1112

Abstract

Introduction: The use of a sedation protocol for mechanically ventilated patients in the intensive care unit (ICU) is recommended to standardize assessment and medication dosing. Our institution implemented a sedation protocol incorporating a benzodiazepine (BZD) basal-bolus dosing strategy. The objective of this study was to compare the effects of a basal-bolus versus continuous infusion BZD dosing strategy for sedation in medical ICU (MICU) patients. Hypothesis: We hypothesize that implementation of a standardized sedation protocol emphasizing a basal-bolus dosing strategy decreases daily BZD use in mechanically ventilated MICU patients. Methods: A single-center, retrospective chart review was conducted comparing patients receiving continuous infusions of BZD from April 2010 to December 2010 (phase I) to patients receiving BZD through the standardized protocol from August 2011 to February 2012 (phase II). Adult patients, requiring mechanical ventilation (MV) for at least 24 hours and managed by the MICU service were included. Total daily BZD use during MV was measured as the milligram of BZD used per hour of MV. Secondarily, duration of MV, ICU length of stay (LOS), and incidence of ventilator-associated pneumonia (VAP) were also evaluated. To determine statistical significance, the Mann-Whitney U and chi-square tests were used. Results: A total of 156 patient encounters met study inclusion and exclusion criteria for the pre-specified study time periods with 78 included in each phase. The difference in the amount of BZD was statistically significant between the two groups (19.3 mg/hr vs 7.6 mg/hr, p<0.001). Additionally, patients in phase II were found to have shorter duration of MV (4.3 days vs 7.7 days, p<0.001), ICU LOS (6.6 days vs 10.5 days, p<0.001), and decreased incidence of VAP (2 cases vs 8 cases, p<0.05). Conclusions: A comparison of a standardized sedation protocol utilizing a basal-bolus dosing strategy for BZD demonstrated a significant decrease in the amount of BZD used in mechanically ventilated MICU patients. Secondarily, decreases in ICU LOS, duration of MV, and incidence of VAP were also observed.