title: Patient experiences during awake mechanical ventilation.
abstract: BACKGROUND
  Sedation practices in an ICU have shifted significantly in the past 20 years toward the use of minimizing sedation in mechanically ventilated patients. While minimizing sedation is clearly in the best interest of patients, data are lacking about how this approach affects patients' experiences.
  
  
  METHODS
  We interviewed mechanically ventilated patients receiving minimal sedation, over a 6-month period in an ICU, in order to explore their emotional, comfort, and communication experiences. Their responses were compared with the responses of their available family members regarding their attitudes and perceptions of the patients' experiences.
  
  
  RESULTS
  Seventy-five percent of the patients agreed or strongly agreed that they experienced pain, and 50% agreed or strongly agreed that they were comfortable. Half of the patients agreed or strongly agreed that they preferred to be kept awake. Five patients (31%) indicated that they were frustrated while 17 relatives (89%) agreed or strongly agreed that the patients were frustrated. When controlling for age and gender of respondents, family members perceived higher levels of patient pain (least square [LS] mean [95% CI]: 4.2 [3.7, 4.7] vs. 3.1 [2.5, 3.8]; p=0.022), frustration (LS mean [95% CI]: 4.2 [3.7, 4.6] vs. 3.2 [2.6, 3.9]; p=0.031), and adequate communication with nurses and doctors (LS mean [95% CI]: 3.9 [3.5, 4.4] vs. 3.1 [2.4, 3.7]; p=0.046) than the patients themselves.
  
  
  CONCLUSIONS
  Patients tolerated minimal sedation without significant frustration while mechanically ventilated despite experiencing discomfort. Patient and family member perceptions of the patient experience may differ, especially in regards to pain and frustration. The use of a communication tool can facilitate understanding of patient experiences and preferences.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT, USA; dinprime@gmail.com.
authors.forename: Danille
authors.initials: D
authors.lastname: Prime
authors.affiliation: Geisinger Health System, Danville, PA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Arkless
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fine
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Winter
authors.affiliation: Center for Public Health and Health Policy, University of Connecticut Health Center, Farmington, CT, USA.
authors.forename: Dorothy B
authors.initials: DB
authors.lastname: Wakefield
authors.affiliation: Section of Pulmonary and Critical Care Medicine, Norwalk Hospital, Norwalk, CT, USA.
authors.forename: Robyn
authors.initials: R
authors.lastname: Scatena
keywords: communication experiences; family perceptions; minimal sedation; patient comfort; patient experience