Barriers to Changing Sedation Practice for Patients Undergoing Mechanical Ventilation on the Intensive Care Unit: A Qualitative Interview Study of Clinical Staff

BACKGROUND: Medical sedation is a requirement for mechanical ventilation for most patients admitted to the intensive care unit (ICU). Sedation can help minimise patient discomfort, pain and distress, but can lead to hypotension, bradycardia, prolonged ventilation and delirium. Improving sedation practice is key to improving sedation-related patient outcomes. AIM: This study aims to explore ICU staff experience with sedation practices and identify potential areas for improvement and innovation. STUDY DESIGN: Semi-structured interview study exploring views, experiences and clinical decision-making of ICU medical and nursing staff from two NHS adult ICUs in Yorkshire, England. Interviews were recorded to enable anonymous transcript production. Transcripts were coded using reflexive thematic analysis guided by Braun and Clarke's six-stage method. FINDINGS: We interviewed 18 members of ICU medical and nursing staff and using thematic analysis four interrelated themes were identified. First, staff perception of sedation, including understanding and reasoning around sedation goals. Second, the impact that ICU culture has on sedation practices. Third, sedation education and training for clinical staff. Finally, motivation to change, aspects impacting the delivery of sedation practices on ICU and key considerations for innovating change. CONCLUSIONS: Sedation practices in ICU are shaped by complex interactions between clinical framing, cultural norms, education and training and organisational pressures. Optimising sedation and implementing innovation require prioritisation of sedation as an active, goal-directed treatment, supported by structured education and leadership engagement. RELEVANCE TO CLINICAL PRACTICE: This analysis offers novel insights into barriers and facilitators to innovating sedation practices for mechanically ventilated patients, highlighting under-prioritisation in clinical practice and training, cultural barriers and external influencers like staff retention and workload.