Abstract Rationale Deep sedation is commonly used in patients with respiratory failure despite being associated with increased mortality and loss of independent living compared to patients receiving light sedation. However, little is known about the organizational factors contributing to the overuse of deep sedation across multiple hospitals. Methods We performed semi-structured interviews of 52 intensive care unit (ICU) clinicians across eight academic and community hospitals. Hospitals were sampled from across the U.S. based on risk-adjusted mortality rates for respiratory failure. Interviews were conducted virtually for approximately 20 minutes. Interview questions were designed to explore environmental, organizational, and operational factors contributing to sedation use. Responses were transcribed and analyzed to identify common themes regarding current sedation practices, unit culture, and suggestions for improving sedation delivery. Results Beginning in October 2024, we interviewed 28 nurses, 12 physicians, 6 pharmacists, 3 respiratory therapists, 2 advanced practice professionals, and 1 certified nursing assistant. Fifteen participants held leadership positions in their ICU. In general, deep sedation was described, not as a medical goal, but as a means of minimizing harm from other challenges, like patient agitation and self-extubation. Several themes regarding the importance of organizational factors to sedation use were identified, including 1) the availability of monitoring technology; 2) policies and procedures relating to sedation; 3) support from unit and hospital leadership; 4) familiarity, rapport, and trust among the caregiver team; and 5) staffing. Better access to state-of-art technologies (monitors and information systems) was proposed for enhanced monitoring of sedated patients (Table). Participants desired more defined sedation protocols, as they felt current practice led to ad hoc individual management. Leadership support was mentioned as vital to understanding nursing needs and improving care processes, as was a general culture of trust and rapport among staff developed over time and shared experiences. The most frequent theme throughout interviews was the need for increased staffing—including more nurses, aides, technicians, and night staff—to enhance monitoring of patients in order to meet light sedation targets. Conclusions In a multi-hospital qualitative study, ICU clinicians identified technology, policies, leadership, culture, and staffing as organizational factors that act as barriers to light sedation for patients with respiratory failure. There is a need for health systems to provide ICU clinicians with the resources necessary to minimize the use of deep sedation, a common clinical practice that is harmful to patients with respiratory failure. This abstract is funded by: NIH (R01HL157361)
Croxton et al. (Fri,) studied this question.