{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:48:52Z","timestamp":1785930532736,"version":"3.56.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Rationale<\/jats:title>\n Mechanically ventilated intensive care unit patients receive sedatives based on clinician observations of arousal and motor activity with potential for negative consequences and poor mitigation of symptoms.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To test the preliminary efficacy of patient self-managed sedative therapy compared to usual care of nurse-administered sedation on self-reported anxiety, duration of mechanical ventilation, and delirium incidence (CAM-ICU).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A two-group, open-label, randomized, multicenter clinical trial in 5 Midwestern hospitals enrolled 161 patients receiving invasive mechanical ventilation who were willing and able to use a push-button device to self-administer sedation for up to 7 days. Patients were randomized 1:1 using center-stratified blocks to usual care (n\u2009=\u200981) or intervention (n\u2009=\u200980) with self-administered dexmedetomidine. Intervention patients were allowed 3 self-administered dexmedetomidine boluses per hour (0.25\u2009mcg\/kg) with 20-minute lock-outs. The initial basal infusion (0.2\u2009mcg\/kg\/hr) was adjusted by nurses between 0.1-0.7\u2009mcg\/kg\/hr based on patient-delivered boluses in the prior 2\u2009hours. Analysis consisted of linear mixed-effects model for comparisons of anxiety ratings over time and duration of mechanical ventilation. Incidence of delirium was analyzed using generalized estimating equations.<\/jats:p>\n <\/jats:sec>\n \n Measurement and Main Results<\/jats:title>\n Sample characteristics had a female (54.7%) and Caucasian preponderance (92.5%) with a median age of 62 years on protocol for a median of 88\u2009hours. Nine intervention patients were extubated prior to protocol initiation. Patient self-reported three times daily anxiety ratings with a visual analog scale (VAS) ranged from 0-100 over time but were not significantly different between groups in either an intention-to-treat (ITT) or per protocol (PP) analysis (p\u2009=\u20090.94, p\u2009=\u20090.30 respectively). While intervention patients had shorter duration of MV [(mean 50.8(52.8) vs. usual care 68.7(58.2) hours), p\u2009=\u20090.02 ITT], PP analysis resulted in no difference between groups (mean 56.4 (53.0) vs. 68.7(58.2), p\u2009=\u20090.23). 10.2% of intervention patients developed new incidence of delirium vs. 8.5% of usual care which was not significantly different between groups by either ITT (p\u2009=\u20090.65) or PP analyses (p\u2009=\u20090.58).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Intervention patients had similar outcomes compared to usual care patients. Self-administration of sedative therapy is a safe, novel patient-centered intervention warranting further rigorous investigation for anxiety self-management.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag233","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:41:15Z","timestamp":1785930075000},"source":"Crossref","is-referenced-by-count":0,"title":["Randomized clinical trial of self-management of sedative therapy by mechanically ventilated patients"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6922-7551","authenticated-orcid":false,"given":"Linda L","family":"Chlan","sequence":"first","affiliation":[{"name":"Mayo Clinic College of Medicine and Science Associate Dean for Nursing Research, Division of Nursing Research, Department of Nursing, Professor of Nursing, , Mayo Clinic, 200 First St. SW, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9186-2332","authenticated-orcid":false,"given":"Mary Fran","family":"Tracy","sequence":"additional","affiliation":[{"name":"University of Minnesota, School of Nursing Professor, Assistant Dean for the PhD Program and Director of Graduate Studies, , 308 Harvard St. SE, Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-0890","authenticated-orcid":false,"given":"Ognjen","family":"Gajic","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine and Science Department of Medicine, Division of Pulmonary and Critical Care Medicine, , Mayo Clinic, 200 First St. SW, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0021-2033","authenticated-orcid":false,"given":"Amos","family":"Lal","sequence":"additional","affiliation":[{"name":"Mayo Clinic College of Medicine and Science Department of Medicine, Division of Pulmonary and Critical Care Medicine, , Mayo Clinic, 200 First St. SW, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9602-807X","authenticated-orcid":false,"given":"Pamela","family":"Peterson","sequence":"additional","affiliation":[{"name":"Division of Nursing Research , Department of Nursing, Mayo Clinic, 200 First St. SWRochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9718-4082","authenticated-orcid":false,"given":"Jay","family":"Mandrekar","sequence":"additional","affiliation":[{"name":"Quantitative Health Sciences-Clinical Trials and Biostatistics , Mayo Clinic, 200 First St. SWRochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7134-5362","authenticated-orcid":false,"given":"William S","family":"Harmsen","sequence":"additional","affiliation":[{"name":"Quantitative Health Sciences-Clinical Trials and Biostatistics , Mayo Clinic, 200 First St. SWRochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6088-1661","authenticated-orcid":false,"given":"Erica","family":"Wittwer","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of Anesthesiology and Perioperative Medicine, , 200 First St. SWRochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8582-6033","authenticated-orcid":false,"given":"Craig R","family":"Weinert","sequence":"additional","affiliation":[{"name":"University of Minnesota Medical School Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, , Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,5]]},"container-title":["Annals of the American Thoracic Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article-pdf\/doi\/10.1093\/annalsats\/aaoag233\/70492576\/aaoag233.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article-pdf\/doi\/10.1093\/annalsats\/aaoag233\/70492576\/aaoag233.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T11:41:15Z","timestamp":1785930075000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article\/doi\/10.1093\/annalsats\/aaoag233\/8752385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/annalsats\/aaoag233","relation":{},"ISSN":["2325-6621"],"issn-type":[{"value":"2325-6621","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]},"article-number":"aaoag233"}}