J A Botha1, P Mudholkar. 1. Intensive Care Unit, Frankston Hospital, Frankston, Victoria.
Abstract
OBJECTIVE: Sedative drugs are used routinely in critically ill patients to reduce both physical and psychological stresses imposed by the hostile intensive care unit environment. However, drug accumulation, particularly during prolonged administration, often poses difficulties. Sedation scales chart the physiological effect of sedation although many surveys have revealed that few units use them to monitor the effect of sedative agents hence oversedation is common. METHODS: We evaluated the impact of a modified Sheffield sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. After an education course on the use of the sedation scale, it was utilised from June 2000 to February 2001. After this 9 month period, the pharmacy and health information services retrieved data on ventilation hours and sedative, analgesic and inotropic use from June 2000 to February 2001 and compared it with data retrieved from a similar period prior to sedation scale use from June 1999 to February 2000. RESULTS: The population studied during both periods were similar in terms of total ventilated patients (141 versus 147), mean age (59.6 versus 61.2) major case mix groupings, discharge destination and hospital mortality (31% versus 31%). After introducing the sedation scale the average patient ventilated hours decreased from 203.7 to 179.5 hours. The intensive care unit's use of midazolam decreased by 38.38%, morphine use decreased by 52.6% and propofol use decreased by 17.3%. Also the adrenaline use decreased by 13.95%, noradrenaline use decreased by 8.25% and dopamine use decreased by 35.7%. CONCLUSIONS: Our study demonstrates that the use of a sedation scale lead to a decrease in sedative, analgesic and inotrope use with a trend to less ventilated hours in critically ill patients.
OBJECTIVE: Sedative drugs are used routinely in critically illpatients to reduce both physical and psychological stresses imposed by the hostile intensive care unit environment. However, drug accumulation, particularly during prolonged administration, often poses difficulties. Sedation scales chart the physiological effect of sedation although many surveys have revealed that few units use them to monitor the effect of sedative agents hence oversedation is common. METHODS: We evaluated the impact of a modified Sheffield sedation scale on ventilation hours, sedative, analgesic and inotropic use in an intensive care unit. After an education course on the use of the sedation scale, it was utilised from June 2000 to February 2001. After this 9 month period, the pharmacy and health information services retrieved data on ventilation hours and sedative, analgesic and inotropic use from June 2000 to February 2001 and compared it with data retrieved from a similar period prior to sedation scale use from June 1999 to February 2000. RESULTS: The population studied during both periods were similar in terms of total ventilated patients (141 versus 147), mean age (59.6 versus 61.2) major case mix groupings, discharge destination and hospital mortality (31% versus 31%). After introducing the sedation scale the average patient ventilated hours decreased from 203.7 to 179.5 hours. The intensive care unit's use of midazolam decreased by 38.38%, morphine use decreased by 52.6% and propofol use decreased by 17.3%. Also the adrenaline use decreased by 13.95%, noradrenaline use decreased by 8.25% and dopamine use decreased by 35.7%. CONCLUSIONS: Our study demonstrates that the use of a sedation scale lead to a decrease in sedative, analgesic and inotrope use with a trend to less ventilated hours in critically illpatients.