A ventilator strategy combining low tidal volume ventilation, recruitment maneuvers, and high positive end-expiratory pressure does not increase sedative, opioid, or neuromuscular blocker use in adults with acute respiratory distress syndrome and may improve patient comfort

Annals of Intensive Care

Table 3 Comfort assessment: perceptions of physicians and respiratory therapists

	Intervention	Control	Relative risk (95% confidence interval)	Pvalue
	N=1,297	N=1,443	Relative risk (95% confidence interval)	Pvalue
How much discomfort is this patient experiencing? n (%)	N =1,185	N =1,309
No discomfort	960 (81.0)	1,020 (77.9)	1.04 (0.99, 1.08)	0.06
Minimal discomfort	152 (12.8)	192 (14.7)	0.87 (0.72, 1.07)	0.18
Moderate, major, or extreme discomfort	73 (6.2)	97 (7.4)	0.83 (0.62, 1.11)	0.22
How does the patient's discomfort manifest? n (%)	N =1,229	N =1,360
Air hunger	40 (3.3)	55 (4.0)	0.80 (0.54, 1.20)	0.29
Agitation	92 (7.5)	122 (9.0)	0.83 (0.64, 1.08)	0.17
Ventilator asynchrony	97 (7.9)	143 (10.5)	0.75 (0.59, 0.96)	0.02
Diaphoresis	4 (0.3)	14 (1.0)	0.32 (0.10, 0.96)	0.03
How uncomfortable are you with the ventilator strategy? n (%)	N =1,186	N =1,308
Not at all	1,002 (84.5)	1,082 (82.7)	1.02 (0.99, 1.06)	0.24
Minimally	105 (8.9)	136 (10.4)	0.85 (0.67, 1.08)	0.19
Moderately	56 (4.7)	62 (4.7)	0.996 (0.70, 1.42)	0.98
Very	17 (1.4)	19 (1.5)	0.99 (0.52, 1.89)	0.97
Extremely	6 (0.5)	9 (0.7)	0.74 (0.26, 2.06)	0.56
What is the cause of your discomfort? n (%)	N =1,223	N =1,357
High level of PEEP	35 (2.9)	10 (0.7)	3.88 (1.93, 7.81)	<0.0001
Apparent patient discomfort	52 (4.3)	81 (6.0)	0.71 (0.51, 1.00)	0.049
Need for large amounts of sedation or paralysis	75 (6.1)	118 (8.7)	0.71 (0.53, 0.93)	0.01
Concerns of other bedside clinician	15 (1.2)	17 (1.3)	0.98 (0.49, 1.95)	0.95
Concerns of family	5 (0.4)	13 (1.0)	0.43 (0.15, 1.19)	0.10

In this table, we present results of the comfort assessments. Daily for the first 4 days after randomization, we administered an anonymous questionnaire to physicians and respiratory therapists, asking about their assessment of the patient's discomfort related to the assigned ventilation strategy, the manifestation of the patient's discomfort, the clinician's discomfort with the ventilator strategy, and the reasons for the clinician's discomfort (see Additional file 1 for the questionnaire). This table represents 417 patients and 2,740 questionnaires; 2,322 (85%) of questionnaires were completed by physicians and 418 (15%) by respiratory therapists. The median number of questionnaires per patient was 4 (IQR 4 to 8).