Intensive care unit patients' experience of being conscious during endotracheal intubation and mechanical ventilation

Abstract

Background: There is a change in paradigm in intensive care units with trends towards lighter sedation. Light or no sedation protocols are, however, a radical change for clinical practice and can cause challenges for the patients. Undergoing mechanical ventilation when conscious can be a distressing experience for the patients. Receiving a tracheostomy increases patient comfort, but some patients still undergo prolonged endotracheal intubation during mechanical ventilation. The experience of being conscious during endotracheal intubation and mechanical ventilation in the intensive care unit has not previously been described.

Aims: The aim of the study was to explore adult intensive care unit patients' experience of being conscious during endotracheal intubation and mechanical ventilation.

Design: Data collection was performed through semi-structured interviews and four patients were enrolled. Data were collected at two multidisciplinary intensive care units in Denmark.

Method: Data were analysed using Ricoeur's theory of interpretation, using the method described by Dreyer and Pedersen. The scientific tradition was phenomenological-hermeneutic.

Result: During the analysis, three themes emerged: (1) The tube in the throat. (2) To be conscious but feeling doped. (3) When passing of time is dragging on.

Conclusion: The findings shed a light over the experience of being conscious during endotracheal intubation and mechanical ventilation in the intensive care unit. A no-sedation protocol may cause problems for the patients both of a physical and an existential character, but despite this, patients seem positive towards being conscious.

Relevance to clinical practice: The study suggests that clinical nursing practice may have to be further developed to accommodate the patients' needs, e.g. communicating and participating as well as optimizing nursing interventions towards thirst, pain and tube management. Furthermore, the intensive care unit setting may need revision, providing space for the patient and sensory meaningful inputs in the technologically intense environment.

Keywords: Intensive care nursing; Mechanical ventilation; Qualitative research; Sedation.