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Background Sedation is commonly used in critically ill patients to facilitate procedures and care as well as provide comfort but can carry risks such as delirium and prolonged mechanical ventilation. Although current guidelines advocate for light sedation, sedation practices are influenced by clinicians’ subjective interpretations. Patients and families may experience distress and unmet needs, and little is known about their perspectives and experiences in the context of contemporary light sedation practices.Objective This study aimed to understand the perceptions and experiences of both patient and family members in the intensive care unit (ICU) of current sedation practices.Settings Canadian, closed, mixed ICU setting.Participants Critically ill adult patients and adult family members.Methods Patients and family members were interviewed, using a semi-structured interview questionnaire, and Braun and Clarke inductive thematic analysis was used to identify themes and subthemes in the data.Results We conducted semi-structured interviews with 10 family members and 10 patients. Family members and patients reported that sedation was needed for patient comfort. Family members also described the need for sedation for patient and staff safety, as well as their own comfort. While both groups described sedation as necessary for enduring the medical procedures in the ICU, both groups reported concerns of sedation use, including negative physiological and cognitive patient outcomes. Patients and family members also recommended strategies for improving how sedation use is communicated in the ICU.Conclusions Perceptions and experiences of patient and families with sedation care practices in the ICU were multifaceted with both positive and negative outcomes reported including psychological and emotional concerns with sedation use. Key recommendations were provided for improving sedation practices with families emphasising the need for family-centred care and patients highlighting the need for self-determination.