Live and Audio-Recorded Positive Suggestion-Based Psychological Support in Mechanically Ventilated ICU Patients: Two Later-Phase Randomized Studies from an Iterative Research Program

Mechanically ventilated ICU patients are exposed to vulnerability, disorientation, loss of control, and reduced communication. This manuscript reports two later phases of an iter-ative program testing positive suggestion-based psychological support as a structured ICU communication intervention. Study 3 randomized 112 mechanically ventilated adults to standard care, audio-recorded positive suggestions (ARPS), or ARPS plus re-duced-frequency live positive suggestion-based psychological support (PSBPS). Study 4 randomized 35 patients to standard care or reduced-frequency live PSBPS. Primary out-comes were mechanical ventilation duration and ICU length of stay; ICU mortality was exploratory. In Study 3, neither ARPS nor combined treatment significantly reduced out-comes in the full randomized sample. However, planned sex-stratified analyses showed that female ARPS patients required 63.69 fewer hours of mechanical ventilation than fe-male controls, a 2.65-day and 44.0% reduction. Exploratory engagement analyses sug-gested shorter ventilation and ICU stay among patients consistently engaging with ARPS, whereas hesitant engagement was associated with less favourable outcomes. In Study 4, live PSBPS significantly shortened mechanical ventilation by 76.62 hours, a 3.19-day and 43.4% reduction; ICU stay was nonsignificantly shorter by 51.45 hours. Mortality was numerically lower in intervention groups but nonsignificant. Findings support further study of coherent, acceptable PSBPS delivery in ICU care.