[Clinical application and evaluation of an early non-sedation protocol for critically ill respiratory patients].

Mar 16, 2017Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases

Using and Testing an Early Non-Sedation Approach for Critically Ill Patients on Breathing Support

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Abstract

Patients managed with an early non-sedation protocol had a shorter duration of mechanical ventilation (7±5 days) compared to those with daily interruption of sedation (11±9 days).

The early non-sedation protocol led to earlier discharge from the RICU (9±7 days vs 18±9 days) and hospital (17±14 days vs 29±22 days).
Lower doses of midazolam were administered in the intervention group (99±104 mg) compared to the control group (482±337 mg).
RICU and hospitalization expenses were significantly reduced in the intervention group (53(84) vs 88(173) thousand CHY for RICU; 72(195) vs 154(234) thousand CHY for hospitalization).
The intervention group had lower rates of ventilator-associated pneumonia (23% vs 46%), tracheotomy (14% vs 37%), and gastrointestinal adverse reactions (17% vs 40%).
No significant differences in RICU and hospital mortality were observed between the two groups.

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To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU).Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group;=35) or with daily interruption of sedation (DIS) (control group;=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared.Patients in the intervention group had a shorter duration of mechanical ventilation than those in the control group [(7±5)(11±9) d,<0.05] and were discharged from the RICU [(9±7)(18±9) d,<0.05] and hospital earlier [(17±14)(29±22) d,<0.05] than those in the control group. The doses of midazolam were significantly lower in the intervention group than in the control group [(99±104) vs (482±337) mg,<0.05]. The RICU and hospitalization expenses were both significantly lower in the intervention group than in the control group [53(84) vs 88(173), 72(195) vs 154(234) thousand CHY,<0.05]. In the intervention group, the occurrence rates of ventilator associated pneumonia (23% vs 46%), tracheotomy (14% vs 37%) and gastrointestinal adverse reactions (17% vs 40%) were significantly lower than those in the control group (<0.05). No differences were recorded in RICU and hospital mortality (>0.05). The occurrence rates of unplanned extubation and reintubation and the need for CT brain scans were similar in the 2 groups (>0.05). The levels of cardiac, liver and renal damage markers, lactic acid and C-reactive protein were the same in both groups (>0.05).The early non-sedation protocol decreased the duration of mechanical ventilation and the length of stay in the RICU and hospital, and it did not increase the incidence of complications and adverse events. Objective: Methods: Results: Conclusions: n n vs P vs P vs P P P P P P P

[Clinical application and evaluation of an early non-sedation protocol for critically ill respiratory patients].

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