Episode 4: Sedation is NOT Sleep
For decades we have sedated nearly all patients the moment they are on mechanical ventilation. Episode #2 revealed the discomfort of the first archaic ventilators and the necessity for sedation to provide patient compliance and tolerance of those ventilators.
Yet, despite the evolution of ventilator technology, we continue to deeply sedate our patients. Is this out of necessity or cultural habits?
At least 68% of nurses truly believe sedation is for “patient comfort”. This must be why we can joke about and demand that our patients be sedated “and had better not move a muscle”.
Yet…. is it really comfortable for patients? We see them motionless with their eyes closed and it makes us feel good. The word “sleep” rolls off our tongues with such confidence and instinct. “They’re asleep under sedation”, we continually tell ourselves.
….Are they really?
Let’s ask and listen to those that have actually survived days to weeks of sedation and hear their side of things. Let’s dive into the research and understand the true cause of post-ICU PTSD.
This won’t be popular, but let’s simplify this:
More sedation = More delirium
More delirium = More traumatic hallucinations
More sedation= More PTSD
Less recall of ICU stay = Worse PTSD symptoms
Let’s realize the reality of sedation…
and TURN IT OFF.
Articles Referenced:
Davydow, D., Gifford, J., Desai, S., Needham, D., & Beinvenu, J.(2008). Posttraumatic stress disorder in general intensive care unit survivors: a systematic review. General Hospital Psychiatry, 30(5), 421–434.
Dziadzko, V., Dziadzko, M., Johnson, M., Gajic, O., & Karnatovskaia, L. (2017). Acute psychological trauma in the critically ill: patient and family perspectives. General Hospital Psychiatry, 47.
Girard, T., Shintanti, A., Jackson, J., Gordon, S., Pun, B., Henderson, M., Dittus, R., Bernard, G., & Ely, W. (2007). Risk factors for post-traumatic stress disorder symptoms follow critical illness requiring mechanical ventilation: a prospective cohort study. Critical Care Medicine, 11(1).
Guttormson, J., Chlan, L., Tracy, M., Hetland, B., & Mandrekar, J. (2019). Nurses’ attitudes and practices related to sedation: a national survey. Pulmonary Critical Care, 28(4).
Jones, C., Griffiths, R., Humphris, G., & Skirrow, P. (2001). Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Critical Care Medicine, 29(3).
Jones, C., Backman, C., Capuzzo, M., Flaatten, H., Rylander, C., Griffiths, R., Nelson, B., Weinert, C., Bury, C., Marinelli, W., & Gross, C. (2007). Precipitants of post-traumatic stress disorder following intensive care: a hypothesis generating study of diversity in care. Intensive Care Medicine, 33(6).
Marra, A., Pandharipande, P., & Patel, M. (2017). ICU delirium and icu-related ptsd. Surgical Clinics of North America, 97(6), 1215–1235.
Nelson, B., Weinert, C., Bury, C., Marinelli, W., & Gross, C. (2000). Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Critical Care Medicine 28(11).
