Real and illusory perceptions of patients in induced coma

The main memories reported after induced coma were thirst, cold, and pain. In some studies, patients reported they were unable to tell whether they were awake or dreaming, whether it was real or unreal. Satisfactory memories were reported by patients related to the care received and the use of bedside journals.

Conclusion:

Evidence showed a number of studies aiming to identify delirium, but without a focus on analyzing real or illusory perceptions of patients after induced coma. Thus, this integrative review identified scientific evidence of memories related to perceptions of sedated patients in the intensive care unit.

Descriptors:
Deep Sedation; Memory; Delirium; Critical Care; Nursing

Level of evidence	Study design	Number of participants	Perceptions identified
VI	Qualitative	10 patients	Memories of delirium, fear, and insecurity⁽¹³13 Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. J Clin Nurs [Internet]. 2016 [cited 2017 Dec 22];25(19-20):2807-15. Available from: https://doi.org/10.1111/jocn.13318 https://doi.org/10.1111/jocn.13318... ⁾.
VI	Qualitative	14 patients	Memory of intubation and uncontrolled pain, even with the administration of sedative and analgesic drugs⁽¹⁴14 Fink RM, Makic MB, Poteet AW, Oman KS. The ventilated patient’s experience. Dimens Crit Care Nurs [Internet]. 2015 [cited 2017 Dec 22];34(5):301-8. Available from: https://doi.org/10.1097/DCC.0000000000000128 https://doi.org/10.1097/DCC.000000000000... ⁾.
VI	Qualitative	4 patients	Self-memories as external to themselves⁽¹⁵15 Whitehorne K, Gaudine A, Meadus R, Solberg S. Lived experience of the intensive care unit for journal who experienced delirium. Am J Crit Care [Internet]. 2015 [cited 2017 Dec 22];24(6):474-9. Available from: https://doi.org/10.4037/ajcc2015435 https://doi.org/10.4037/ajcc2015435... ⁾.
VI	Qualitative	24 patients	The use of a bedside journal enabled the recovery of consistent memories⁽¹⁶16 Clukey L, Weyant RA, Roberts M, Henderson A. Discovery of unexpected pain in intubated and sedated patients. Am J Crit Care. [Internet] 2014 [cited 2017 Dec 22];23(3):216-20 Available from: https://doi.org/10.4037/ajcc2014943 https://doi.org/10.4037/ajcc2014943... ⁾.
IV	Prospective cohort	152 patients	Reduced factual memory of delusional patients in relation to non-delusional patients⁽⁸8 Costa JB, Marcon SS, Macedo CRL, Jorge AC, Duarte PAD. Sedation and memories of patients subjected to mechanical journal in an intensive care unit. Rev Bras Ter Intensiva [Internet]. 2014 [cited 2017 Dec 22];26(2):122-129. Available from: https://doi.org/10.5935/0103-507X.20140018 https://doi.org/10.5935/0103-507X.201400... ⁾.
VI	Qualitative	18 patients	Memory of fear and perception of death⁽¹⁷17 Ewens B, Champman R, Tulloch A, Hendricks JM. ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study. Aust Crit Care [Internet]. 2014 [cited 2017 Dec 22];27(1):28-35. Available from: https://doi.org/10.1016/j.aucc.2013.07.001 https://doi.org/10.1016/j.aucc.2013.07.0... ⁾.
IV	Prospective cohort	115 patients	The use of abedside journal supported memory recovery⁽¹⁸18 Meriläinen M, Kyngäs H, Ala-Kokko T. Patient’s interactions in an intensive care unit and their memories of intensive care: a mixed method study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):78-87. Available from: https://doi.org/10.1016/j.iccn.2012.05.003 https://doi.org/10.1016/j.iccn.2012.05.0... ⁾.
IV	Prospective cohort	641 patients	Delirium was detected in 65% of patients during the first interview in the ICU⁽¹⁹19 Engström Å, Nyström N, Sundelin G, Rattray J. People’s experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):88-95. Available from: https://doi.org/10.1016/j.iccn.2012.07.003 https://doi.org/10.1016/j.iccn.2012.07.0... ⁾.
VI	Descriptive	8 patients	Bedside journals allowed patients to recover memories of the disease, treatment, reactions of the patient, and the presence and support of professionals⁽²⁰20 Svenningsen H. Associations between sedation, delirium and posttraumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit. Dan Med J [Internet]. 2013 [cited 2017 Nov 20];60(4):B4630. Available from: https://www.researchgate.net/publication/236653057_Associations_between_sedation_delirium_and_post-traumatic_stress_disorder_and_their_impact_on_quality_of_life_and_memories_following_discharge_from_an_intensive_care_unit https://www.researchgate.net/publication... ⁾.
VI	Descriptive	84 patients 77 family members	Memories of pain, no correlation with the perception of the family member⁽²¹21 Åkerman E, Ersson A, Feidlund B, Samuelson K. Preferred content and usefulness of a photodiary as journal by ICU patients: a mixed method analysis. Aust Crit Care [Internet]. 2013 [cited 2017 Nov 20];26(1):29-35. Available from: https://doi.org/10.1016/j.aucc.2012.04.002 https://doi.org/10.1016/j.aucc.2012.04.0... ⁾.
VI	Descriptive	250 patients	Pleasant memories of care, stress relief, and distressing memories of physical suffering and perceptive distress⁽²²22 Samuelson KAM. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patient - findings from 250 interviews. Intensive Crit Care Nurs [Internet]. 2011 [cited 2017 Nov 20];27(2):76-84. Available from: https://doi.org/10.1016/j.iccn.2011.01.003 https://doi.org/10.1016/j.iccn.2011.01.0... ⁾.
VI	Qualitative	325 patients	Memories of delirium in a face-to-face interview after two weeks and in a telephone interview after two and six months were a mixture of fiction and facts actually experienced by the patient⁽²³23 Storli SL, Lind R. The meaning of follow-up in intensive care: patients’ perspective. Scand J Caring Sci [Internet]. 2009 [cited 2017 Nov 20];23(1):45-56. Available from: https://doi.org/10.1111/j.1471-6712.2007.00589.x https://doi.org/10.1111/j.1471-6712.2007... ⁾.
IV	Prospective cohort	128 patients	Memory of ICU experience, combining real and illusory events⁽²⁴24 Engström Å, Grip K, Hamrém M. Experiences of intensive care unit diaries: touching a tender wound. Nurs Crit Care [Internet]. 2009 [cited 2017 Dec 22];14(2):61-7. Available from: https://doi.org/10.1111/j.1478-5153.2008.00312.x https://doi.org/10.1111/j.1478-5153.2008... ⁾.
VI	Qualitative	9 patients	A beside journal provided information about events of which the patients had fragmented memories⁽²⁵25 Roberts BL, Rickard CM, Rajbhandari D, Reynolds P. Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission - a multicenter cohort study. J Clin Nurs [Internet]. 2007 [cited 2017 Dec 22];16(9):1669-77. Available from: http://doi.org/10.1111/j.1365-2702.2006.01588.x http://doi.org/10.1111/j.1365-2702.2006.... ⁾.
VI	Qualitative	8 patients	Memories of dependence on other people, dependence on technology as if the body was not able to function⁽²⁶26 Roulin MJ, Hurst S, Spirig R. Diaries written for ICU patients. Qual Health Res [Internet]. 2007 [cited 2017 Dec 22];17(7):893-901. Available from: http://doi.org/10.1177/1049732307303304 http://doi.org/10.1177/1049732307303304... ⁾.

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[1] Corresponding Author: Simone de Godoy. E-mail: sig@eerp.usp.br

Year	Author	Title of study	Journal	Country
2016	Svenningsen H, Egerod I, Dreyer P⁽¹³13 Svenningsen H, Egerod I, Dreyer P. Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur’s interpretation theory. J Clin Nurs [Internet]. 2016 [cited 2017 Dec 22];25(19-20):2807-15. Available from: https://doi.org/10.1111/jocn.13318 https://doi.org/10.1111/jocn.13318... ⁾.	Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory.	Journal of Clinical Nursing 25: 2807-2815	Denmark
2015	Fink RM, Makic MBF, Poteet AW, Oman KS⁽¹⁴14 Fink RM, Makic MB, Poteet AW, Oman KS. The ventilated patient’s experience. Dimens Crit Care Nurs [Internet]. 2015 [cited 2017 Dec 22];34(5):301-8. Available from: https://doi.org/10.1097/DCC.0000000000000128 https://doi.org/10.1097/DCC.000000000000... ⁾.	The ventilated patient's experience.	Dimensions of Critical Care Nursing 34: 301-308	USA
2015	Whitehorne K, Gaudine A, Meadus R, Solberg S⁽¹⁵15 Whitehorne K, Gaudine A, Meadus R, Solberg S. Lived experience of the intensive care unit for journal who experienced delirium. Am J Crit Care [Internet]. 2015 [cited 2017 Dec 22];24(6):474-9. Available from: https://doi.org/10.4037/ajcc2015435 https://doi.org/10.4037/ajcc2015435... ⁾.	Lived experience of the intensive care unit for patients who experienced delirium.	American Journal of Critical Care 24: 474-479	Canada
2014	Clukey L, Weyant AR, Roberts M, Henderson A⁽¹⁶16 Clukey L, Weyant RA, Roberts M, Henderson A. Discovery of unexpected pain in intubated and sedated patients. Am J Crit Care. [Internet] 2014 [cited 2017 Dec 22];23(3):216-20 Available from: https://doi.org/10.4037/ajcc2014943 https://doi.org/10.4037/ajcc2014943... ⁾.	Discovery of unexpected pain in intubated and sedated patients.	American Journal of Critical Care 23: 216-220	Canada
2014	Costa JB, Marcon SS, Macedo CRL, Jorge AC, Duarte PAD⁽⁸8 Costa JB, Marcon SS, Macedo CRL, Jorge AC, Duarte PAD. Sedation and memories of patients subjected to mechanical journal in an intensive care unit. Rev Bras Ter Intensiva [Internet]. 2014 [cited 2017 Dec 22];26(2):122-129. Available from: https://doi.org/10.5935/0103-507X.20140018 https://doi.org/10.5935/0103-507X.201400... ⁾.	Sedation and memories of patients subjected to mechanical ventilation in an intensive care unit.	Revista Brasileira de Terapia Intensiva 26: 122-129	Brazil
2014	Ewens B, Chapman R, Tulloch A, Hendricks JM⁽¹⁷17 Ewens B, Champman R, Tulloch A, Hendricks JM. ICU survivors’ utilisation of diaries post discharge: A qualitative descriptive study. Aust Crit Care [Internet]. 2014 [cited 2017 Dec 22];27(1):28-35. Available from: https://doi.org/10.1016/j.aucc.2013.07.001 https://doi.org/10.1016/j.aucc.2013.07.0... ⁾.	ICU survivors' utilisation of diaries post discharge: a qualitative descriptive study.	Australian Critical Care 27: 28-35	Australia
2013	Meriläinen M, Kyngäs H, Ala-Kokko T⁽¹⁸18 Meriläinen M, Kyngäs H, Ala-Kokko T. Patient’s interactions in an intensive care unit and their memories of intensive care: a mixed method study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):78-87. Available from: https://doi.org/10.1016/j.iccn.2012.05.003 https://doi.org/10.1016/j.iccn.2012.05.0... ⁾.	Patients' interactions in an intensive care unit and their memories of intensive care: A mixed method study.	Intensive and Critical Care Nursing 29: 78-87	Finland
2013	Engström A, Nyström N, Sundelin G, Rattray J⁽¹⁹19 Engström Å, Nyström N, Sundelin G, Rattray J. People’s experiences of being mechanically ventilated in an ICU: a qualitative study. Intensive Crit Care Nurs [Internet]. 2013 [cited 2017 Nov 20];29(2):88-95. Available from: https://doi.org/10.1016/j.iccn.2012.07.003 https://doi.org/10.1016/j.iccn.2012.07.0... ⁾.	People's experiences of being mechanically ventilated in an ICU: a qualitative study.	Intensive and Critical Care Nursing 29: 88-95	Sweden
2013	Svenningsen H⁽²⁰20 Svenningsen H. Associations between sedation, delirium and posttraumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit. Dan Med J [Internet]. 2013 [cited 2017 Nov 20];60(4):B4630. Available from: https://www.researchgate.net/publication/236653057_Associations_between_sedation_delirium_and_post-traumatic_stress_disorder_and_their_impact_on_quality_of_life_and_memories_following_discharge_from_an_intensive_care_unit https://www.researchgate.net/publication... ⁾.	Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit.	Danish Medical Journal 60: 1-22	Denmark
2013	Akerman E, Ersson A, Fridlund B, Samuelson K⁽²¹21 Åkerman E, Ersson A, Feidlund B, Samuelson K. Preferred content and usefulness of a photodiary as journal by ICU patients: a mixed method analysis. Aust Crit Care [Internet]. 2013 [cited 2017 Nov 20];26(1):29-35. Available from: https://doi.org/10.1016/j.aucc.2012.04.002 https://doi.org/10.1016/j.aucc.2012.04.0... ⁾.	Preferred content and usefulness of a photodiary as described by ICU patients - a mixed method analysis.	Australian Critical Care 26: 29-35	Australia
2011	Samuelson KAM⁽²²22 Samuelson KAM. Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patient - findings from 250 interviews. Intensive Crit Care Nurs [Internet]. 2011 [cited 2017 Nov 20];27(2):76-84. Available from: https://doi.org/10.1016/j.iccn.2011.01.003 https://doi.org/10.1016/j.iccn.2011.01.0... ⁾.	Unpleasant and pleasant memories of intensive care in adult mechanically ventilated patient - findings from 250 interviews.	Intensive and Critical Care Nursing 27: 76-84	Sweden
2009	Storli SL, Lind R⁽²³23 Storli SL, Lind R. The meaning of follow-up in intensive care: patients’ perspective. Scand J Caring Sci [Internet]. 2009 [cited 2017 Nov 20];23(1):45-56. Available from: https://doi.org/10.1111/j.1471-6712.2007.00589.x https://doi.org/10.1111/j.1471-6712.2007... ⁾.	The meaning of follow-up in intensive care: patients' perspective.	Scandinavian Journal of Caring Science 23: 45-56	Norway
2008	Engström A, Grip K, Hamrén M⁽²⁴24 Engström Å, Grip K, Hamrém M. Experiences of intensive care unit diaries: touching a tender wound. Nurs Crit Care [Internet]. 2009 [cited 2017 Dec 22];14(2):61-7. Available from: https://doi.org/10.1111/j.1478-5153.2008.00312.x https://doi.org/10.1111/j.1478-5153.2008... ⁾.	Experiences of intensive care unit diaries: touching a tender wound.	Nursing in Critical Care 14: 61-67	Sweden
2007	Roberts BL, Rickard CM, Rajbhandari D, Reynolds P⁽²⁵25 Roberts BL, Rickard CM, Rajbhandari D, Reynolds P. Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission - a multicenter cohort study. J Clin Nurs [Internet]. 2007 [cited 2017 Dec 22];16(9):1669-77. Available from: http://doi.org/10.1111/j.1365-2702.2006.01588.x http://doi.org/10.1111/j.1365-2702.2006.... ⁾.	Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission - a multicenter cohort study.	Journal of Clinical Nursing 16: 1669-1677	Australia and New Zealand
2007	Roulin MJ, Hurst S, Spirig R⁽²⁶26 Roulin MJ, Hurst S, Spirig R. Diaries written for ICU patients. Qual Health Res [Internet]. 2007 [cited 2017 Dec 22];17(7):893-901. Available from: http://doi.org/10.1177/1049732307303304 http://doi.org/10.1177/1049732307303304... ⁾.	Diaries written for ICU patients.	Qualitative Health Research 17: 893-901	Sweden