Cultural changes in ICU sedation management

Abstract

The aim of this study was to explore physicians' views and perceptions of sedation, and offer a new approach to the understanding of issues of sedation. I used a qualitative, descriptive, and explorative multicenter design. Data were generated by seven key-informant interviews using a semistructured interview guide. One experienced doctor was selected at each of the seven largest intensive care units in Denmark. Interpretational analysis was performed by comprehensive overview, individual case analysis, cross-case analysis, and integrated thematic analysis and identification of emerging themes. The following themes emerged: a paradigm shift from sedated to more awake and comfortable patients, cultural changes toward intracollegial openness, increased interdisciplinary and staff/patient/family collaboration, patient and environmental normalization, and humanization. The study findings provide an understanding of contextual issues of sedation, safety, and comfort, and suggest that a cultural change in sedation strategies might reduce the duration of sedation and mechanical ventilation while containing cost and improving the well-being of the patients.