Patients’ Recollections of Therapeutic Paralysis in the Intensive Care Unit

Abstract

• 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. • Objectives 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.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…Given the uncertainty that still exists pertaining to these important outcomes and the balance between benefits and potential harms, the panel decided that a weak recommendation was most suitable. If NMBAs are used, clinicians must ensure adequatepatient sedation and analgesia [400,401]; recently updated clinical practice guidelines are available for specific guidance [402].…”

Neuromuscular blockade management in the critically Ill patient

“…Unintended (or accidental) awareness and recall are also a major concern during the use of NMBAs [110,111]. In patient interviews, feelings of dying, being tied down, and fear were expressed with the concomitant use of NMBAs.…”

Patients and ICU nurses' perspectives of non‐pharmacological interventions for pain management

“…Pain is a major stressor for patients in the intensive care unit (ICU; ; ; ). Indeed, recent studies have reported that more than 70% of patients recalled experiencing moderate to severe pain during their stay in the ICU (; ).…”