Quote from delphine22
No, but I had a family member who was awake while intubated and self-extubated. His vivid description of the experience has stayed with me and I think of it every time I see a pair of frightened eyes look up at me as they try to speak, to tell me they feel like they're drowning while I assure them they are not.
I don't "snow" my patient to make my shift go more smoothly. It's for their comfort, not mine. It's not easy to get to the "sweet spot" of sedation where they're out until we want them not to be. I did mention sedation vacations q shift which is my unit's policy. As for delirium, which do you think is worse -- being asleep and having no memory of the experience, or being in a terrifying twilight state where you can't communicate your fears and, being half sedated, aren't sure what's real and what's not, or whether you're even dead or alive?
I urge you to read the current literature and some of the links users have posted. Many of our ICU's are involved in the SCCM's ABCDEF Bundle Collaborative.
The "twilight state" you're describing IS delirium. The research shows that a lot of the sedatives/analgesia's we use to "help" our patients are actually causing acute ICU delirium and long-term neurological deficits. Avoiding or minimizing analgesia and sedation is a major component, but other things like promoting proper sleep cycles (e.g. no 2am baths) are important as well.
You mention sedation vacations, but does your unit routinely assess for delirium using the CAM-ICU tool? What is your target for sedation? Do you use a reliable tool like the RASS?
It's normal to resist change, but just because we've always done things a certain way or we were taught a certain way does not mean it is right. There was definitely a lot of resistance in my unit initially as well (especially from the more "seasoned" nurses) but we've definitely seen a reduction in vent-days and shorter ICU stays. It's now quite common to most of our vented patients awake/alert. Some of them even ambulate around the unit.
And yes, there are exceptions. Some patients simply cannot be safely weaned off sedation/analgesia. Patient safety still takes priority. However, you'll find that when your unit is more aggressive with weaning sedation/analgesia and assessing for delirium a lot of your patients were being more heavily medicated than necessary.