Crit Care Med. 1999 Dec;27(12):2609-15.
Comment in:
Crit Care Med. 1999 Dec;27(12):2824-5.
Effect of a nursing-implemented sedation protocol on the
duration of mechanical ventilation.
Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G,
Shannon W, Kollef MH.
Division of Pulmonary and Critical Care Medicine, Washington
University School of Medicine, St. Louis, MO, USA.
OBJECTIVE: To compare a practice of protocol-directed
sedation during mechanical ventilation implemented by nurses
with traditional non-protocol-directed sedation administration.
DESIGN: Randomized, controlled clinical trial. SETTING: Medical
intensive care unit (19 beds) in an urban teaching hospital.
PATIENTS: Patients requiring mechanical ventilation (n = 321).
INTERVENTIONS: Patients were randomly assigned to receive either
protocol-directed sedation (n = 162) or non-protocol-directed
sedation (n = 159). MEASUREMENTS AND MAIN RESULTS: The median
duration of mechanical ventilation was 55.9 hrs (95% confidence
interval, 41.0-90.0 hrs) for patients managed with
protocol-directed sedation and 117.0 hrs (95% confidence
interval, 96.0-155.6 hrs) for patients receiving
non-protocol-directed sedation. Kaplan-Meier analysis
demonstrated that patients in the protocol-directed sedation
group had statistically shorter durations of mechanical
ventilation than patients in the non-protocol-directed sedation
group (chi-square = 7.00, p = .008, log rank test; chi-square =
8.54, p = .004, Wilcoxon's test; chi-square = 9.18, p = .003, -2
log test). Lengths of stay in the intensive care unit (5.7+/-5.9
days vs. 7.5+/-6.5 days; p = .013) and hospital (14.0+/-17.3
days vs. 19.9+/-24.2 days; p < .001) were also significantly
shorter among patients in the protocol-directed sedation group.
Among the 132 patients (41.1%) receiving continuous intravenous
sedation, those in the protocol-directed sedation group (n = 66)
had a significantly shorter duration of continuous intravenous
sedation than those in the non-protocol-directed sedation group
(n = 66) (3.5+/-4.0 days vs. 5.6+/-6.4 days; p = .003). Patients
in the protocol-directed sedation group also had a significantly
lower tracheostomy rate compared with patients in the
non-protocol-directed sedation group (10 of 162 patients [6.2%]
vs. 21 of 159 patients [13.2%], p = .038). CONCLUSIONS: The use
of protocol-directed sedation can reduce the duration of
mechanical ventilation, the intensive care unit and hospital
lengths of stay, and the need for tracheostomy among critically
ill patients with acute respiratory failure.
Publication Types: Clinical Trial Randomized Controlled Trial
PMID: 10628598 [PubMed - indexed for MEDLINE]
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