxiolytic medications are often administered to manage symptoms, but these treatments have been linked to delirium and worse physical and mental health outcomes. “Limiting sedation, keeping patients awake, and mobilizing patients early during their ICU stay optimizes physical and emotional outcomes,” explains Megan M. Hosey, PhD. “Recently, major changes in critical care have increased our interest in humanizing the ICU environment for patients and their families. It’s becoming increasingly important to acknowledge the need to care for patients emotionally as well as physically during their ICU stay.”

 

An Animal-Assisted Intervention

Throughout the United States, some healthcare facilities have integrated animal-assisted interventions (AAIs) in a wide range of patient groups to reduce suffering and promote recovery behaviors. Studies suggest that these interventions can reduce anxiety and depression symptoms, promote engagement in rehabilitation, and ease distressing physiologic symptoms like pain. Despite these potential benefits, few analyses have explored AAIs in the ICU setting. “Anecdotal evidence suggests that the presence of dogs in the ICU can benefit patients,” Dr. Hosey says. “Patients receiving a visit from a trained dog might experience improvements in mood and be more likely to participate in rehabilitation therapies.”

In an editorial published in Critical Care, Dr. Hosey and colleagues described their experiences partnering with a hospital’s existing animal therapy program, its epidemiology and infection control department, and its risk management team to extend an AAI program to the ICU setting. “We took the proper precautions prior to implementing an AAI program to ensure that extending it to the ICU would be both safe and effective for patients and the dog teams,” says Dr. Hosey. “Building these interventions takes a concerted, multidisciplinary effort.”

Six critical success factors have been identified for building an AAI program (Table). When implementing an AAI, there are several key steps for clinicians and hospitals to keep in mind. The first step is to ensure the appropriateness of ICU patients being considered for an AAI. This requires determining if patients are interested and have the cognitive ability to participate in an AAI. It also requires assessing if patients can be involved in an AAI without concerns for exposure to infections. The second step is to place a consult request for AAI, and the third is to coordinate the timing of the intervention to fit patients’ schedules and the ICU workflow.

 

Encouraging Results

The editorial by Dr. Hosey and colleagues indicates that the early results of AAI have been encouraging. “So far, participants in our clinical activity have responded positively about their dog therapy visits,” Dr. Hosey says. “Patients receiving the intervention have reported feeling more relaxed and being distracted from pain. These individuals also tend to participate in therapies for longer periods of time. For example, they will stand longer to pet a dog or bend over to give it a treat. These activities can help mobilize patients more quickly during their ICU stay. In the future, we’re hoping to measure ratings on pain, emotion, and rehabilitation engagement before and after ICU visits.”

Clinicians in the ICU have traditionally operated under the mindset that giving patients the right medication is the best way to improve psychological status. “Psychological medications can still play a role, but non-pharmacological interventions like AAI are crucial to caring for the mind, body, and spirit,” says Dr. Hosey. “Other non-pharmacological interventions like music therapy and relaxation training are alternative methods that put patients in the driver’s seat of their own recovery. AAIs and other non-pharmacological interventions can play an important role in improving outcomes in the ICU.”

References

Hosey MM, Jaskulski J, Wegener ST, Chlan LL, Needham DM. Animal-assisted intervention in the ICU: A tool for humanization. Crit Care. 2018;22(22). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808422/

Lefebvre SL, Golab GC, Christensen E, et al. Guidelines for animal-assisted interventions in health care facilities. Am J Infect Control. 2008;36:78-85.

Hoffmann AO, Lee AH, Wertenauer F, Ricken R, Jansen JJ, Gallinat J, et al. Dog-assisted intervention significantly reduces anxiety in hospitalized patients with major depression. Eur J Integr Med. 2009;1:145-148.

Lasa SM, Ferriero G, Brigatti E, Valero R, Franchignoni F. Animal-assisted interventions in internal and rehabilitation medicine: a review of the recent literature. Panminerva Med. 2011;53:129-136.