The experience of cognitive impairment in critically ill patients in and beyond intensive care: findings from a larger phenomenological study

Background: Although Daily Sedation Interruption (DSI) is associated with better physical outcomes, many intensive care (ICU) survivors continue to suffer from cognitive impairment in and beyond ICU; neither has the meaning patients attach to the experience of cognitive impairment been extensively explored in the context of DSI. Objective: To gain an understanding of and uncover the experience of critical illness in ICU and beyond in the context of DSI. To establish whether or not DSI improves the experience of critical illness in ICU and beyond. Design: A hermeneutic phenomenological study using purposive sampling. Setting: Single centre 16 bed ICU in a 500 bed regional tertiary referral Hospital in Australia. Participants: Fifteen potential participants were approached. Two refused to participate, one died a week before the first interview, and 12 were enrolled into the study. Two participants withdrew from the study after the first interview, one was lost to follow-up and one was hospitalised. Inclusion criteria was patients aged 18 years and above who were mechanically ventilated and underwent DSI for at least 24 hours and were all able to speak English and give informed consent to participate in the study. Patients were excluded from the study if they had a poor prognosis, were less than 18 years old, unable to speak English, not ventilated and sedated for at least 24 hours. Methods: Participants were interviewed using open ended questions at two weeks after discharge from ICU and at six to eleven months following the initial interview. Interviews were tape recorded, transcribed and thematically analysed by highlighting themes using a phenomenological approach. Results: All the participants suffered some form of cognitive impairment resulting in the overarching theme of ‘Being in Limbo’ with three major themes of ‘Being Disrupted’, Being Imprisoned’ and ‘Being trapped’. The major themes ‘Being Disrupted and ‘Being Trapped’ highlighted the prevalence of cognitive impairment. Conclusion: Although DSI is associated with better physical ICU outcomes, it does not improve the experience of critical illness and it does not decrease the incidence of cognitive impairment in and beyond ICU. What is already known about the topic. Daily sedation interruption is associated with improved physical outcomes. Critical illness is associated with cognitive impairment. What this paper adds This research shows that despite DSI the experience of critical illness in ICU and beyond is that of being in limbo during and after critical illness. DSI does not decrease the incidence of cognitive impairment in ICU survivors.