Living with mechanical ventilation: A grounded theory study of patients’ experiences in the intensive care unit

INTRODUCTION: Mechanical ventilation (MV) is an essential life-sustaining intervention in intensive care units (ICU). However, beyond its physiological benefits, patients frequently experience profound physical dependence, communication barriers, and emotional distress. Understanding these experiences is essential to inform person-centred nursing care and humanisation strategies in critical care settings. OBJECTIVES: The aim of this study was to explore the experiences of patients receiving invasive MV, identify the meanings attributed to these experiences, and generate a substantive theory to inform humanised critical care nursing. METHODS: A qualitative study based on Classical Grounded Theory (Glaser and Strauss) was conducted. Adult patients who received invasive MV for at least 48 h in the ICU at Vall d'Hebron University Hospital (Barcelona, Spain) participated in semistructured interviews. Data were analysed using constant comparative analysis involving open, axial, and selective coding, supported by NVivo 12 software. Guba and Lincoln's criteria were applied to ensure trustworthiness. FINDINGS: Extreme Vulnerability was identified as the core category explaining patients' experiences. Participants described profound bodily dependence associated with invasive medical devices and immobility, an inability to communicate that generated frustration and helplessness, and emotional isolation during critical illness. Nurses mitigated distress by recognising nonverbal communication, maintaining a therapeutic presence, and providing continuity of care, while family members provided emotional support through their reassuring presence and by helping healthcare professionals interpret participants' nonverbal cues. Following ICU discharge, participants described the transition to the general ward not only as a positive step towards recovery but also as a period of adjustment characterised by uncertainty and reduced perceived continuity and intensity of care. CONCLUSIONS: Invasive MV was experienced not only as a life-sustaining intervention but also as a period of profound bodily dependence, disrupted communication, and reliance on others during critical illness. These findings highlight the need to integrate technical excellence with person-centred, relational care. By providing a substantive grounded theory of Extreme Vulnerability, this study highlights the central role of critical care nurses in leading person-centred interventions, promoting active family involvement, and humanising intensive care practice throughout the care trajectory.