Abstract
Background/aimsSedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients.Material and methodsWe made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013. Patients were divided into two groups, including Group P (continuous infusion of sedative agent) and Group D (daily sedation interruptions - daily recovery).Demographics, mechanical ventilation time, stay at intensive care unit, hospitalization period, time of first weaning, success of weaning, ventilator-related pneumonia (VRP), total doses of drugs, re-intubation frequency, Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA) scores and mortality rates of patients were compared. Ramsay Sedation Score (RSS) was used to evaluate the level of sedation. Considering that ideal sedation level is "3" with RSS, RSS < 3 is considered as mild sedation, while RSS > 3 is considered as deep sedation.ResultsThere was no difference between demographics of patients. Mechanical ventilation period was significantly longer in Group P than Group D (p < 0.001). When stay at ICU unit was considered, ICU stay was significantly longer in Group P than Group D (p < 0.001). No statistically significant difference was found between two groups with respect to hospitalization period. In inter-group comparison, time to start first weaning was significantly late in Group P than Group D (p < 0.05). There was no difference between groups in terms of frequency of success of weaning and mortality rate (p > 0.05). In inter-group comparison the frequency of reintubation viewed in Group D was significantly less than in Group P (p < 0.05). Considering development of VRP, it was significantly more common in Group P in comparison with Group D (p < 0.05). No statistically significant difference was found between groups in terms of doses of sedative agents (p > 0.05). Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses of morphine (p > 0.05). Again, no statistical difference was found in doses of muscle relaxant agents (p > 0.05).ConclusionIt was observed that the sedation technique with daily interruption is superior to continuous infusion of sedatives. Accordingly, we believe that daily weaning will make positive contributions to patients who are mechanically ventilated at intensive care unit.
Highlights
To increase compliance with treatment and to reduce anxiety and pain, sedative and analgesics are used for patients linked to mechanical ventilators (MV) in intensive care units (ICU) [1]
Considering doses of opioid analgesics, the total dose of fentanyl was significantly higher in Group P than Group D (p = 0.04), while no difference was found for doses
The aim of this study is to investigate the effects of daily sedation cessation procedure on the mechanical ventilator duration, stay in intensive care, stay in the hospital, spontaneous respiratory attempt (SRA) success, morbidity and mortality for intubated patients linked to mechanical ventilator in intensive care
Summary
To increase compliance with treatment and to reduce anxiety and pain, sedative and analgesics are used for patients linked to mechanical ventilators (MV) in intensive care units (ICU) [1]. Insufficient or excessive sedation may cause harmful effects in the patient. Insufficient sedation may be displayed as symptoms like hypertension, tachycardia, discomfort, hypoxia, hypercapnia and struggling with the ventilator. Excessive sedation may cause unwanted situations such as hypotension, bradycardia, coma, respiratory depression, ileus, renal failure, venous stasis and immunosuppression [2,3]. Lengthening of the sedation duration is proposed as a risk factor for the development of ventilator-related pneumonia (VRP). Delays in patient healing lengthen the duration of mechanical ventilation and stay in the intensive care unit and hospital increasing hospital costs [4,5]
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