Patients' recollections of therapeutic paralysis in the intensive care unit.
BACKGROUND
Neuromuscular blocking agents used for therapeutic purposes, such as facilitating mechanical ventilation and relieving life-threatening agitation, paralyze patients but leave them fully conscious. Aggressive sedation or analgesia is necessary to reduce awareness, relieve fear, produce comfort, decrease anxiety, induce unconsciousness, and minimize possible complications such as posttraumatic stress syndrome. Little information is available on the extent to which patients experience awareness during therapeutic paralysis.


OBJECTIVE
To determine and describe the remembered experiences of critical care patients who were given neuromuscular blocking agents and sedatives and/or analgesics to facilitate mechanical ventilation, improve hemodynamic stability, and improve oxygenation.


METHODS
A phenomenological approach with in-depth interviews with 11 patients was used. Data were analyzed by using the constant comparative approach.


RESULTS
A total of 4 themes and 3 subthemes were identified. The first theme was back and forth between reality and the unreal, between life and death; the subtheme was having weird dreams. The second theme was loss of control; the 2 subthemes were (1) fighting or being tied down and (2) being scared. The third theme was almost dying, and the fourth theme was feeling cared for.


CONCLUSIONS
Patients can remember having both negative and positive experiences during neuromuscular blockade. Steps to improve the experiences of patients receiving neuromuscular blockers include improving assessment parameters, developing and using sedation/analgesia guidelines, and investing in quality improvement programs to provide assessment of awareness during therapeutic paralysis and follow-up and referral as necessary. Ways to decrease the use of neuromuscular blockers would also be useful.
Ballard
Nancy
N
WellStar Health System, Marietta, GA, USA.
Robley
Lois
L
Barrett
Darcy
D
Fraser
Danielle
D
Mendoza
Inocencia
I
D000328:Adult; D000368:Aged; D000698:Analgesia / Q000523:psychology; D001007:Anxiety / Q000523:psychology; D001364:Awareness / Q000187:drug effects; D016292:Procedural Sedation / Q000523:psychology; D003422:Critical Care / Q000379:methods*; D004325:Dreams / Q000523:psychology; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods / Q000523:psychology*; D007297:Inpatients / Q000523:psychology*; D007362:Intensive Care Units; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008568:Memory / Q000502:physiology*; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D010146:Pain / Q000517:prevention & control / Q000523:psychology
D009466:Neuromuscular Blocking Agents