| Sub-title | |
| Authors | A Aquilina S Sciberras M Galea Scannura |
| Abstract | Introduction: Mechanically-ventilated intensive care patients often need to be sedated to tolerate ventilation. However, over sedation can itself lead to an increase in morbidity and mortality by delaying weaning and prolonging ventilation. There is also some evidence that sedatives may alter the patients immune response. The introduction of a regular assessment of Departmenth of sedation coupled with a protocol that allows nurses to adjust the dose of sedatives accordingly has been shown to improve outcome. Aim: To show that a nurse-led sedation protocol introduced into our local intensive care unit (ITU) leads to a decrease in mortality. Methods: The study was conducted in three parts. The first part consisted of an audit of current sedation practice and outcomes and was performed over a six-month period. All patients undergoing prolonged (>24 hours) mechanical ventilation were included. The second part involved an educational programme directed at nurses and doctors explaining the rationale behind the introduction of a sedation protocol. The third part saw a re-audit performed after the protocol had been introduced to demonstrate that things had indeed changed and that outcome had improved. Results: A total of 170 patients were assessed. The two groups were well matched with respect to size, age, sex and APACHE score. The patients in the group managed by a sedation-protocol spent more time optimally sedated i.e. comfortable but rousable and cooperative. The mortality was significantly reduced (26.5% vs. 49.4%, p=0.003) in this group. This reduction was not clearly related to faster weaning from ventilation. Conclusion: The use of a nurse-led sedation protocol in mechanically-ventilated intensive care patients results in better sedation and improved mortality. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
| Page | |
| Date | |
| Link to journal | |
| Key words | intensive care, mechanical ventilation, mortality, nurse-led, sedation protocol |