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μImpact of a nursing-driven sedation protocol with criteria for infusion initiation in the surgical intensive care unit.

Abstract：

PURPOSE:Analgesia and sedation protocols (ASPs) reduce duration of mechanical ventilation (MV) in the medical intensive care unit (ICU), but data in the surgical ICU (SICU) are limited. The objective of this study was to determine the impact of a nursing-driven ASP with criteria for infusion initiation in the SICU. MATERIALS AND METHODS:A single-center, retrospective study compared ventilator-free days at day 28 from start of MV (VFD28) before and after ASP implementation. Secondary endpoints included cumulative opioid and sedative requirements, level of sedation, incidence of delirium, SICU and hospital length of stay. RESULTS:One hundred thirty two patients were included (66 per group). The protocol group had greater VFD28 compared to the control group (21 vs. 14.5 days, p = .04). Lower rates of benzodiazepine (42.4% vs. 84.8%, p < .001) and opioid (24.2 vs. 78.8, p < .001) infusion use occurred in the protocol group, resulting in lower cumulative doses per ventilator-day through day 7. The protocol group had more documented sedation scores within target range. There were no differences in ICU delirium, SICU or hospital length of stay. CONCLUSIONS:A nursing-driven ASP with criteria for infusion initiation in mechanically-ventilated SICU patients may increase ventilator-free time, maintain patients at the target sedation goal, and reduce opioid and benzodiazepine utilization.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Kaplan JB,Eiferman DS,Porter K,MacDermott J,Brumbaugh J,Murphy CV

doi

10.1016/j.jcrc.2018.11.029

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

195-200

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(18)30645-2

journal_volume

50

pub_type

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