1106

Abstract

Introduction: Sedation and analgesia are an integral part of the multimodal management of critically ill patients. Patients are often treated with continuous intravenous infusions of sedatives and analgesics. However, continuous infusions have been associated with prolonged mechanical ventilation and longer intensive care unit (ICU) stay. The use of protocols in the ICU promote evidence-based practice and may reduce inter-clinician variability. Utilization of dexmedetomidine in ICU sedation and analgesia practice may decrease time mechanically ventilated. Hypothesis: We hypothesized initiation of a sedation and analgesia protocol including the use of dexmedetomidine will decrease time to ventilator liberation, and ICU length of stay. Methods: A multidisciplinary team at an urban academic medical center created a sedation and analgesia protocol to include early use of dexmedetomidine for patients requiring sedative infusions. Data was collected in a prospective cohort design from a seventeen bed surgical ICU for a three month period pre and post implementation of the protocol. The primary outcome was number of ventilator free days. Secondary outcome measures were ICU length of stay (LOS), overall hospital LOS, and cumulative dosing of sedatives and analgesics during mechanical ventilation. Patients were excluded if they were not mechanically ventilated, not receiving continuous infusions of sedatives or analgesics, required greater than 28 days of mechanical ventilation, or were receiving continuous neuromuscular blockade. Results: One hundred and sixty six patients (83 pre implementation and 95 post implementation) were collected. The groups were well matched for age (59.1 vs 58 years old), gender (40% vs 42% female) and APACHE II scores (13.5 vs 12.9). A two-tailed t-test performed comparing days to ventilator liberation resulted in less days post implementation of the protocol (5.67 vs 4.28 days [p=0.083]) while ICU LOS (9.08 vs 8.92 days) and hospital LOS (21.1 vs 20.2 days) remained similar. Conclusions: Institution of a sedation and analgesia protocol with the early use of dexmedetomidine in the surgical ICU setting may increase ventilator free days. Larger trials are needed to further evaluate this relationship.