Advertisement

Intensive Care Medicine

, Volume 32, Issue 10, pp 1506–1514 | Cite as

The effect of an algorithm-based sedation guideline on the duration of mechanical ventilation in an Australian intensive care unit

  • Rosalind ElliottEmail author
  • Sharon McKinley
  • Leanne M. Aitken
  • Joan Hendrikz
Original

Abstract

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.

Keywords

Intensive care Mechanical ventilation Clinical practice guideline Sedation Nursing 

References

  1. 1.
    Nelson BJ, Weinert CR, Bury CL, Marinelli WA, Gross CR (2000) Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Crit Care Med 28:3626–3630PubMedCrossRefGoogle Scholar
  2. 2.
    Woods JC, Mion LC, Connor JT, Viray F, Jahan L, Huber C, McHugh R, Gonzales JP, Stoller JK, Arroliga AC (2004) Severe agitation among ventilated medical intensive care unit patients: frequency, characteristics and outcomes. Intensive Care Med 30:1066–1072PubMedCrossRefGoogle Scholar
  3. 3.
    Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G (1998) The use of continuous IV sedation is associated with prolongation of mechanical ventilation. Chest 114:541–548PubMedGoogle Scholar
  4. 4.
    Kress JP, Pohlman AS, O'Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New Engl J Med 342:1471–1477PubMedCrossRefGoogle Scholar
  5. 5.
    Rodrigues GR, Gomes do Amaral JL (2004) Influence of sedation on morbidity and mortality in the intensive care unit. São Paulo Med J 122:8–11Google Scholar
  6. 6.
    Mascia MF, Koch M, Medicis JJ (2000) Pharmoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care. Crit Care Med 28:2300–2306PubMedCrossRefGoogle Scholar
  7. 7.
    De Jonghe B, Bastuji-Garin S, Fangio P, Lacherade J-C, Jabot J, Appéré-De-Vecchi C, Rocha N, Outin H (2005) Sedation algorithm in critically ill patients without acute brain injury. Crit Care Med 33:120–127PubMedCrossRefGoogle Scholar
  8. 8.
    Brook AD, Ahrens TS, Schaiff R, Prentice D, Sherman G, Shannon W, Kollef MH (1999) Effect of a nursing-implemented sedation protocol on the duration of mechanical ventilation. Crit Care Med 27:2609–2615PubMedCrossRefGoogle Scholar
  9. 9.
    Brattebø G, Hofoss D, Flatten H, Muri AK, Gjerde S, Plsek PE (2002) Effect of a scoring system and protocol for sedation on duration of patients' need for ventilator support in a surgical care unit. Br Med J 324:1386–1389CrossRefGoogle Scholar
  10. 10.
    Devlin JW, Holbrook AM, Fuller HD (1997) The effect of ICU sedation guidelines and pharmacist interventions on clinical outcomes and drug cost. Ann Pharmacother 31:689–695PubMedGoogle Scholar
  11. 11.
    Greiner J, Greiner JA (2004) Sedation management for the adult mechanically ventilated patient. Evid Based Nurs 7:101–102PubMedCrossRefGoogle Scholar
  12. 12.
    Ramsay MAE, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxone–alphadolone. Br Med J 2:656–659PubMedCrossRefGoogle Scholar
  13. 13.
    Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE (1981) Acute physiology and chronic health evaluation physiologically based classification system. Crit Care Med 9:591–597PubMedCrossRefGoogle Scholar
  14. 14.
    Elliott R, McKinley S, Aitken L (2006) The adoption of a sedation scoring system and a sedation guideline in an Australian intensive care unit. J Adv Nurs 54:208–216PubMedCrossRefGoogle Scholar
  15. 15.
    Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56:9–14PubMedCrossRefGoogle Scholar
  16. 16.
    American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. APA, Washington DCGoogle Scholar
  17. 17.
    Briere J, Runtz M (1989) The Trauma Symptom Checklist (TSC-33): Early data on a new scale. J Interpers Viol 4:151–163Google Scholar
  18. 18.
    Horowitz M, Wilner N, Alvarez W (1979) The Impact of Event Scale: a measure of subjective stress. Psychosomatic Med 41:209–218Google Scholar
  19. 19.
    MacLaren R, Plamondon JM, Ramsay KB, Rocker GM, Patrick WD, Hall RI (2000) A prospective evaluation of empiric versus protocol-based sedation and analgesia. Pharmacotherapy 20:662–772PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Rosalind Elliott
    • 1
    Email author
  • Sharon McKinley
    • 2
  • Leanne M. Aitken
    • 3
  • Joan Hendrikz
    • 4
  1. 1.Intensive Care UnitThe Royal North Shore HospitalSydneyAustralia
  2. 2.Critical Care Nursing, Intensive Care UnitThe Royal North Shore Hospital and The University of TechnologySydneyAustralia
  3. 3.Critical Care Nursing, Research Centre for Clinical Practice InnovationGriffith University and Princess Alexandra HospitalBrisbaneAustralia
  4. 4.Statistics, CONROD, Mayne Medical CentreThe University of QueenslandBrisbaneAustralia

Personalised recommendations