The Intensive Care Units (ICUs) we know about are filled with the rhythmic hum of ventilators, keeping patients alive in a seemingly serene state, but reality often masks the horrors of their condition. Since the 1980s, the practice of ventilating patients has evolved, but unfortunately, the approach to sedation has remained stagnant. Today, deeply sedating patients into medically induced comas upon ventilator connection is standard practice, justified under the guise of humane care. However, the myths surrounding this practice conceal a far more alarming truth - a truth that critical care nurse practitioner Kali Dayton, DNP, AGACNP, seeks to expose.
There are various myths about sedation. These include the belief that patients are 'sleeping', which is not true. The sedation disrupts brain activity and can lead to confusion and hallucinations, known as delirium. Many ICU clinicians believe that patients are peacefully unaware of their surroundings while comatose under sedation. However, many patients may still be aware of their surroundings but lost in a world of delusions resulting in a greater risk of post-ICU PTSD. Ironically, these myths that medically-induced comas are harmless, humane, and essential for all patients on mechanical ventilation, contradict the evidence that demonstrates that sedation increases the likelihood of mortality, complications, and prolonged ICU stays. Most ICU patients can and should be awake and moving while on the ventilator, despite some exceptional cases that require continuous sedation.
