Integrating Nonpharmacological, Adjunctive Interventions Into Critical Care Practice: A Means To Humanize Care?

1appeared in a medical journal a few years ago describing the grotesque and inhumane scenarios in critical care units. Patients receiving mechanical ventilation were lying deeply sedated and paralyzed, overmedicated with various pharmacological agents. Sedative and paralytic agents are staples in critical care units and, when used appropriately, can be helpful in reducing airway pressure and promoting adequate gas exchange in patients receiving mechanical ventilation. These agents must be used judiciously, however, to avoid complications. Sedative agents can cause numerous adverse effects such as hypotension, muscle weakness, delayed weaning from mechanical ventilation, and increased risk for ventilator-associated nosocomial pneumonia. 2-6 Sedation does not have to be the first choice in attempts to allay a patient’s anxiety and distress associated with mechanical ventilatory support. Routine, automatic sedation of patients receiving mechanical ventilation is inappropriate; overuse of sedation can be detrimental to patients, 7 and heavy dosages of medications do not necessarily improve outcomes and may even cause longterm harm, such as depression and paranoid delusions. 8