OBJECTIVE: To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU. DESIGN AND SETTING: The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit. PATIENTS: Adult mechanically ventilated patients were selected consecutively (n=322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group. INTERVENTION: An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy. MEASUREMENTS AND RESULTS: The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P=0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P=0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used. CONCLUSIONS: The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.
RCT Entities:
OBJECTIVE: To examine the effect of an algorithm-based sedation guideline developed in a North American intensive care unit (ICU) on the duration of mechanical ventilation of patients in an Australian ICU. DESIGN AND SETTING: The intervention was tested in a pre-intervention, post-intervention comparative investigation in a 14-bed adult intensive care unit. PATIENTS: Adult mechanically ventilated patients were selected consecutively (n=322). The pre-intervention and post-intervention groups were similar except for a higher number of patients with a neurological diagnosis in the pre-intervention group. INTERVENTION: An algorithm-based sedation guideline including a sedation scale was introduced using a multifaceted implementation strategy. MEASUREMENTS AND RESULTS: The median duration of ventilation was 5.6 days in the post-intervention group, compared with 4.8 days for the pre-intervention group (P=0.99). The length of stay was 8.2 days in the post-intervention group versus 7.1 days in the pre-intervention group (P=0.04). There were no statistically significant differences for the other secondary outcomes, including the score on the Experience of Treatment in ICU 7 item questionnaire, number of tracheostomies and number of self-extubations. Records of compliance to recording the sedation score during both phases revealed that patients were slightly more deeply sedated when the guideline was used. CONCLUSIONS: The use of the algorithm-based sedation guideline did not reduce duration of mechanical ventilation in the setting of this study.
Authors: Jeffery C Woods; Lorraine C Mion; Jason T Connor; Florence Viray; Lisa Jahan; Cecilia Huber; Renee McHugh; Jeffrey P Gonzales; James K Stoller; Alejandro C Arroliga Journal: Intensive Care Med Date: 2004-02-14 Impact factor: 17.440
Authors: Peter Andrews; Elie Azoulay; Massimo Antonelli; Laurent Brochard; Christian Brun-Buisson; Daniel De Backer; Geoffrey Dobb; Jean-Yves Fagon; Herwig Gerlach; Johan Groeneveld; Duncan Macrae; Jordi Mancebo; Philipp Metnitz; Stefano Nava; Jerôme Pugin; Michael Pinsky; Peter Radermacher; Christian Richard Journal: Intensive Care Med Date: 2006-12-19 Impact factor: 17.440
Authors: Christopher R Dale; Delores A Kannas; Vincent S Fan; Stephen L Daniel; Steven Deem; N David Yanez; Catherine L Hough; Timothy H Dellit; Miriam M Treggiari Journal: Ann Am Thorac Soc Date: 2014-03