title: Clinician perspectives on protocols designed to minimize sedation.
abstract: OBJECTIVE
  Within a multicenter randomized trial comparing protocolized sedation with protocolized sedation plus daily interruption (DI), we sought perspectives of intensive care unit (ICU) clinicians regarding each strategy.
  
  
  METHODS
  At 5 ICUs, we administered a questionnaire daily to nurses and physicians, asking whether they liked using the assigned strategy, reasons for their responses, and concerns regarding DI.
  
  
  RESULTS
  A total of 301 questionnaires were completed, for 31 patients (15 protocol only and 16 DI); 117 (59 physicians and 58 nurses) were the first questionnaire completed by that health care provider for that patient and were included in analyses. Most respondents liked using the assigned strategy (81% protocol only and 81% DI); more physicians than nurses liked DI (100% vs 61%; P < .001). Most common reasons for liking the assigned sedation strategy were better neurologic assessment (70% DI), ease of use (58% protocol only), and improved patient outcomes (51% protocol only and 44% DI). Only 19% of clinicians disliked the assigned sedation strategy (equal numbers for protocol only and DI). Respondents' concerns during DI were respiratory compromise (61%), pain (48%), agitation (45%), and device removal (26%). More questionnaires from nurses than physicians expressed concerns about DI.
  
  
  CONCLUSIONS
  Most respondents liked both sedation strategies. Nurses and physicians had different preferences and rationales for liking or disliking each strategy.
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Academic Department of Critical Care, Queen Alexandra Hospital, University of Portsmouth, Portsmouth, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Fitzgerald
authors.affiliation: Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, St Joseph's Healthcare, Hamilton, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.affiliation: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Kim
authors.affiliation: Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Steinberg
authors.affiliation: School of Pharmacy, Northeastern University, Boston, MA.
authors.forename: John W
authors.initials: JW
authors.lastname: Devlin
authors.affiliation: St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Betty Jean
authors.initials: BJ
authors.lastname: Ashley
authors.affiliation: Division of Critical Care Medicine and Center for Health Evaluation and Outcome Sciences, St Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Orla
authors.initials: O
authors.lastname: Smith
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Kerri
authors.initials: K
authors.lastname: Poretta
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Yoon
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Keenan Research Centre and the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Burns
authors.affiliation: Hôpital Maisonneuve Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Johanne
authors.initials: J
authors.lastname: Harvey
authors.affiliation: Département de Médecine, Soins Intensifs, Hôpital Maisonneuve Rosemont, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Yoanna
authors.initials: Y
authors.lastname: Skrobik
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute and Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.affiliation: Departments of Medicine, Clinical Epidemiology & Biostatistics, McMaster University, Department of Critical Care, Hamilton Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Meade
authors.affiliation: Mount Sinai Hospital, and Program in Developmental Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Kraguljac
authors.affiliation: Department of Pharmacy and Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Burry
authors.affiliation: Department of Medicine and Interdepartmental Division of Critical Care, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: Geeta.mehta@utoronto.ca.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods*; D064648:Critical Care Nursing; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010348:Patient Care Team; D011595:Psychomotor Agitation / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods; D011795:Surveys and Questionnaires
keywords: Analgesia; Attitudes of health personnel; Daily interruption; Intensive care unit; Mechanical ventilation; Sedation protocol