# Hidden Burden of ICU: Patient-Perceived Stressors After Cardiothorasic Surgery

## TL;DR

This study identifies sleep problems and heart monitor alarms as major stressors for cardiac surgery patients in the ICU, suggesting ways to reduce their distress.

## Contribution

The study provides new insights into specific ICU stressors affecting postoperative cardiac surgery patients and their associations with clinical and environmental factors.

## Key findings

- Sleep problems and hearing heart monitor alarms were the most distressing stressors for ICU patients.
- Longer respiratory support and higher pain intensity were linked to higher stressor ratings.
- Higher room occupancy increased stress from environmental disturbances.

## Abstract

Background/Objectives: Patients after cardiac surgery admitted to the intensive care unit (ICU) are exposed to environmental, procedural, and psychological stressors that may affect comfort and recovery. This study aimed to assess perceived ICU stressors in postoperative cardiac surgery patients, identify the most and least distressing factors, and examine associations between stressor intensity and selected clinical and organizational variables. Methods: A single-center cross-sectional survey was conducted in an ICU in Poland (January 2024–February 2024). Adult patients after cardiac surgery who provided informed consent and had no cognitive impairment were included; cognitive status was screened using the Montreal Cognitive Assessment (MoCA). Perceived stressors were measured using the Intensive Care Unit Environmental Stressor Scale (ICUESS; 40 items; 4-point Likert scale). Results: The highest-rated stressors were sleep problems (M = 2.30; SD = 0.86) and hearing heart monitor alarms (M = 2.16; SD = 0.82). The lowest-rated stressors were not knowing what day it was (M = 1.46; SD = 0.54) and nurses not introducing themselves (M = 1.50; SD = 0.54). Longer respiratory support and higher pain intensity were associated with higher stressor ratings for multiple ICUESS items, whereas age showed no significant association. Higher room occupancy was linked to higher perceived stress related to environmental disturbances. ICU length of stay showed only limited item-level associations. Conclusions: Postoperative cardiac surgery patients experience a multifactorial burden of ICU stressors, with sleep disruption and alarm-related noise among the most distressing. Prioritizing modifiable environmental factors, symptom control (particularly pain), and patient-centered communication may help reduce perceived stress, especially in shared-room settings and among patients requiring longer respiratory support.