[Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation].

Sep 5, 2008Revista medica de Chile

Sedation guided by a set plan versus usual care in critically ill patients on breathing machines

AI simplified

Circadian Biology on OpenScience ↗PubMed ↗

Abstract

In a study of 40 patients on mechanical ventilation, nurse-applied sedation protocols reduced Midazolam doses compared to physician-guided practice.

SAS scores were monitored more frequently within goal boundaries in the nurse protocol group (44%) than in the control group (32%), p = 0.001.
No differences in inadequate sedation rates were found between the two groups.
Midazolam doses were significantly lower in the nurse protocol group (0.04 mg/kg/h) compared to the control group (0.06 mg/kg/h), p = 0.005.
The study included patients requiring mechanical ventilation for more than 48 hours.

AI simplified

BACKGROUND: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of protocols, however this is seldom done in clinical practice.

AIM: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C).

MATERIAL AND METHODS: Inclusion criteria was the need of MV more than 48 h. The exclusion criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl were used in both groups. The level of sedation was monitored with the Sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to adjust the sedative doses according to a predefined SAS goal.

RESULTS: Forty patients were included, 22 aged 65+/-19 years in group P and 18 aged 54+/-21 years in group C. Apache II scores were 16+/-8 and 19+/-8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44% and 32%, respectively p =0.001). No differences in the proportion of patients with inadequate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04 (0.02-0.07) and 0.06 (0.03-0.08) mg/kg/h respectively, p =0.005).

CONCLUSIONS: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients.

[Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation].

Abstract

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief

Abstract

Related papers

You found one interesting study. We’ll send the next 7.

what lands in your inbox each week:

Recent issues from the circadian biology brief