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 face vulnerability, disorientation, loss of control, and reduced communication. We report two later phases of an iterative program testing positive suggestion-based psychological support. Study 3 randomized 112 adults to standard care, audio-recorded positive suggestions (ARPS), or ARPS plus reduced-frequency live positive suggestion-based psychological support (PSBPS); Study 4 randomized 35 patients to standard care or reduced-frequency live PSBPS. Primary outcomes were mechanical ventilation (MV) duration and ICU length of stay (LOS). In Study 3, neither intervention significantly reduced MV duration or ICU LOS in the full randomized sample. Planned sex-stratified analyses showed 63.69 fewer MV hours among female ARPS patients than female controls, but treatment-by-sex interaction was nonsignificant. Exploratory post hoc engagement analyses yielded a hypothesis-consistent pattern: consistently engaged ARPS patients had approximately 1.7 days shorter MV and 2.8 days shorter ICU LOS than controls, while patients with hesitant engagement had longer courses. In Study 4, live PSBPS reduced MV duration by 76.62 h (95% CI [1.07, 152.16]; p = 0.047), supported by nonparametric, SAPS II-adjusted, and competing risk sensitivity analyses; ICU LOS was nonsignificantly shorter by 51.45 h. Mortality was numerically lower in intervention groups but nonsignificant. These historical randomized findings support confirmatory evaluation of coherent, acceptable PSBPS delivery in contemporary ICU care.