Self-management of Sedative Therapy by Ventilated Patients

Inclusion Criteria:

1. Subject is acutely mechanically ventilated during the current hospitalization.

2. Subject is currently receiving a continuous intravenous infusion of asedative/opioid medication(s) or has received at least one intravenous bolus dose ofa sedative/opioid medication in the previous 24 hours (fentanyl, hydromorphone,ketamine, morphine, midazolam, diazepam, lorazepam, propofol, haloperidol,dexmedetomidine).

3. Subject must pass pre-Patient-Controlled Sedation (PCS) screening test and beassessed Richmond Agitation-Sedation Scale (RASS) -2 to +1

4. Subject Age ≥ 18 years

5. Subject or their proxy is capable of providing informed consent

Exclusion Criteria:

1. Aggressive ventilatory support or prone ventilation.

2. Hypotension (systolic blood pressure < 85 mmHg) requiring a vasopressor at a dosegreater than norepinephrine or epinephrine 0.15 mcg/kg/min or vasopressin > 2.4units per hour. Subjects will be excluded if they require more than one continuousinfusion of a catecholamine vasopressor medication simultaneously. Subjects will beexcluded if the vasopressor dose was higher than norepinephrine or epinephrine 0.15mcg/kg/min, vasopressin > 2.4 units per hour, phenylephrine >3 mcg/kg/min, dopamine >10 mcg/kg/min or dobutamine at any dose in the prior 6 hours. If dopamine is beingused to increase heart rate, rather than as a vasopressor for hypotension, subjectwill be excluded.

3. Second or third degree heart block or bradycardia (heart rate < 50 beats/min).

4. Paralysis or other condition preventing the use of push button device

5. Positive pregnancy test or lactation

6. Acute hepatitis or liver failure (direct bilirubin >5 mg/dL)

7. Acute stroke or uncontrolled seizures.

8. Acute myocardial infarction within 48 hours prior to enrollment.

9. Severe cognition or communication problems (such as coma, deafness without signingliteracy, physician-documented dementia)

10. Assessed RASS -3, -4, -5 or RASS +2,+3, +4

11. Chronic ventilator support in place of residence prior to current hospitalization.

12. Imminent extubation from mechanical ventilator support.