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[Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation].
Rev Med Chil. 2008 Jun; 136(6):711-8.RM

Abstract

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.

Authors+Show Affiliations

Unidad de Paciente Crítico, Hospital Clínico Universidad de Chile, Santos Dumont 999, Santiago, Chile. edotobar@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

spa

PubMed ID

18769826

Citation

Tobar A, Eduardo, et al. "[Protocol Based Sedation Versus Conventional Treatment in Critically Ill Patients On Mechanical Ventilation]." Revista Medica De Chile, vol. 136, no. 6, 2008, pp. 711-8.
Tobar A E, Lanas M A, Pino P S, et al. [Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation]. Rev Med Chil. 2008;136(6):711-8.
Tobar A, E., Lanas M, A., Pino P, S., Aspée L, P., Rivas V, S., Prat R, D., Asenjo B, R., & Castro O, J. (2008). [Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation]. Revista Medica De Chile, 136(6), 711-8. https://doi.org//S0034-98872008000600004
Tobar A E, et al. [Protocol Based Sedation Versus Conventional Treatment in Critically Ill Patients On Mechanical Ventilation]. Rev Med Chil. 2008;136(6):711-8. PubMed PMID: 18769826.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Protocol based sedation versus conventional treatment in critically ill patients on mechanical ventilation]. AU - Tobar A,Eduardo, AU - Lanas M,Alejandra, AU - Pino P,Sandra, AU - Aspée L,Paulina, AU - Rivas V,Sandra, AU - Prat R,Daniela, AU - Asenjo B,Rosmi, AU - Castro O,José, Y1 - 2008/08/26/ PY - 2008/9/5/pubmed PY - 2009/5/5/medline PY - 2008/9/5/entrez SP - 711 EP - 8 JF - Revista medica de Chile JO - Rev Med Chil VL - 136 IS - 6 N2 - 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. SN - 0034-9887 UR - https://www.unboundmedicine.com/medline/citation/18769826/[Protocol_based_sedation_versus_conventional_treatment_in_critically_ill_patients_on_mechanical_ventilation]_ L2 - http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000600004&lng=en&nrm=iso&tlng=en DB - PRIME DP - Unbound Medicine ER -