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


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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. 14.5days, 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.HIGHLIGHTSExisting literature supports sedation and analgesia protocols in the medical ICU.Limited data exist demonstrating efficacy of protocols in the surgical ICU.A surgical ICU sedation and analgesia protocol increased ventilator-free days.Fewer patients received continuous infusion benzodiazepines and opioids.Protocol patients had more documented sedation scores in target range.

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