Perceptions of a critically ill patient experiencing therapeutic paralysis in an ICU

Prolonged therapeutic paralysis with pancuronium is commonly used in ICUs to facilitate mechanical ventilation of patients with respiratory failure. Sedation is usually given concomitantly to reduce patient discomfort, but assessment of its adequacy is made difficult by the paralysis. We recently cared for a former ICU nurse who required prolonged mechanical ventilation and paralysis and received morphine as a sedative. When she recovered, she was able to relate her experiences. She stressed the need for very frequent reorientation to time and her desire for constant explanation and re-explanation of all procedures being done by the nursing and physician staff. Her experiences provide insights that allow all ICU staff to provide better care for patients requiring therapeutic paralysis.