Staff and families perception of critically ill patient stressors: the role of conscious sedation

Rationale: Intensive care unit stay is a stressful experience. Caregivers may help to understand patients’ perceptions; however, their reliability is uncertain. Despite the recent recommendations of lighter sedation targets, little is known about the impact of conscious sedation on ICU-patients’ experience and staff perception. Objectives: To analyze stress perception in consciously-sedated ICU-patients, comparing it to that of caregivers and staff members. To analyze the impact of awake sedation on staff members’ perception. Materials and Methods: High-risk ICU-patients with sedation titrated to an awake/cooperative level. Before discharge, patients received a validated questionnaire for ICU stressors, also administered to their main caregiver, and to members of the staff (ICU-A). A second set of ICU staff members was selected from an institution in which patients were regularly maintained at a deeper level of sedation (ICU-B). Results and Conclusions: Stress score was: patients 141±41 (N=29), relatives: 205±68 (N=62), ICU-A staff: 232±44 (N=56), ICU-B staff: 252±49 (N=69), p<0.001. Among patients, older age (p=0.031), longer ICU-stay (p=0.018) and awake-sedation (p=0.022) were associated with lower stress; sex and illness severity had no effect; mechanical ventilation length (p=0.021) and agitation (p=0.029) were associated with higher stress. Nurses overestimated stressors more than trainees and attending physicians. Within ICU-A staff, age (p=0.021) and years of experience (p=0.069) were positively associated with overestimation. Conscious sedation is associated with lower stressor perception. Relatives and staff members tend to overestimate patient perception, more so with increasing age or expertise, if they are nurses and if they are not used to consciously-sedated patients.