Effect of a sedation guideline on the duration of mechanical ventilation and length of stay in intensive care unit

authors:

avatar Hassan Babamohamadi , avatar Fatemeh Tangestani , avatar Mohsen Soleimani ORCID , * , avatar Saeed Abbasi Dorche

Koomesh: Vol.19, issue 2; 380-390
published online: July 08, 2017
article type: issue_documents_importer
received: August 02, 2016
accepted: December 07, 2016

how to cite: Babamohamadi H, Tangestani F, Soleimani M, Abbasi Dorche S. Effect of a sedation guideline on the duration of mechanical ventilation and length of stay in intensive care unit. koomesh. 2017;19(2):e151091. 

Abstract

Introduction: Achieving an adequate level of sedation for patients who receive mechanical ventilation is a big critical care challenge. This study aimed to determine the effect of sedation guideline on the duration of mechanical ventilation and length of stay in intensive care unit (ICU) patients. Materials and Methods: This clinical trial study was conducted in an ICU located in Isfahan, Iran, from September 2012 to February 2103. A sedation guideline was developed based on the recent 10 years existing literatures as well as the recommendations of the practicing anesthesiologists and nurses. Coresspondingly, fifty patients who had undergone abdominal surgery with vertical incision and were receiving mechanical ventilation were recruited by convenience sampling method and divided to treatment (guideline) and control (routine) groups. At first, twenty five patients (need to sedation based on Richmond scale) were sedated by using the routine sedation method. The remaining 25 patients were treated by sedation guideline. The two groups were compared in terms of duration of mechanical ventilation and length of stay in ICU. Data collection tools were include patients’ demographic characteristics questionnaire, APACHE II, Richmond scale, the dose of administered sedatives, the duration of mechanical ventilation and length of ICU stay. Results: About 76% of the participants were male. The mean of the participants’ age was 53.3. The mean of mechanical ventilation duration in the control group was significantly different from the treatment group (220.80±91.4 vs. 116.4±96.4 hours P value

References

  • 1.

    Shahin J, Harrison DA, Rowan KM. Is the volume of mechanically ventilated admission to UK critical care units associated with improved outcomes? Intensive Care Med 2014; 40: 353-360.

  • 2.

    Wunsch H, Wagner J, Herlim M, Chong DH, Kramer AA, Halpern SD. ICU occupancy and mechanical ventilation use in the United States. Crit Care Med 2013; 41: 2712-2719.

  • 3.

    Martin J, Franck M, Fischer M, Spies C. Sedation and analgesia in German intensive care units: how is it done in reality? Results of a patient-based survey of analgesia and sedation. Intensive Care Med 2006; 32: 1137-1142.

  • 4.

    Williams TA, Martin S, Leslie G,Thomas L, Leen T, Tamaliunas S, et al. Duration of mechanical ventilation in an adult intensive care unit after introduction of sedation and pain scales. Am J Crit Care 2008; 17: 349-356.

  • 5.

    Quenot JP, Ladoire S, Devoucoux F, Doise JM, Cailliod R, Cunin N, et al. Effect of a nurse-implemented sedation protocol on the incidence of ventilator-associated pneumonia. Crit Care Med 2007; 35: 2031-2036.

  • 6.

    Nseir S, Makris D, Mathieu D, Durocher A, Marquette CH. Intensive Care Unit-acquired infection as a side effect of sedation. Crit Care 2010; 14: R30.

  • 7.

    De Jonghe B, Lacherade JC, Sharshar T, Outin H. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med 2009; 37: S309.

  • 8.

    Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison's principles of internal medicine. 18th Edition. McGraw-Hill co. Part 11: Disorders of the respiratory system. 2011.

  • 9.

    Siegel MD. Management of agitation in the intensive care unit. Clin Chest Med 2003; 24: 713-726.

  • 10.

    Yilmaz C, Kelebek Girgin N, Ozdemir N, Kutlay O. The effect of nursing-implemented sedation on the duration of mechanical ventilation in the ICU. Ulus Travma Acil Cerrahi Derg 2010; 16: 521-526.

  • 11.

    Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomized controlled trial. Lancet 2008; 371: 126-134.

  • 12.

    Schweickert WD, Kress JP. Strategies to optimize analgesia and sedation. Crit Care 2008; 12: S6.

  • 13.

    Marino PL, Sutin KM. The ICU Book. Lippincott Williams & Wilkins; 3rd edition. 2009.

  • 14.

    Jackson DL, Proudfoot CW, Cann K, Walsh T. A systematic review of the impact of sedation practice in the ICU on resource use, costs and patient safety. Crit Care 2010; 14: R59.

  • 15.

    Chanques G, Jaber S, Barbotte E, Violet S, sebbane M, Perriqault PF, et al. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med 2006; 34: 1691-1699.

  • 16.

    Waldmann C. Sedation management in the ICU: are we at a cross roads? J Intensive Care Soc 2010; 2.

  • 17.

    Bucknall TK, Manias E, Presneill JJ. A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Crit Care Med 2008; 36: 1444-1450.

  • 18.

    Strom T, Toft P. Update on sedation and analgesia in mechanical ventilation. Eur Respir Mon 2012; 55: 229-238.

  • 19.

    Bugedo G, Tobar E, Aguirre M, Gonzalez J, Godoy J, Teresa Lira M, et al. The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation. Rev Bras Ter Intensiva 2013; 25: 188-196.

  • 20.

    Arias-Rivera S, Snchez-Snchez Mdel M, Santos-Daz R, Gallardo-Murillo J, Snchez-Izquierdo R, Frutos-Vivar F, et al. Effect of a nursing-implemented sedation protocol on weaning outcome. Crit Care Med 2008; 36: 2054.

  • 21.

    Keough J, Nee P. Daily interruption of sedation and nursing-implemented sedation protocol in mechanically ventilated adult patients. JICS 2013; 14: 269-270.

  • 22.

    Elliott R, McKinley S, Aitken LM, Hendrikz J. The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit. Intensive Care Med 2006; 32: 1506-1514.

  • 23.

    McLean SE, Jensen LA, Schroeder DG, Gibney NRT, Skjodt NM. Improving adherence to a mechanical ventilation weaning protocol for critically ill adults: outcomes after an implementation program. Am J Crit Care 2006; 15: 299-309.

  • 24.

    Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O'Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. BMJ 2011; 342: c7237.

  • 25.

    Esmaeili Abdar M, Rafiei H, Abbaszade A, Hosseinrezaei H, Abdar ZE, Delaram M, et al. Effects of nurses practice of a sedation protocol on sedation and consciousness levels of patients on mechanical ventilation. Iranian J Nurs Midwifery Res 2013; 18: 391-395.

  • 26.

    Mirzaei M, Pourmirza Kalhori R, Moradi G, Khatoni A, Rezaei M. The effect of Riker sedation-agitation scale on clinical outcome of patients under coronary artery bypass graft surgery. Iranian J Crit Care Nursing 2013; 6: 223-228. (Persian).

  • 27.

    Tadrisi SD, Madani SJ, Farmand F, Ebadi A, Karimi Zarchi AA, Mirhashemi S. Richmond agitationsedation scale validity and reliability in intensive care unit adult patients Persian version. Iranian J Crit Care Nurs 2009; 2: 15-21. (Persian).

  • 28.

    Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, et al. Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 1999; 27: 2609-2615.

  • 29.

    Bratteb G, Hofoss D, Flaatten H, Muri AK, Gjerde S, Plsek PE. Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical intensive care unit. BMJ 2002; 324: 1386-1389.

  • 30.

    Adam C, Rosser D, Manji M. Impact of introducing a sedation management guideline in intensive care. Anaesthesia 2006; 61: 260-263.

  • 31.

    De Wit M, Gennings C, Jenvey WI, Epstein SK. Randomized trial comparing daily interruption of sedation and nursing-implemented sedation algorithm in medical intensive care unit patients. Crit Care 2008; 12: R70.

  • 32.

    Atiken LM, Bucknall T, Kent B, Mitchell M, Burmeister E, Keogh SJ. Protocol directed sedation versus non-protocol directed sedation to reduce duration of mechanical ventilation in mechanically ventilated intensive care patients. Cochrane Database Syst Rev 2015; 1: CD009771.

  • 33.

    Soleimani M, Rajabi M, Imani A, Bagheri S, Jafarpour H, Tangestani F. Evaluation of patient mortality in intensive care units using the APACHE II scoring system. Koomesh 2014; 15: 289-294. (Persian).

  • 34.

    Norouzi K, Mashmool Z, Dalvandi A, Soleimani MA. Comparison of two tools APACHE IV and SAPS II in predicting mortality rate in patients hospitalized in intensive care unit. Koomesh 2015; 16: 347-355. (Persian).

  • 35.

    Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000; 342: 1471-1477.##.