Associação entre nível de sedação e mortalidade de pacientes em ventilação mecânica em terapia intensiva

Taís Pagliuco Barbosa,Alessandra Soler Bastos,Lúcia Marinilza Beccaria,Daniele Cristiny Da Silva

doi:10.1590/s1980-220x2019006903628

Abstract

To associate the sedation level, criteria for daily interruption of sedation and mortality of patients on mechanical ventilation in an Intensive Care Unit. Prospective, longitudinal and quantitative study conducted with patients by using the Richmond Agitation-Sedation Scale (RASS) and the Sepsis-related Organ Failure Assessment (SOFA) score, through a care protocol managed by a nurse at the unit for the daily interruption of sedation once a day. The Chi Square test was used to check the association between variables and the T test for independent analyzes. Participation of 204 patients. Most were male, surgical, aged between 40 and 60 years, in sedoanalgesia with fentanyl, midazolam and propofol, with sedation time of one to five days and average stay of 10.7 days. They were in moderate sedation and at high risk for mortality. There was a statistical correlation between death in patients in deep sedation, and sensitivity in relation to discharge from the Intensive Care Unit of those who underwent daily interruption of sedation and were reassessed daily. Daily interruption of sedation guided by the Richmond Agitation-Sedation Scale assists in the control of sedation, which favors the treatment and recovery of patients and guides nurses' decision making. However, in this study, it was not configured as an independent factor for predicting mortality in intensive care.

Highlights

The sedation of patients on Invasive Mechanical Ventilation (IMV), previously maintained with high-dose medications to keep deep levels of sedation for many days, has been modified to lower doses
As deep sedation is a serious problem in patients on IMV, the use of sedation control protocols has resulted in shorter ventilation times, and reduction of Intensive Care Unit (ICU) stay and overall mortality[17]
Mortality occurred in patients aged between 40 and 60 years, different from a study that identified an association between age and high mortality rate in the ICU

Summary

Introduction

The sedation of patients on Invasive Mechanical Ventilation (IMV), previously maintained with high-dose medications to keep deep levels of sedation for many days, has been modified to lower doses. This change allows treatment with more physiological dosages and decreases the length of stay in the Intensive Care Unit (ICU), the rate of Ventilator-Associated Pneumonia (VAP) and mortality[1]. After checking patients’ sedation levels, the dosage of these medications is reduced by half This process must be performed once a day by nurses of the unit until the ICU multiprofessional team is sure that the patient is fit for extubation and decides that sedation will not be turned on again[2]

Methods

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Discussion

Conclusion