Acupressure for Agitation, Pain, and Sleep in Mechanically Ventilated ICU Patients

Effects of a Repeated Acupressure Program on Agitation, Pain, and Sleep in Mechanically Ventilated Intensive Care Unit Patients: A Randomized Controlled Trial

Mechanically ventilated intensive care unit (ICU) patients commonly experience agitation, pain, and sleep disturbances, which may negatively affect recovery and increase the need for sedative medications. Non-pharmacological interventions such as acupressure have been proposed as potential supportive strategies for symptom management in critically ill patients.

This randomized controlled trial aims to evaluate the effects of a repeated acupressure program on agitation, pain, and sleep in mechanically ventilated ICU patients. Participants will be randomly assigned to either an acupressure intervention group or a control group receiving light touch at the same acupoints. The intervention was administered twice daily for four consecutive days. Agitation, pain, and sleep outcomes will be assessed using both subjective and objective measurements, including wearable device-based monitoring. The study also aims to explore the cumulative effects of repeated acupressure intervention during ICU hospitalization.

Inclusion Criteria:

• Adult patients aged 20 years or older
• Admitted to an intensive care unit
• Receiving mechanical ventilation via an oral endotracheal tube
• Richmond Agitation-Sedation Scale (RASS) score between +2 and +3
• Expected to remain in the ICU for at least 4 consecutive days
• Able to receive acupressure intervention as determined by the clinical care team

Exclusion Criteria:

• planned extubation or ventilator weaning during the study period to ensure a stable clinical condition throughout the intervention period
• requirement for deep sedation (e.g., continuous high-dose midazolam or propofol)
• severely hemodynamic or respiratory instability (e.g., APACHE II ≥30, heart rate ≥150 beats/min with severe arrhythmia, respiratory rate ≥30 breaths/min, SpO₂ <90%, or use of high-dose vasopressors with mean arterial pressure ≤50 mmHg)
• severe agitation requiring immediate pharmacological restraint
• diagnosed delirium, psychiatric disorders, or neurocognitive disorders
• bleeding tendency (e.g., platelet count <20,000/µL) or contraindications to acupressure